Labor rationing in a medical organization. The current state of labor rationing in health care. Inconsistency of the values of labor standards in different, simultaneously valid documents

Keywords

LABOR RATING/ LABOR STANDARDS / STATE (MUNICIPAL) INSTITUTIONS / EFFECTIVE CONTRACT / PERFORMANCE INDICATORS AND CRITERIA / LOCAL REGULATORY ACT / STATE (MUNICIPAL) INSTITUTIONS/ NORMING OF THE LABOR / LABOR NORMS / EFFICIENT CONTRACT / INDEXES AND CRITERIA OF EVALUATION/ LOCAL NORMATIVE ACT

annotation scientific article on economics and business, the author of the scientific work - Kadyrov F.N.

Despite the recommendations issued by the Ministry of Labor of Russia, the editorial office is often asked to tell about the system labor rationing, on the rights of health care institutions in matters labor rationing etc. Today we publish the first material on this topic. This topic will be continued in the next issues. Questions labor rationing are becoming increasingly important in connection with the need to establish indicators and criteria for assessing the effectiveness of employees' performance in the framework of the introduction effective contract... Logically labor rationing should precede the introduction effective contract... but labor rationing a complex and lengthy process, which, moreover, must take place continuously. Therefore, these processes go in parallel in many ways. The starting document for institutions (along with the recommendations of state (municipal) bodies should be local regulation System Statement labor rationing in the institution.

The order for developing the regulation on labor system norms in a state (municipal) healthcare institution

Questions with regards to the labor norming standards are becoming gradually relevant due to the necessity of establishing indexes and criteria for evaluating employees activity efficiency in the frames of introducing an efficient contract. Logically speaking, norming of the labor should come first before introducing the efficient contract. However, norming the labor is a complex and time-consuming process, which has to run consistently on an ongoing basis. Therefore, these processes, to a large extent, develop parallel one to another. The starting document for institutions (along with the recommendations of state (municipal) bodies has to become a local normative act Resolution regarding the system of norming the labor in institution.

The text of the scientific work on the topic "The procedure for the development of the Regulation on the system of labor rationing in a state (municipal) health care institution"

From the editor:

Despite the recommendations issued by the Ministry of Labor of Russia, the editorial office is often asked to tell about the system of labor rationing, the rights of health care institutions in matters of labor rationing, etc. Today we publish the first material on this topic. This topic will be continued in the next issues.

Chief editor N.G. Kurakova

F.N. Kadyrov,

FSBI "TsNIIOIZ" Ministry of Health of Russia, Moscow, Russia

PROCEDURE FOR DEVELOPING THE REGULATIONS ON THE LABOR RATE SYSTEM IN THE STATE (MUNICIPAL) HEALTHCARE INSTITUTION

UDC 614: 338.26

F.N. Kadyrov The procedure for developing a regulation on the system of labor rationing in a state (municipal) health care institution (FSBI "TsNIIOIZ" of the Ministry of Health of Russia, Moscow, Russia)

Annotation. The issues of labor rationing are becoming increasingly important in connection with the need to establish indicators and criteria for assessing the effectiveness of workers' activities within the framework of the introduction of an effective contract. Logically, labor rationing should precede the introduction of an effective contract. However, rationing of labor is a complex and lengthy process, which, moreover, must take place continuously. Therefore, these processes go in parallel in many ways. The starting document for institutions (along with the recommendations of state (municipal) bodies should be a local normative act - the Regulation on the system of labor rationing in the institution.

Key words: labor rationing, labor norms / labor, state (municipal) institutions, effective contract, indicators and criteria for evaluating activities, local regulations.

The main normative documents related to the regulation of labor in the institution include:

Labor Code of the Russian Federation (Chapter 22).

Resolution of the Government of the Russian Federation of November 11, 2002 No. 804 "On the rules for the development and approval of standard labor standards."

Order of the Government of the Russian Federation of November 26, 2012 No. 2190-r "On approval of the Program for the gradual improvement of the remuneration system in state (municipal) institutions for 2012-2018."

Order of the Ministry of Labor and Social Protection of the Russian Federation dated September 30, 2013 No. 504 "On the approval of the method

The issues of labor rationing are becoming increasingly important in connection with the need to establish indicators and criteria for assessing the effectiveness of workers' activities within the framework of the introduction of an effective contract. The basic document for the development of a labor rationing system for institutions (along with the recommendations of state (municipal) bodies should be a local normative act - the Regulation on the labor rationing system in the institution (hereinafter - the Regulation).

These issues are disclosed in the most detail in the Order of the Ministry of Labor and Social Protection of the Russian Federation dated September 30, 2013 No. 504 "On the approval of methodological recommendations for the development of labor rationing systems in state (municipal) institutions" (hereinafter referred to as the Recommendations).

However, the Recommendations do not cover all aspects of the problem under consideration. In addition, they do not take into account the specifics of the healthcare sector. Therefore, the purpose of this publication is to analyze and summarize normative and methodological materials devoted to the issues of labor rationing in health care institutions and to develop proposals on the procedure for the development and content of the Regulation on the labor rationing system in a health care institution.

Within the framework of the adopted system of labor rationing, the main types of labor standards are: time rates, production rates (load), service rates and headcount rates.

In addition to labor standards, there are also labor standards. The fundamental differences between them lie in the fact that labor standards are calculated in relation to the specific conditions for the performance of the standardized process for certain values

factors. And the standard is the estimated amount of expenditure of working time, material and monetary resources used in the regulation of labor, planning. Labor standards are set for various variants of typified or averaged organizational and technical conditions. An example of such standards are staffing standards, which are used to calculate the number of staff positions when drawing up a staffing table.

Labor standards are established for a specific job and are systematically revised. Labor standards are repeatedly used to calculate labor standards and operate without revision for a long time, since changes in organizational, technical and other conditions in the aggregate of work occur more slowly than at specific workplaces.

There are the following standards: labor standards, time standards, headcount standards.

Let's consider labor standards in more detail.

Labor rationing establishes the measure of labor for performing a certain amount of work, that is, reasonable rates of expenditure of working time for performing various works.

Labor standards are an expression of the measure of labor:

Time rates;

Load rates;

Production rates;

Service standards;

Population norms.

From various angles, they characterize the labor costs required to perform a certain amount of work by employees of appropriate qualifications in certain organizational and technical conditions.

Time norms - the expenditure of working time for the performance of a unit of work (function) or the provision of a service by one or a group of employees of appropriate qualifications (regulated duration

performance of a unit of work in certain organizational and technical conditions). Time rates are expressed in seconds, minutes, hours, conventional units, conventional units of labor intensity (UET-ah).

Load rates - the amount of work performed per unit of time under certain organizational and technical conditions. Workload indicators are such as the number of visits per hour, patients per day, the number of examinations, procedures per day, month, year (function of the doctor's position), etc.

Production rate - the amount of products produced per unit of working time. Production rates are expressed in terms of volume or value. In health care, volumetric natural indicators of production are not widespread (with the exception of UETs). The cost indicators can be indicators such as the cost of services rendered, profit, conditional profit, etc.

Workload rates and output rates in health care are often used interchangeably, or workload rates are viewed as output rates for health care (as an area of non-material production).

Service standards - the number of objects (workplaces, equipment, areas, etc.) that an employee or a group of employees of appropriate qualifications must serve during a unit of working time.

The differences between the load (output) rates and the service rates are that the service rate is the number of production facilities that an employee or a group of employees of appropriate qualifications must service during a unit of working time under certain organizational and technical conditions.

Moreover, the amount of work for each individual object is not regulated either in time or in established units (in different

depending on the production rate or load) - it is calculated on the average and depends on specific conditions, therefore, in some cases, in practice, in principle, it can be equal to zero.

A bed or a person is usually a production unit serving as a service object in healthcare.

Therefore, service standards are the number of beds or people served by a given doctor, nurse, etc., while load rates reflect exactly the amount of work: the number of visits, discharged patients, etc. per doctor, etc.

The task of establishing service standards is to achieve the normal functioning of an object, while the task of establishing load (output) rates is to determine the value of an indicator characterizing the amount of work without reference to a specific object.

Headcount norms - the established number of employees of a certain professional and qualification composition, necessary to perform specific production, management functions or work volumes.

Time rates and load rates (service) have an inverse mathematical relationship.

The employer is responsible for the state of labor regulation in the institution. The organization of work related to labor rationing, including the implementation of organizational and technical measures, the introduction of rational organizational, technological and labor processes, the improvement of the organization of labor, can be carried out either directly by the head of the institution, or, in the prescribed manner, can be entrusted by the head to one of his deputies.

The development (definition) of a labor rate setting system in an institution should be carried out by specialists with the necessary knowledge and skills in the field

organization and regulation of labor. Taking into account the number of employees and the specifics of the institution's activities for performing work related to labor rationing, it is advisable to create in the institution a specialized structural unit (service) for labor rationing, for example, a labor rationing department. In its absence, the performance of work related to labor rationing may be entrusted to a structural unit (employee) in charge of issues of economics, labor organization and wages (for example, labor and wages department, planning and economic department) and / or staffing the activities of the institution (personnel department, etc.).

The names of the positions of the relevant departments can be different: economist, engineer, etc. In particular, the Qualification Handbook of Positions of Managers, Specialists and Other Employees, 4th edition, supplemented (approved by the Decree of the Ministry of Labor of the Russian Federation of August 21, 1998 No. 37) (with amendments and additions), contains such positions as “Labor Rate Setting Engineer "And" Timekeeper ".

In the general case, labor rationing (including an analysis of the standards used, their revision, etc.) should logically precede the conclusion of an employment contract (an additional agreement to an employment contract) as part of the introduction of an effective contract. This is due to the following:

The introduction of an effective contract involves the establishment of indicators and criteria for assessing the effectiveness of their activities for employees, which in many cases are based on labor standards (load indicators, etc.);

The procedure for notifying employees of changes in labor standards generally coincides with the procedure for notification of changes in the terms of an employment contract when an effective contract is introduced, which makes it advisable to combine these procedures.

However, labor rationing is a complex and lengthy process, which, moreover, must occur constantly. Therefore, in practice, these processes are largely parallel. In this regard, it is permissible to introduce an effective contract within the framework of previously used labor standards (which may be revised later) or even without specifying specific labor standards (in this case, an entry is made in the concluded employment contract or an addendum to the employment contract that the employee is labor standards will be determined in the established manner).

In accordance with Article 162 of the Labor Code of the Russian Federation (hereinafter referred to as the Labor Code), local regulations providing for the introduction, replacement and revision of labor standards are adopted by the employer taking into account the opinion of the representative body of employees.

Therefore, it is recommended to establish the system of labor rationing in the institution in the Regulations on the labor rationing system of the institution, which is either approved by the local normative act of the institution, taking into account the opinion of the representative body of employees, or is included as a separate section in the collective agreement. In the first case, the Regulations are approved by an order for the institution, which can be called: "On the approval of the Regulations on the system of work rate setting in the institution" (hereinafter - the Order).

The order must be adopted taking into account the opinion of the representative body of workers (trade union organization, etc.). In this regard, the draft order should be sent to the approval of the organization, which is the representative body of the employees of this institution.

The procedure for taking into account the opinion of the elected body of the primary trade union organization when adopting local regulations is established by Article 372 of the Labor Code.

The elected body of the primary trade union organization no later than five working days

from the date of receipt of the draft local normative act, sends the employer a reasoned opinion on the draft in writing.

If the reasoned opinion of the elected body of the primary trade union organization does not contain agreement with the draft local normative act or contains proposals for its improvement, the employer may agree with it or is obliged to conduct additional consultations with the elected body of the primary trade union organization within three days after receiving a reasoned opinion. workers in order to achieve a mutually acceptable solution.

If no agreement is reached, the disagreements that have arisen are formalized in a protocol, after which the employer has the right to adopt a local normative act, which can be appealed by the elected body of the primary trade union organization to the relevant state labor inspectorate or to the court. The elected body of the primary trade union organization also has the right to initiate a collective labor dispute procedure in accordance with the procedure established by the Labor Code.

Upon receipt of a complaint (application) from an elected body of a primary trade union organization, the State Labor Inspectorate must, within one month from the date of receipt of the complaint (application), issue an order to the employer to abolish the local normative act, which is binding on the employer.

The structure of the Regulation is not strictly regulated. Nevertheless, in accordance with clause 22 of the Recommendations, it is proposed to include the following sections in the Provision:

a) "Labor standards applied in the institution";

b) "Procedure for the implementation of labor standards";

c) "The procedure for organizing the replacement and revision of labor standards";

d) "Measures aimed at compliance with established labor standards."

In our opinion, at the stage of the beginning of systematic work on the regulation of labor in the institution, the structure of the Regulations should be somewhat different. Indeed, according to the Recommendations, section a) "Labor standards applied in the institution" should contain not only references to the standard labor standards used in determining labor standards, but also the applied methods for determining the headcount rate based on the standard time rate, the headcount rate based on the standard rate service and service rates based on the standard time rate (if calculations were made).

However, one of the tasks of rationing is precisely the systematization of the standards used, making calculations, solving the question of in which cases (in which divisions, etc.) standard labor standards are used, and in which - developed in the institution itself, etc. etc. In other words, at the current stage, the Regulations should first of all determine the directions and methods of rationing, and not consolidate the results of rationing (which, in fact, do not yet exist).

Therefore, we propose a slightly different structure of the Regulation on the system of work rate setting in the institution, which is given below. In the future, the structure of the Regulation may be closer to that provided for in the Recommendations. So, we propose a section "The procedure for timing", which is rather methodical than organizational. It is important due to the novelty of timing issues for most institutions. Subsequently, this section, like some others, may be deleted.

In addition, the proposed version of the Regulation provides for the creation of a Commission on Labor Standards, about which nothing is said in the Recommendations. In practice, the functions of this commission may

Manager

be broader than those proposed, including the issues of rationing of consumables (detergents, food, etc.). In this case, it is advisable to use the following (broader) name of the commission: "Commission for standardization" (without using the word "labor").

Below is a sample of the Order for a health care institution "On the approval of the Regulation on the system of work rate setting in the institution" (it contains samples of not all documents approved by the Order). It can be used not only in state (municipal) health care institutions, but also in medical organizations with other organizational and legal forms.

We draw your attention to the fact that the example of creating a special

a special subdivision - the department of labor rationing. In practice, due to the small size of institutions, limited financial resources, etc. such departments will not be created in all institutions. As mentioned above, in such cases, these functions should be assigned to employees of other departments.

In conclusion, we note that in normative legal acts, other materials on labor rationing, phrases such as: "in order to introduce rational organizational, technological and work processes" are often found. With regard to healthcare, these conditions are, in particular, the conditions provided for by the procedures for the provision of medical care in order to introduce standards of medical care, clinical guidelines, etc.

1. Margulis A.L., Shipova V.M., Gavrilov V.A. The number of posts in health care facilities. Methodological and normative materials for calculating the number of posts and drawing up staffing tables for medical and preventive institutions. - M .: AGAR, 1997 .-- 72 p.

2. Reference information: "Labor standards" (Material prepared by ConsultantPlus specialists). - http://base.consultant.ru/cons/cgi/online.cgi?req=home#doc/ / LAW / 148265/4294967295/0.

3. Shipova V.M. Staffing of hospital care in modern conditions / deputy chief physician: clinical work and medical expertise.

2009 .-- S. 12-22.

4. Shipova V.M., Belostotsky A.V., Kindarov Z.B., Ermolova M.V. The current state of the normative base for labor in health care // 3rd deputy chief physician: medical work and medical examination. - 2010. - No. 6. - S. 22-28.

5. Shipova V.M., Gavrilov V.A. Staffing of a healthcare institution // Edited by Academician of the Russian Academy of Medical Sciences, O.P. Shchepina. - M .: GRANT, 2001 .-- 160 p.

6. Shipova V.M., Gavrilov V.A., Margulis A.L. Labor rationing of medical personnel (instructions for carrying out regulatory research work).

M .: VNII im. ON THE. Semashko, 1987. - 130 p.

7. Shipova V.M., Gaidarov G.M., Belostotsky A.V., Kindarov Z.B. Modern approaches to the compilation of the staffing of health care facilities // Ed. Academician of the RAMS O.P. Shchepina. - Irkutsk: NTsRVKh SO RAMS, 2010 .-- 52 p.

8. Shipova V.M., Kindarov Z.B. Complex issues of planning the number of medical personnel in hospitals to meet the volume of medical

Qing aid within the framework of the program of state guarantees for 2010 // Deputy chief physician: medical work and medical examination. - 2010. - No. 4. - S. 22-27.

9. Shipova V.M., Margulis A.L., Gavrilov V.A. Methodological recommendations for determining the number of positions of medical personnel in the context of the transition to medical insurance. - M., Research Institute named after H.A. Semashko RAMS, 1993 .-- 50 p.

10. Shipova VM, Minin OG, Frolova Yu.V. Planning the number of doctors in hospital institutions (subdivisions) in modern conditions // Children's Hospital. - 2011. - No. 2. - S. 8-10.

11. Shipova V.M., Minin O.G. Planned and normative indicators for inpatient care for 2013 // Zam. ch. doctor. - 2013. - No. 4. - S. 20-26.

(name of institution)

P R I K A 3

(locality)

□ 6 approval of the Regulation on the system of labor rationing in the institution

In order to develop a labor rationing system in the institution, taking into account the opinions of employees (representative body of employees) (protocol No._from_)

I ORDER:

1. Approve

Regulation on the system of labor rationing in the institution (Appendix No. 1);

Regulation on the Commission for Labor Standards (Appendix No. 2);

Form of notification of changes in labor standards (Appendix No. 3);

Regulations on the department of labor rationing;

The staffing table of the department of rationing of labor.

2. To enter into force this order from "_" _ 20_y.

3. Control over the implementation of this order shall be entrusted to the Deputy Chief Physician for Economic Affairs_.

Chief physician

(signature)

(full name)

Appendix No. 1

REGULATIONS ON THE LABOR RATE SYSTEM

IN THE ESTABLISHMENT

1. General Provisions

This Regulation on the labor rate setting system in the institution (hereinafter referred to as the Regulation) was developed on the basis of the Labor Code of the Russian Federation (hereinafter referred to as the Labor Code), Resolution of the Government of the Russian Federation of November 11, 2002 No. 804 "On the rules for the development and approval of standard labor standards", Orders of the Government of the Russian Federation of November 26, 2012 No. 2190-r "On approval of the Program for the gradual improvement of the remuneration system in state (municipal) institutions for 2012-2018", Methodological recommendations for federal executive bodies on the development of standard industry-specific labor standards, approved by the Order of the Ministry of Labor Russia dated May 31, 2013 No. 235, Order of the Ministry of Labor and Social Protection of the Russian Federation dated September 30, 2013 No. 504 "On the approval of guidelines for the development of labor rationing systems in state (municipal) institutions."

In accordance with the Labor Code (art. 159), employees are guaranteed:

State assistance to the systemic organization of labor rationing;

Application of labor rationing systems determined by the employer taking into account the opinion of the representative body of workers or established by a collective agreement.

The system of labor rationing is developed taking into account the organizational and technical conditions for the implementation of technological (labor) processes in institutions (equipment and materials used, technologies and methods of performing work, other organizational and technical factors that can significantly affect the value of the labor standard).

The system of labor rationing in the institution determines:

Labor standards applied in the institution by types of work and workplaces when performing certain types of work (functions) (hereinafter - labor standards), as well as methods and methods of their establishment;

The procedure and conditions for the introduction of labor standards in relation to specific production conditions, workplace;

The procedure and conditions for the replacement and revision of labor standards as the improvement or introduction of new equipment, technology and organizational or other measures to ensure the growth of labor productivity, as well as in the case of the use of physically and morally obsolete equipment;

Measures aimed at compliance with established labor standards.

The main goals of the labor rate setting system in the institution are:

Creation of the conditions necessary for the implementation of rational organizational, technological and labor processes (procedures for the provision of medical care, standards of medical care, clinical protocols, etc.), improving the organization of work;

Ensuring a normal level of tension (intensity) of labor in the performance of work (provision of state (municipal) services);

Improving the efficiency of medical care.

Organization of work related to labor rationing includes:

Organizational and technical measures;

Implementation of rational organizational, technological and work processes;

Improving the organization of work.

Labor standards are used in the process

development of wage systems in the institution and preparation of employment contracts with employees.

When developing a labor rate system, labor standards are determined in relation to technological (labor) processes and organizational and technical conditions for their implementation in an institution.

Analysis of the labor process based on the standard for the provision of state (municipal) services (standard of medical care), dividing it into parts;

The choice of the optimal option for the technology and organization of labor, effective methods and techniques of work;

Designing the operating modes of equipment, techniques and methods of work, systems of servicing workplaces, modes of work and rest;

Determination of labor standards in accordance with the characteristics of the technological and labor processes, their implementation and subsequent adjustment as the organizational and technical conditions for the implementation of technological (labor) processes (procedures for the provision of medical care, standards of medical care, clinical guidelines, etc.) change.

When carrying out this work, the approaches established in the methodological recommendations for federal executive authorities on the development of standard sectoral labor standards are used,

issued by the Order of the Ministry of Labor of Russia dated May 31, 2013 No. 235 (in terms of organizing work and calculating labor standards) and in other materials on rationing.

When purchasing new equipment in accordance with the established procedure, it is recommended that institutions carry out a comparative calculation of the impact on the labor standard of the introduction of the purchased equipment. At the same time, it is recommended to provide for a comparison of the characteristics of the purchased equipment with the characteristics of the equipment used in the development of standard labor standards (in the absence of standard labor standards, with the equipment used in the institution).

Along with the labor standards established in the institution for an indefinite period, temporary and one-time labor standards can be applied for the technological (labor) processes that are stable in terms of organizational and technical conditions.

Temporary labor standards are established for the period of mastering certain jobs in the absence of approved normative materials for labor rationing.

The term of validity of temporary labor standards determined by the institution is recommended to be set no more than 3 months.

One-time labor standards are determined by the employer for individual jobs that are of a single nature (unscheduled, emergency).

The main requirements for standards and labor standards are as follows:

Taking into account the current level of development of medical science, the organization of medical care, the organization of labor, equipment, compliance with the relevant technologies of the medical and diagnostic process;

Compliance in terms of the degree of enlargement with the conditions and nature of the work of a particular type of institution, unit or employee, ensuring the necessary accuracy when establishing staff standards - the degree of enlargement of standards depends

Manager

from the influence of the main norm-forming factors and the need to take them into account in the normative indicator;

Coverage of the most common options for performing work, convenience for calculating staff positions.

3. Analysis of the used labor standards and organizational and technical conditions

Work on labor rationing begins with an analysis of the state of affairs with rationing in the institution, which includes:

Inventory of used labor standards;

Analysis of the organizational and technical conditions for the implementation of technological (labor) processes.

During the analysis of the organizational and technical conditions for the implementation of technological (labor) processes in the institution, the following should be taken into account:

Technologies, techniques used;

The degree of ensuring the procedures for the provision of medical care, the applied standards of medical care;

Parameters of work and maintenance of the equipment used;

Working conditions at workplaces;

Forms of work organization, work and rest regimes, including regulated breaks;

Other parameters: characteristics of the work performed, the rationality of the division and cooperation of labor, etc.

4. Use of standard labor standards

When determining labor standards, an analysis of the available standard (intersectoral, sectoral, professional and other) labor standards is carried out, approved by federal executive bodies in accordance with the Decree of the Government of the Russian Federation of November 11, 2002 No. 804 "On the rules for the development and approval of standard labor standards" (hereinafter referred to as standard labor standards), and their correlation with the actual

technical organizational and technical conditions for the implementation of technological (labor) processes in the institution.

In the absence of the standard norms established in accordance with the above order, as such (from the point of view of assessing the feasibility of their use), recommendatory norms established by the current orders of the executive authorities of the USSR and the Russian Federation in the field of health care, as well as the norms recommended specialized scientific organizations (Research Institute named after Semashko, TsNIIOIZ, etc.).

On the basis of the standard labor standards, appropriate labor standards can be determined for application in the institution.

Labor rates can be determined for a separate type of work, an interconnected group of works (consolidated labor norm) and a complete set of works (complex labor norm). An example is labor standards for a patient treated in a hospital. The degree of consolidation of labor standards is determined by the specific conditions of the organization of medical care and labor.

Labor standards can serve to establish a standardized task (a set amount of work that an employee or a group of employees performs per work shift or in another unit of working time).

Indicators such as the number of patients treated in the unit, financial plan, etc. can serve as a standardized task.

When determining labor standards on the basis of standard labor standards, comprehensively substantiated labor costs established for homogeneous work are used in relation to standard technological (labor) processes and standard organizational and technical conditions for their implementation in health care (for example, a doctor's visit).

If the organizational and technical conditions for the implementation of the technology coincide with them

the standard labor standards are used in the institution's (labor) processes.

A similar decision is made if the existing differences in the organizational and technical conditions for the implementation of technological (labor) processes cannot significantly affect the labor rate. The decision on the significance of differences in the organizational and technical conditions for the implementation of technological (labor) processes is made taking into account the opinion of the representative body of workers.

Comprehensively justified norms of labor costs provide for progressive modes of operation of equipment, rational techniques and methods of labor, organization and maintenance of workplaces, optimal employment of workers, maximum use of job opportunities, high quality products (works, services), preservation of health and working capacity of workers. In this case, a comparison of the existing organizational and technical conditions with the conditions provided for the procedures for the provision of medical care, standards of medical care, tables of equipment, etc. is used as criteria.

When creating more progressive organizational and technical conditions for the implementation of technological (labor) processes or their inconsistency with standard labor standards, it is recommended to use standard labor standards as a basis for determining and substantiating labor standards by adjusting them taking into account the actual organizational and technological conditions for performing technological (labor) processes in the institution.

When planning measures to improve the efficiency of the provision of state (municipal) services, it is recommended to use standard labor standards as a benchmark:

For institutions in which the organizational and technical conditions are below the level for which the standard norms are designed;

When researching the cost of working time and analyzing the loss of working time.

After taking measures to change the organizational and technical conditions for the implementation of technological (labor) processes, labor standards in the institution can be revised in the manner prescribed by law.

In the absence of standard labor standards for certain types of work and workplaces, the corresponding labor standards are developed in the institution, taking into account the recommendations of the organization performing the functions and powers of the founder, or with the involvement of relevant specialists in the prescribed manner.

5. Procedure for timing

To determine the time spent on a particular repetitive operation, for example, on individual studies, manipulations, surgical interventions, medical procedures, etc., time measurements are used.

Timing refers to the analytical and research method of labor rationing, which consists in measuring the time spent on all the constituent elements of the labor process in optimal organizational and technical conditions, corresponding to modern technology of the treatment and diagnostic process.

For timing, statistical tools are being developed:

Dictionary (list) of activities and labor operations,

Observation sheet,

Patient card,

Map of reference data to the observation sheet.

In this case, a unit of observation is determined (for example, the time spent per patient for individual diseases or, on average, with a doctor of this specialty; time spent on hospitalized in a planned manner, for emergency indications or on average per patient according to the profile of the department, regardless of the order of admission, etc. etc.).

The experience of labor rationing in health care shows that when designing a standard for a particular position, a 2-week time-lapse observation of 2-3 positions is sufficient.

When carrying out time measurements, the scope of observations is limited, as a rule, to 30 studies of the same type and manipulations.

In some cases, for example, when calculating cost estimates, developing incentive measures, etc. it becomes necessary to determine the costs of working time of various groups of personnel not for a separate labor operation, but for the entire labor process (for example, the time spent on treating one patient in a hospital).

When conducting timing, the following basic rules must be observed:

Timing should be carried out by a specialist of sufficiently high qualifications, who is well aware of the technology of the treatment and diagnostic process.

In the process of time observation, an examination of the volume and quality of work is carried out, an assessment of the compliance of treatment and diagnostic measures with the diagnosis and state of health of the patient is carried out;

Before carrying out photo-timing observations, a list (dictionary) of labor operations inherent in the position and specialty of the observed is compiled;

When processing time statistical data, regulation of the frequency of certain types of work, the structure of the working day, etc. is carried out.

6. Calculation of the number of employees

Calculation of the number of employees is a part of the labor rationing process, which consists in setting standards for the number of employees - the number of employees required to perform a certain amount of work.

The calculation of the number of employees is based on:

Standard labor standards, which in this case include staffing standards;

By calculation method based on the values of other norms (time norms, load norms, service norms).

The institution establishes the applied methods for determining the number rate (based on the standard time rate, the rates adopted at the institution, staff standards, etc.).

7. Labor rationing within the framework of the introduction of an effective contract

When concluding an employment contract with an employee, he must be familiar with labor standards. In the event that the employee has established the norms of time for the performance of work (provision of services) or the norms of service, it is recommended to indicate in the employment contract with the employee that their performance is carried out within the duration of the working time established for him.

It is advisable in an employment contract with an employee, concluded within the framework of an effective contract being introduced, to clearly prescribe that the employee's duty is to comply with labor standards, specifying what exactly is the labor standard for this employee (the volume of services provided in certain units, the cost of services provided, etc. .), as well as the value of these norms.

8. The procedure for the introduction, replacement and revision of labor standards

Labor standards - production rates, time rates, headcount standards and other standards - are established in accordance with the achieved level of technology, technology, organization of production and labor (Article 160 of the Labor Code).

Employees are notified of the introduction of new labor standards no later than two months before their entry into force. In a similar period of time, employees are notified of the correction of erroneous labor standards (labor standards when establishing which were incorrect

organizational and technical conditions for the implementation of technological (labor) processes were taken into account or inaccuracies were made in the application of regulatory materials or in the calculations).

Taking into account the opinion of the representative body of employees on the reduction of erroneous labor standards, employees can be notified in a shorter period.

The form of notification of the introduction of new labor standards is determined by the institution independently. At the same time, it is recommended to indicate the previously valid labor standards, new labor standards, factors that served as the basis for the introduction of new labor standards or their adjustment.

Before the introduction of new labor standards, it is necessary to instruct and train workers in the most effective techniques and methods of performing work, while both individual and group forms of their implementation can be used.

When carrying out work on the development of labor standards, an analysis of the degree of mastering of work by each employee is carried out on the basis of data on the implementation of standards.

When mastering labor standards in connection with the introduction of new techniques and technology, when, along with mastering rational methods of labor, workers need to acquire new theoretical and practical knowledge, workers are trained.

When mastering new types of work (including when introducing standards of medical care, etc.) or inconsistency of the actual organizational and technical conditions for performing technological (labor) processes with those projected in the newly introduced labor standards, correction factors are applied.

The analysis period to determine the feasibility of revising the applicable labor standards is at least once every five years. Based on the results of the analysis, a decision can be made to maintain the established norms.

labor or the development of new labor standards. Until the introduction of new labor standards, the previously established ones continue to apply.

Labor standards can be revised as the improvement or introduction of new equipment, technology and organizational or other measures to ensure an increase in labor productivity, as well as in the case of the use of physically and morally obsolete equipment.

Other grounds for revising labor standards are not established by labor legislation.

The overfulfillment of labor standards by individual workers, including due to the high level of personal professional qualities, the use of new methods of work on their initiative and the improvement of workplaces, cannot be considered as a basis for revising the labor standards established in the institution.

In other words, the achievement of a high level of production (provision of services) by individual workers through the use of new methods of labor and improvement of workplaces on their initiative is not a basis for revising previously established labor standards.

Revision of erroneous labor standards is carried out as soon as they are identified, taking into account the opinion of the representative body of workers.

9. Organization of work on labor rationing

The organization of work related to labor rationing is entrusted to the deputy chief physician for economic issues.

The performance of work related to labor rationing is entrusted to the labor rationing department.

To facilitate the implementation of labor rationing in the institution, a Commission is created

The purpose of the Commission is to plan work on labor standards and a collegial assessment of the labor standards expected to be introduced.

The tasks of the Commission are:

Approval of a work plan for work rationing;

Preliminary consideration of the proposals of the labor rate setting department on the establishment and revision of labor standards, the use of rate setting methods, etc .;

Making proposals on the use of standard labor standards.

The composition of the Commission includes, in accordance with the position:

Head of HR department;

Legal Counsel;

Occupational safety engineer.

The decision of the commission is made by a simple majority of votes. In case of equality of votes for and against the proposed decision, the vote of the chairman (acting chairman) of the Commission is decisive.

The Commission draws up its decision in a protocol.

Draft orders for the institution, agreed at the meeting of the Commission and drawn up in the minutes, do not need additional approval by the officials of the institution. In this case, in the sheet

approval of the project, only the number and date of the minutes of the meeting of the Commission are indicated and the signature of the chairman or secretary of the Commission is put.

10. Measures aimed at compliance with established labor standards

The efforts of both the employees themselves and the manager, as well as other officials of the institution (hereinafter referred to as the Administration of the institution), should be directed to the implementation of labor standards.

The administration of the institution takes measures aimed at observing the established labor standards, including ensuring normal conditions for employees to comply with labor standards. These conditions include, in particular:

Good condition of premises, structures, machines, technological equipment and equipment;

Timely provision of technical and other documentation necessary for work;

Adequate quality of materials, tools, other means and items necessary for the performance of work, their timely provision to the employee;

Working conditions that meet the requirements of labor protection and production safety.

If these measures are not taken, employees have the right to make claims to the Administration of the institution in accordance with labor legislation.

The following measures of influence are applied to employees aimed at meeting labor standards:

1. Moral and ethical.

2. Disciplinary.

3. Economic.

Moral and ethical measures of influence involve:

Encouragement (public recognition, gratitude, praise, presentation for diplomas, awards, etc.);

Condemnation (negative assessment, collective condemnation, etc.).

Disciplinary measures are applied in accordance with labor legislation, including, in particular, disciplinary sanctions. Compliance with labor standards is the responsibility of the employee - Article 21 of the Labor Code, dedicated to the rights and obligations of the employee, establishes that the employee is obliged to comply with the established labor standards. In accordance with article 192 of the Labor Code, for the commission of a disciplinary offense, that is, failure to perform or improper performance by an employee through his fault of the labor obligations assigned to him, the employer has the right to apply the following disciplinary sanctions:

1) remark;

2) a reprimand;

3) dismissal on appropriate grounds.

Accordingly, for non-fulfillment of labor duties by an employee in the form of failure to comply with labor standards, a disciplinary sanction in the form of a remark or reprimand may be imposed on him, and in case of further non-fulfillment of labor duties, he may be dismissed.

Economic measures of influence are based on material incentives

in accordance with the accepted system of wages, deductions from wages in cases stipulated by law, etc.

When deciding on the application of measures of influence to employees in case of non-compliance with labor standards, the question of whose fault is not fulfilled the labor standards is considered without fail.

In accordance with article 155 of the Labor Code, in case of non-fulfillment of labor standards, non-fulfillment of labor (official) duties through the fault of the employer, labor remuneration is made in an amount not lower than the average employee's salary, calculated in proportion to the hours actually worked.

In case of non-fulfillment of labor standards, non-fulfillment of labor (official) duties for reasons beyond the control of the employer and the employee, the employee retains at least two-thirds of the tariff rate, salary (official salary), calculated in proportion to the hours actually worked.

In case of non-fulfillment of labor standards, non-fulfillment of labor (official) duties through the fault of the employee, payment of the standardized part of wages is made in accordance with the volume of work performed.

Appendix No. 2

LABOR RATE COMMISSION REGULATIONS

1. General Provisions

1.1. This Regulation on the Commission for Labor Standards (hereinafter referred to as the Commission) has been developed in order to implement the Order of the Ministry of Labor and Social Protection of the Russian Federation dated September 30

2013 No. 504 "On the approval of guidelines for the development of labor rationing systems in state (municipal) institutions" and provides for the formation procedure, main tasks, functions and rights of the Commission.

1.2. In its work, the Commission is guided by the legislative and other regulatory legal acts of the Russian Federation on labor, rationing and labor protection, the collective agreement, local regulatory legal acts of the institution.

1.3. The commission is an integral part of the system for managing labor rationing in the institution.

1.4. The work of the commission is based on the principles of social partnership, which is expressed in the inclusion in the Commission of a representative of workers (trade union organization) and taking into account the opinion of the representative of workers during the work of the Commission.

1.5. The composition of the Commission includes, in accordance with the position:

Deputy Chief Physician for Economic Affairs - Chairman of the Commission;

Chief Accountant - Deputy Chairman of the Commission;

Head of the Labor Rate Setting Department - Secretary of the Commission;

Deputy Chief Physician for Medical Affairs (Chief Medical Officer);

Head of HR department;

The chairman of the trade union organization of the institution - as agreed;

Legal Counsel;

Occupational safety engineer.

The personal (surname) composition of the Commission is approved by the order of the chief physician.

The nomination of representatives of the employees of the institution to the commission is carried out on the basis of the decision of the trade union committee.

Other employees of the institution with an advisory voice may be involved in the work of the Commission.

2. Functions of the Commission

2.1. The purpose of the Commission's activities is to facilitate the organization of labor rationing in the institution by planning work on labor rationing, collegial assessment of labor standards expected to be introduced, etc.

2.2. The Commission performs the following functions:

Coordination of a work plan for work rate setting in the institution;

Preliminary consideration of the proposals of the labor rate setting department for the establishment and revision of labor standards;

Making proposals on the use of standard labor standards;

Ensuring public control over the state of working conditions and safety measures directly at workplaces, taking measures to improve working conditions and standards stipulated by the collective agreement (agreement);

Informing employees of the organization about the state of labor rationing in the institution and measures taken to improve labor standards;

Consideration of proposals from the Administration of the institution, representatives of employees and individual employees on labor rationing issues;

Creation of a system of measures aimed at compliance with established labor standards.

3. The order of work of the Commission

3.1. The Commission is headed by the Chairman of the Commission.

3.2. The Deputy Chairman of the Commission, upon instructions or in agreement with the Chairman of the Commission, as well as during his absence, performs his functions and has the right to sign documents in the absence of the Chairman.

3.3. The secretary of the commission carries out:

Operational control over the implementation of plans, decisions and recommendations of the Commission;

Implementation of the instructions of the chairman or deputy chairman of the Commission;

Preparation of draft work plans of the Commission, recommendations, decisions, conclusions of the Commission on relevant issues, controls their passage and the necessary approvals;

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Notification of the members of the Commission, as well as the specialists involved in working with it about the time and place of events (meetings of the Commission, etc.);

Keeping minutes of the Commission meetings;

By agreement, in accordance with the established procedure, he can represent the Commission at public events, in public organizations, and carry out the necessary contacts with the media.

3.4. The Commission carries out its activities in accordance with the regulations and work plan developed by it, which are considered and approved at its meetings and are an integral part of the work plan of the institution.

3.5. The meetings of the commission are held as necessary, but at least once a quarter, and are considered competent if more than half of the members of the commission participate in their work.

3.6. The decisions of the commission are taken by an open vote by a majority of votes in the presence of a quorum and are advisory in nature. In case of equality of votes for and against the proposed decision, the vote of the chairman of the commission (acting chairman) is decisive.

3.7. The Commission formalizes its decisions in minutes.

3.8. Draft orders for the institution, agreed at the meeting of the Commission and drawn up in the minutes, do not need additional approval by the officials of the institution. In this case, only the date of the minutes of the meeting of the Commission is indicated in the draft approval sheet and the signature of the chairman or secretary of the Commission is put.

3.9. The Commission reports on the work done to the Administration and the staff of the institution at least once a year. The chairman of the commission informs the trade union about the decisions taken by the Commission.

3.10. The activities of the commission are provided (including, if necessary, financed) by the Administration of the institution. By agreement of the Administration of the institution with the trade union organization, the activities of the Commission may be fully or partially financed by the employee's representative (trade union organization).

4. Rights of the Commission

The Commission has the right:

4.1. Receive information from the Administration of the institution:

On the state of working conditions at workplaces, industrial injuries and occupational diseases, the presence of harmful industrial factors and measures to protect against them, the existing risk of damage to health;

On the used labor standards and labor standards.

4.2. Hear at the meetings of the commission:

Messages from the Administration of the institution, heads of structural divisions and other employees of the institution about the labor standards used, about their implementation, etc.;

Proposals for improving the regulation of labor in the institution.

4.3. Participate in the preparation of proposals for the section of the collective agreement on issues within the competence of the Commission.

4.4. Submit to the Administration of the institution proposals for encouraging employees of the organization for active participation in work on work rate setting.

4.5. To freely visit workplaces and relevant services of the institution to clarify issues within the competence of the Commission;

4.6. Promote the resolution of labor disputes related to violation of labor regulation legislation, changes in working conditions.

Manager

Appendix No. 3 NOTICE OF CHANGES IN LABOR STANDARDS

To the employee of the unit

institutions _

position_

In accordance with Art. 162 of the Labor Code of the Russian Federation, we inform you that

that due to the introduction of new equipment (_), which reduces labor costs

to perform one study, after at least two months from the date of acquaintance

You with this notice (namely from _20_year) instead of the previously valid norms

labor (load) -_ new norms of labor (load) are introduced, namely_.

(head position)

Notice received _

(signature, full name of the head)

(employee signature)

KadirovF.N. The order for developing the regulation on labor system norms in a state (municipal) healthcare institution (FSHI "Health Organization and Informatics" Ministry of Health Care of Russia, Moscow, Russia) Annotation. Questions with regards to the labor norming standards are becoming gradually relevant due to the necessity of establishing indexes and criteria for evaluating employees activity efficiency in the frames of introducing an efficient contract. Logically speaking, norming of the labor should come first before introducing the efficient contract. However, norming the labor - is a complex and time-consuming process, which has to run consistently on an ongoing basis. Therefore, these processes, to a large extent, develop parallel one to another. The starting document for institutions (along with the recommendations of state (municipal) bodies has to become a local normative act - Resolution regarding the system of norming the labor in institution.

Keywords: norming of the labor, labor norms, state (municipal) institutions, Efficient contract, indexes and criteria of evaluation, local normative act.

Healthcare 2014

REGIONS WILL RECEIVE 29.57 BILLION RUBLES FOR DRUGS OF SEPARATE CATEGORIES OF CITIZENS

The volume of federal subsidies provided in 2014 to regional budgets for the provision of certain categories of citizens with the necessary medicines, medical devices, as well as specialized health food for disabled children has been clarified. The corresponding Order No. 1492-r dated 09.08.2014 was signed by Prime Minister Dmitry Medvedev.

In total, 29.57 billion rubles are provided for these purposes. The largest amount of subsidies is provided for Moscow (4.66 billion), St. Petersburg (1.29 billion), Moscow (1.24 billion), Sverdlovsk (973.9 million) and Rostov regions (719.5 million). .).

Planning methods:

1) analytical method- is used to assess the initial and achieved levels when comparing the plan and analyzing its implementation; planned:

- provision of the population with medical and paramedical personnel, hospital beds

- indicators of the volume of medical care (percentage of hospitalizations, average number of visits per inhabitant per year)

- the function of a medical position

- the function of a hospital bed (bed turnover), etc.

2) comparative method- an integral part of the analytical, makes it possible to determine the direction of development processes, to evaluate various indicators (morbidity, mortality, etc.) in dynamics in space (when comparing them with similar indicators of other administrative territories) and in time (when comparing them over a number of years)

3) balance method- ensures the proportionality of the development of the AO between the real possibilities and the planned indicators, allows to reveal the emerging imbalances during the implementation of the plan; used in the preparation of intersectoral balances (balances of training and growth of the network of hospital and outpatient clinics, etc.)

4) expert method- highly professional, independent, but does not always take into account the traditions of the country

5) economic and mathematical method- it is used when it is necessary to scientifically substantiate the optimal options for the plan, most often they use linear programming, queuing theory and the method of statistical tests.

6) normative method- the basis for planning the state AO system, its basis is the use of norms and standards approved by the Ministry of Health; it is used in drawing up any plan based on the use of the balance method, i.e. in all cases when it is necessary to ensure the proportionality of development. This method is also widely used in the development and execution of the budget and estimates of AO institutions.

Norm- a quantitative indicator of the state of the environment, medical and preventive care, the activities of medical organizations in specific organizational and technical conditions.

Standard- a calculated indicator that characterizes the totality of funds necessary to achieve the established norm under certain standard organizational and technical conditions.

The number of beds per 1 medical position is a standard, and the number of physiotherapy units per year per 1 position of a nurse is a standard.

Norms and standards can be:

A) social- are aimed at meeting the needs of the population in medical care (provision with general practitioners and district therapists - 1 doctor per 1,300 residents, beds - 9 ppm, pharmacies - 1 per 8 thousand residents, ambulance teams - 1 per 2.5 thousand residents ) and Economic- aimed at ensuring the financial and economic activities of health care facilities (budgetary expenditures for the ZO - 170 USD per 1 inhabitant)

B) minimal- reflect the level of living conditions of people necessary at this stage of socio-economic development and the needs of the ZO for resources, below which the normal functioning of the health care system is disrupted (standards for the need for medical care, specific capital investments in the development of the industry) and Rational- focused on the full satisfaction of the needs of the population and the industry (standards for physicians and nurses).

C) complex- characterize the socio-economic aspects of the management and provision of the population with medical care and Private- characterize individual aspects of ongoing processes

The ZO has norms and standards:

- by scope: local and industry

- by the period of validity: temporary and conditionally permanent

- by the way of construction: uniform and standard

- by the method of justification: scientifically based, statistical, experimental, averaged

- by unit of measure: norms of time, norms of load, service, number of personnel, material costs, etc.

The norms and standards in the ZO can be grouped into 4 groups:

1.provision of medical services (labor standards, standards for the development of a network of organizations, standards for the cost of medical services)

2.consumption (standards of wages, standards of financing AO)

3.development of the industry (the industry's need for specialists, etc.)

4.sanitary and hygienic (building codes and regulations, limit standards for the content of substances in soil and air)

Basic principles for the development of norms and standards:

- use the assessment by the population of the degree of satisfaction of the needs for the services of the AO system

- take into account public opinion on key issues of the AO development

- take into account, when developing norms and standards, WHO recommendations and the level of satisfaction of needs for medical care in developed countries

- to develop norms and standards not only for the country as a whole, but also for the regions, taking into account the level of medical care, consumption of medical services by sex, age and occupational groups of the population in the territorial context, as well as the structure of morbidity

Functions of norms and standards:

- analysis of the achieved level of development of the industry and the results of the LPO activity

- planning and forecasting of LPO activities

- control over the use of material, financial and labor resources

- a necessary element of the economic mechanism of the industry for the organization of work on the provision of medical services

7) extrapolation method- is used to identify trends in morbidity indicators for individual nosological forms, fertility, mortality, etc. in subsequent years, etc.

Territorial State Guarantee Programs (TPGG) for the provision of medical care to the population, they determine the types and volume of medical care, as well as the conditions for their provision at the expense of the budget, contain standards for specific volumes of medical care and planned indicators for their financial support, are approved annually by the executive authorities.

The basis of the TPGG is the state-guaranteed volume of medical and pharmaceutical care, which provides for the provision of quantitatively regulated medical care for the prevention, diagnosis and treatment of diseases, determined annually by the Ministry of Health of the Republic of Bashkortostan in the form of state minimum social standards in the area of health protection.

Legislative acts when drawing up a TPGG:

1. The Constitution of the Republic of Belarus

2. Law on State Minimum Social Standards

3. Resolution of the Council of Ministers of the Republic of Belarus on state minimum social standards in the field of AO (2002)

4. Decree of the Ministry of Health of the Republic of Belarus on the approval of the average republican standards for the volume of medical care that are provided by state organizations to citizens of the Republic of Belarus at the expense of the budget (the number of visits to the polyclinic is 10,600 per 1,000, the hospitalization rate is 220 per 1,000, the average duration of treatment is 11.7 days, the number of ambulance calls 260 per 1,000, etc.)

5. Instructions for the development and implementation of TPGG

It is also necessary to know the standards for the provision of medical care (the budgetary funding standard for 1 person, the provision of primary care doctors - 1 per 1300, the provision of beds - 9 per 1000 population, pharmacies - 1 per 8000 residents, emergency medical teams - 1 per 12.5 thousand residents ), health indicators (morbidity, mortality, disability), financial data.

TPGG structure:

1. General Provisions

2. The list of types of medical care provided to the population at the expense of the budget of a particular region

3. Conditions for the provision of medical care to the population

4. The volume of medical care

5. Duties and responsibilities of local and AO authorities

Who establishes the labor rationing system in health care institutions?

The system of labor standards in health care institutions is established by the employer on the basis of standard labor standards. By virtue of Art. 161 of the Labor Code of the Russian Federation, standard labor standards are developed and approved in the manner established by the federal executive body authorized by the Government of the Russian Federation. In the field of health care, such a body is the Ministry of Health of Russia. So, by order of the Ministry of Health of Russia dated 06/02/2015 No. 290n, standard industry standards of time were established for performing work related to a visit by one patient to a district pediatrician, a district general practitioner, a general practitioner (family doctor), a neurologist, an otorhinolaryngologist , ophthalmologist and obstetrician-gynecologist. These standard norms are the basis for calculating workload norms, standards for the number and other labor standards of doctors of medical organizations providing primary medical and primary specialized health care on an outpatient basis.

In turn, according to Art. 163 of the Labor Code of the Russian Federation, local regulations providing for the introduction, replacement and revision of labor standards are adopted by the employer taking into account the opinion of the representative body of workers.

The main local regulatory legal act in this case is the staffing table of the institution.

What are the requirements for the staffing table of a medical organization and the calculation of staffing standards?

Currently, when calculating staffing standards, first of all, it is necessary to be guided by the Decree of the President of the Russian Federation of 05/07/2012 No. 597 and the order of the Government of the Russian Federation of 11/26/2012
No. 2190-r, which approved the Program for the phased improvement of the remuneration system in state (municipal) institutions for 2012-2018.

According to the specified Program for the gradual improvement of the remuneration system, the formation of the staffing of institutions should be carried out using labor rationing systems, taking into account the need for high-quality provision of state (municipal) services, the implementation of the volume of medical care established by the Program of state guarantees of free provision of medical care to citizens and the corresponding territorial program.

In accordance with Art. 159 of the Labor Code of the Russian Federation, labor rationing systems are determined by the employer taking into account the opinion of the representative body of workers or are established by a collective agreement. Institutions can independently develop appropriate labor standards, taking into account the recommendations of the organization performing the functions and powers of the founder, or with the involvement of relevant specialists in the prescribed manner (clause 16 of the Methodological Recommendations, approved by order of the Ministry of Labor of Russia dated September 30, 2013 No. 504).

It should be noted that in accordance with sub. "G" p. 39 sec. X Unified Recommendations, approved by by the decision of the Russian Trilateral Commission of December 24, 2014 (Protocol No. 11), the formation of the staffing tables of health care institutions must be carried out taking into account the Nomenclature of positions of medical workers and pharmaceutical workers, approved. by order of the Ministry of Health of Russia dated 20.12.2012 No. 1183n.

In relation to the staffing standards of the organizational and methodological departments of medical organizations, the following orders were developed in Soviet times.

Order of the Ministry of Health of the USSR dated 06.06.1979 No. 600 (with amendments and additions).
Order of the Ministry of Health of the USSR of 09/26/1978 No. 900 (with amendments and additions).
Order of the USSR Ministry of Health dated 05/31/1979 No. 560.

These documents have not been officially canceled by the Ministry of Health of Russia and, in accordance with the order of the Ministry of Health of the USSR No. 504 dated 31.08.1989, are recommendatory in nature. In this connection, they can be used as a basis for the development of labor rationing systems installed in medical organizations. When applying these documents, it should be borne in mind that the names of the positions of medical and other personnel of healthcare institutions must comply with the Nomenclature of positions of medical workers and pharmaceutical workers (approved by order of the Ministry of Health of Russia dated 20.12.2012 No. 1183n).

Regarding the definition of the standard of staffing of employees and workers of state and municipal healthcare institutions, one can be guided by the order of the Ministry of Health of Russia dated 09.06.2003 No. 230, which establishes the dependence of the number of staff units of blue-collar occupations on the amount of work according to technically sound standards, and in their absence - according to the norms, developed by the institution in an experimental and statistical way.

Thus, the staffing table of a medical organization is established by the medical organization itself on the basis of reasonable labor standards and is approved by its head (subparagraph "d", clause 33, Section VIII of the Unified Recommendations, approved by the decision of the Russian Trilateral Commission of 12/25/2013, Protocol No. 11) ...

It should be especially noted that the staffing table should be uniform and take into account all personnel involved in the implementation of the state assignment and in the provision of paid services.

The staffing table is used to formalize the structure, staffing and staffing of the organization in accordance with its charter (statute). The staffing table contains a list of structural divisions, job titles, specialties, professions with an indication of qualifications, information on the number of staff units (Instructions on the use and filling out of primary accounting forms, approved by the decree of the State Statistics Committee of Russia dated 05.01.2004 No. 1).

According to sub. "In" p. 35 of the Unified Recommendations, approved. By the decision of the Russian Tripartite Commission of 12.24.2014 (Minutes No. 11), the formation of a unified staffing table in the institution is carried out regardless of what types of economic activity the structural divisions of the institution belong to.

In turn, in accordance with clause 10 of the Regulation on the establishment of wage systems for employees of federal budgetary, autonomous and state institutions (approved by the RF Government Decree of 05.08.2008 No. 583), the staffing table should include all positions (professions) of this institution ... At the same time, the wage fund for employees of a federal budgetary institution is formed based on the amount of funds received in accordance with the established procedure by the federal budgetary institution from the federal budget and funds received from income-generating activities (clause 11 of Regulation No. 583).

It follows from these provisions of the legislation that institutions make up a single staffing table, which includes all positions (professions) of this institution, regardless of what funds are used to finance a particular position.

Speaking about the form of the staffing table, it should be said that there are no direct explanations of the federal authorities on this issue. However, since the departmental normative act (order of the Ministry of Healthcare of Russia dated 01.18.1996 No. 16) approved its own form of staffing for health care institutions, in my opinion, it should be used.

So, for example, the corresponding departmental regulations approved the forms of schedules for subordinate institutions: staffing, approved. by order of the Federal Agency for Special Construction dated 03.12.2010 No. 540, staffing, approved. by order of the Federal Agency for State Reserves dated 09.09.2010 No. 180, staffing, approved. by order of the Federal Customs Service of 18.10.2005 No. 970, staffing, approved. Methodological recommendations for working with documents in educational institutions (letter from the Ministry of Education of Russia dated 20.12.2000 No. 03-51 / 64), and others.

From January 1, 2013 in connection with the entry into force of the provisions of the Federal Law of December 6, 2011
No. 402-FZ "On accounting", unified forms for accounting for labor and its payment, approved by the decree of the State Statistics Committee of Russia dated 05.01.2004 No. 1 "On approval of unified forms of primary accounting documentation for accounting for labor and its payment", are not mandatory. At the same time, the information of the Ministry of Finance of Russia dated 04.12.2012 No. PZ-10/2012 explains that the forms of documents used as primary accounting documents established by authorized bodies in accordance with and on the basis of other federal laws (for example, cash documents ).

Who should approve the staffing table of a medical organization?

Such a duty is legally assigned to the head of a medical organization.

So, the right of the head of a medical organization to approve the staffing table is enshrined in the following regulatory legal acts:

by order of the Ministry of Health and Medical Industry of the Russian Federation of January 18, 1996 No. 16 "On the introduction of staffing forms for health care institutions";
Unified recommendations for the establishment at the federal, regional and local levels of remuneration systems for employees of state and municipal institutions for 2015, which were approved by the decision of the Russian Tripartite Commission for the Regulation of Social and Labor Relations dated December 24, 2014, Protocol No. 11 (sub. p. 33).

In addition, according to sub. "E" clause 8 of the standard form of an employment contract with the head of a state (municipal) institution, approved. Decree of the Government of the Russian Federation of 12.04.2013 No. 329, the head has the right to approve the structure and staffing of the institution in accordance with the established procedure. It should be noted that by virtue of Part 3 of Art. 275 of the Labor Code of the Russian Federation, an employment contract with the head of a state (municipal) institution is concluded on the basis of a standard form of an employment contract approved by the Government of the Russian Federation, taking into account the opinion of the Russian tripartite commission for the regulation of social and labor relations.

It should also be said that by virtue of the direct indication of the law, namely part 2 of Art. 13 of the Federal Law of 03.11.2006 No. 174-FZ, the head of the autonomous institution independently approves the staffing table.

Should the head of a medical organization agree on the staffing table with higher authorities?

In accordance with clause 19 of the Unified Recommendations for the Establishment of Remuneration Systems for Employees of State and Municipal Institutions for 2015 at the federal, regional and local levels, approved by the decision of the Russian Tripartite Commission for the Regulation of Social and Labor Relations dated December 24, 2014, Protocol No. 11, the staffing table is approved by the head of the institution and includes all positions of employees (workers' professions) of this institution. In turn, the obligation of the head of a budgetary institution to coordinate the staffing table, including information on the number of staff units, with the founder is not established by federal legislation.

At the same time, this obligation can be established for certain types of institutions in the legal act of the founder or fixed in other agreements regulating the issues of remuneration of employees.

According to clause 11 of Regulation No. 583, the wage fund for employees of a federal budgetary institution is formed on the basis of the amount of subsidies received in accordance with the established procedure by the federal budgetary institution from the federal budget, and funds received from income-generating activities.

Consequently, the procedure for approving the staffing table does not depend on the sources of funding for the remuneration of employees of the institution.

Thus, if the obligation to agree on the staffing table is not established in the legal act of the founder or in other agreements regulating the issues of remuneration of employees, then the budgetary institution develops and approves the staffing table independently. Additional approval is not required in this case.

It is especially worth noting that in practice there are also quite often requirements from the territorial compulsory health insurance funds to agree on the staffing table directly with them. It should be said that federal legislation also does not provide for such a duty for the heads of a medical organization. In turn, the letter of FFOMS dated 06.04.2015 No. 1726 / 30-4 "On the procedure for forming staffing tables" explicitly explains that the structure and staffing are set by the head of the medical organization based on the volume of medical diagnostic work and the number of the population served, taking into account recommended staffing standards stipulated by the procedures for the provision of medical care. Thus, the coordination of the staffing table approved by the head of the medical organization with the TFOMI is not required.

What should the head of a medical organization be guided by when calculating staffing standards? Is it possible to apply orders, for example, the order of the Ministry of Health of Russia dated 09.06.2003 No. 230?

The staffing standards established by order of the Ministry of Health of Russia dated 06/09/2003 No. 230 are recommended, they must be followed when drawing up the staffing table along with the procedures for the provision of medical care, but the medical organization is not obliged to strictly comply with them.

In accordance with the letter of the Ministry of Health of Russia dated 08.01.2004 No. 14-04 / 9846, the order of the Ministry of Health of Russia dated 09.06.2003 No. 230 was recognized by the Ministry of Justice of Russia (letter dated 26.06.2003 No. 07/6476-YUD) that does not need state registration, since it has an organizational nature and does not contain legal provisions. Accordingly, as follows from the above letters, the order of the Ministry of Health of Russia dated 09.06.2003 No. 230 is of a recommendatory nature, since it does not contain binding legal norms.

In addition, in accordance with clause I of the current order of the USSR Ministry of Health of 02/10/1988 No. 90, the heads of health care institutions, based on production needs, are allowed to strengthen individual structural divisions or introduce positions that are not provided for them by the current staffing standards, at the expense of positions of other structural subdivisions within the established institution number of posts and the payroll. At the same time, it is allowed to replace posts in any order. The changes made are made to the staffing tables without the consent of the higher health authority.

It should also be noted that the economic justification is not a priority in the modern approach to the establishment of staffing standards:

In accordance with section IV of the Program for the phased improvement of the remuneration system in state (municipal) institutions for 2012-2018. (approved by the order of the Government of the Russian Federation of November 26, 2012 No. 2190-r) the formation of the staffing of institutions should be carried out using labor rationing systems, taking into account the need for high-quality provision of state (municipal) services (performance of work).
In accordance with the order of the Ministry of Health of Russia dated June 26, 2014 No. 322, when determining the need for medical personnel, the following are taken into account:

peculiarities of morbidity, taking into account the sex and age of the population in the constituent entity of the Russian Federation;
territorial features of the constituent entities of the Russian Federation (location of the constituent entity in the regions of the Far North and equivalent localities, population density, share of the rural population);
the volume of medical care provided within the territorial program of state guarantees of free provision of medical care to citizens (TPGG);
the presence in the constituent entity of the Russian Federation of settlements remote (more than 400 km) from medical organizations where specialized medical care is provided.

In addition, in accordance with sub. 7 p. 2 of Art. 7 of Federal Law No. 174 of 03.11.2006, the charter of an autonomous institution must necessarily reflect the structure and competence of the bodies of an autonomous institution. Thus, if the powers to approve the number of employees of a given institution are not attributed to the competence of the founder or the supervisory board, then they refer to the powers of the head of the autonomous institution, along with the approval of the staffing table (clause 2 of article 13 of Federal Law No. 174 of 03.11.2006) ...

Judicial practice is also of the opinion that the establishment of staffing standards is the right of the head of the institution. So, in the appeal ruling of the Tomsk Regional Court dated February 14, 2014 in case No. 33-140 / 2014, the judicial board ruled: “In realizing the rights enshrined in the Constitution of the Russian Federation (part 1 of article 34 and part 2 of article 35), the employer, in order to exercise effective economic activity and rational property management have the right to independently, under their own responsibility, make the necessary personnel decisions, while ensuring, in accordance with the requirements of Art. 37 of the Constitution of the Russian Federation enshrined in labor legislation guarantees of workers' labor rights ”.

It is especially worth noting that at present, the procedures for the provision of medical care, which, according to the current legislation, are mandatory, contain the recommended staffing standards for the number of medical personnel. The very fact that these staffing standards are recommended does not oblige the head of a medical organization to strictly adhere to them when drawing up a staffing table. It should also be noted that if in the Unified Recommendations for the Establishment of Remuneration Systems for Employees of State and Municipal Institutions for 2014 at the federal, regional and local levels, there was an indication of the formation of the staffing table in accordance with the procedures for the provision of medical care, then in similar recommendations on 2015, there is no such indication. Thus, the legislation does not establish a strict obligation to use the recommended staffing standards established by the procedures for the provision of medical care when drawing up the staffing table.

Can the head of a medical organization increase staffing standards, for example, in order to organize income-generating activities?

Yes, the manager has the right to do this. In addition, in a letter from the Ministry of Health of Russia dated 10/25/2012
No. 16-5 / 10 / 2-3238 "On the direction of methodological recommendations" Determination of the optimal ratio of medical / nursing / other personnel in state and municipal health care institutions of the general medical network and specialized services " / nursing / other personnel in state and municipal health care institutions of the general medical network and institutions of specialized services, it is advisable to take into account such factors as the presence of full-time and employed positions contained through income-generating activities (paid services). This activity is self-sustaining, and there is no need to monitor the availability and ratio of positions funded by paid medical services and other areas of income-generating activities. For example, additional positions of other personnel help to improve the quality of patient care in the provision of paid medical services.

Should a medical organization introduce separate staffing tables by funding source (for example, compulsory medical insurance and income-generating activities)?

No, the creation of separate staffing tables is not required in this case. This is directly indicated by the FFOMS in a letter dated 06.04.2015 No. 1726 / 30-4, explaining that a separate establishment of the staffing table within the framework of activities in the field of compulsory health insurance is not provided and is not required.

Labor rationing in the medical business is often quite problematic. The reason is that the main methodological technique that is required for the formation of calculation norms is timing (or a photograph of the working day), and to carry it out, appropriate specialists are needed - rationers. There are not always such specialists in the clinic.

However, on the recommendation of the Ministry of Labor, these duties can be performed by "a structural unit (employee), which is in charge of staffing the activities of the institution, the organization of labor and wages."

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Labor rationing of medical personnel: specifics, legal support

The specificity of the medical sphere presupposes certain peculiarities in carrying out work on labor rationing. The norms themselves can also vary significantly. For example, labor standards may depend on the level of diagnostics, treatment methods and preventive procedures, and forms of medical care. In addition, the rates should be easy to calculate.

To calculate the norms for the number of employees, it is better to use formulas and standards recommended by ministries and departments. The advantages of this approach are: objectivity, relevance and relative ease of use. To calculate labor standards and norms for the number of clinic staff, I would recommend using the following documents:

1. Order of the Ministry of Labor of the Russian Federation No. 504 of 09/30/2013 "On the approval of guidelines for the development of labor rationing systems in state (municipal) institutions" and its accompanying methodological materials: 1. Recommended methods for calculating the headcount rate in accordance with standard time standards and standard standards service and 2. Examples (algorithms) for calculating labor standards by editing standard labor standards, taking into account the organizational and technical conditions for the implementation of technological (labor) processes.

The specified document and its accompanying guidelines provide formulas and specific examples of calculations for the rationing of personnel labor, applicable just for medical institutions and which can be used without significant adaptation by a private clinic.

2. Recommendations and methodological materials of the Ministry of Health of the Russian Federation. For example, the standard industry norms of time for the provision of medical care to a client of a clinic by a district pediatrician, a district general practitioner, a general practitioner (family doctor), a neurologist, an otorhinolangologist, an ophthalmologist and an obstetrician-gynecologist, approved by order Ministry of Health of the Russian Federation from 2.06.2015.

Doctor's appointment times

In particular, according to the above document, the time norms for 1 appointment of a clinic client with a specialist doctor in connection with an illness, which are required to carry out the necessary labor actions in an outpatient setting for the provision of medical services (including the time spent on filling out the necessary medical documentation):

a) district pediatrician - 15 minutes;
b) a local therapist - 15 minutes;
c) general practitioner (family doctor) - 18 minutes;
d) neurologist - 22 minutes;
e) otorhinolaryngologist - 16 minutes;
f) ophthalmologist - 14 minutes;
g) obstetrician-gynecologist - 22 minutes.

As for the norms of time for doctors to visit the clinic for a second visit in the presence of a disease, they are set at 70-80% of the time norms associated with the first visit to the doctor by one patient.

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These norms of time for admission by doctors can be adjusted by a private clinic, depending on the characteristics of technological processes, on the basis of methodological recommendations (see clause 1)

Calculation of the norm of the number of medical personnel

Knowing the norms of time, it is easy to determine the norms for the number of medical personnel for doctors of each category and, based on them, draw up the staffing table in your clinic.

To calculate the norm for the number of medical personnel at a known standard of time, the following set of formulas is used:

Нч = (To / Фп) * Кн
To = Tr * Cr
Kn = 1+ Vr / (Fsum * Chsr)
Tr = Hb * Oi

NP is the norm for the number of employees of a certain qualification
That is the total time spent per year for the amount of work carried out by employees (hours)
Фп - the planned normative fund of working time of one employee of the clinic per year
Кн - coefficient for which planned absenteeism of employees during unpaid leave, illness, etc. are taken into account.
Tr is the time spent on the corresponding type of work, for which the norms of time are determined
Кр is a coefficient that takes into account labor costs for work of a one-time nature, for which the norms of time are not determined
Вр - the total time not worked due to the absence of the clinic staff at work for the estimated period of time
Fsum - normative fund of working time of one specialist for the estimated period of time
Chsr - the average number of all employees of the clinic for the estimated period of time
Нв - time norm
Оi - the amount of work of the i-th type performed by the employee. It is recommended to recognize the calculation period for the two previous years.

EXAMPLE
Let us calculate the norm of the number of medical personnel using the example of a therapist, using the above-mentioned norms of time recommended by the ministry (converting them from minutes to hours) and based on the fact that 6800 initial visits to a therapist and 9500 repeated visits to the clinic take place in the clinic per year, doctors work 5 days a week for 8 hours, vacation 28 calendar days, the working time fund according to the production calendar is equal in the current year - 1970, in the previous two years - 1986 and 1981 hours. All work is scheduled (Kp = 1), the average number of employees in the clinic for the two previous years is 215 people, the total time not worked due to absenteeism for the billing period (Bp) was 7213 hours.

Tr = 6800 * (15 minutes of the standard / 60 minutes) + 5500 * (15 minutes of the standard * 80/60 minutes) = 6800 * 0.25 + 9500 * 0.2 = 1700 + 1900 = 3600

That = 3600 * 1 = 3600

Fsum = (1986 + 1981) - (2 years * 28 vacation days / 7 days a week * 5 working days * 8 hours) = 3647

Kn = 1 + 7213 / (3647 * 215) = 1.0092

FP = 1970- (28/7 * 5 * 8) = 1810

Nh = 3600/1810 * 1.0092 = 2.007 = 2 people

Therefore, in the staffing of the clinic, it is necessary to provide for two doctors of this category.

Introduction

The current stage of health care development raises in a new way the issues of the quality of medical care provided to the population. The proper level of medical care can be achieved only with the appropriate staffing of health care institutions. The formation of the number of medical personnel, the establishment of labor standards, the rational placement and use of personnel are the most significant components of the labor rationing system in health care, which are based on sectoral labor regulations. Currently, the regulatory framework developed by the USSR Ministry of Health at the end of the 80s is used. Normative documents on labor are not focused on the organizational and technical conditions for the operation of medical and preventive healthcare institutions, as well as the incidence of the population and the demographic situation that are currently taking place in Russia. The need to update the existing regulatory framework and develop modern labor regulations is quite obvious. First, the crisis phenomena in the economy and the deterioration of the ecological situation in recent years have significantly changed the nature of the pathology and the severity of the disease in the population served, as well as the frequency of referrals, the duration and intensity of treatment. In this regard, it became necessary to develop new modern norms and standards for labor and improve the existing ones. Secondly, the standard standards for most of the main types of institutions (regional, city hospitals, adult and children's city polyclinics, etc.), developed 25-30 years ago and corresponding to the technology of the diagnostic and treatment process adopted at that time, do not correspond to modern requirements and need revision. Thirdly, the rapid development of medical science, the introduction of new technologies and modern technology in the treatment and diagnostic process, the improvement of instrumental research methods have significantly changed the nature and content of a doctor's work and also require a serious revision and updating of the regulatory framework in health care.

The purpose of this work is to consider the types of labor rationing methods, methods for studying the costs of working time and approximate calculations of labor rationing for middle and junior medical personnel.

The work uses various sources, publications, educational literature.

The work consists of several sections. The first section characterizes the concept of labor standards, its types, defines the functions, tasks and principles of labor rationing, as well as the procedure for introducing, replacing and revising labor standards. The second section examines the types of labor rationing, methods of studying the cost of working time. In the third section, the calculations of the rate setting for the work of middle and junior medical personnel of various departments of a medical institution are given.

The conclusion contains conclusions about the work done and a list of references.

Theoretical aspects of labor rationing in health care

The essence of labor standards and its types

The standard of work is the amount of work established for an employee per hour, day (shift), week, month, year, which he is obliged to perform under normal working conditions. The employer is obliged to ensure normal working conditions: good condition of mechanisms, equipment, devices, timely provision of technical documentation, proper quality materials and tools for work, their timely submission, safe and healthy working conditions. Labor standards - production, time, service rates - are established in accordance with the achieved level of technology, technology, labor and production organization, and should be systematically revised if they change. Labor standards are also subject to mandatory replacement as the certification of workplaces is carried out, the introduction of new equipment, technology, technical re-equipment of production, ensuring an increase in labor productivity. The introduction, revision and replacement of labor standards is made by the employer, taking into account the opinion of the trade union committee, local regulations. Employees are notified of the introduction of new standards at least two months in advance.

There are the following types of labor standards: production rates; time norms; service standards; population norms; standardized tasks; consolidated and complex norms used in collective forms of organization and remuneration (in the production team). According to their sphere of action, labor standards are distinguished: uniform, standard, intersectoral, sectoral (departmental) and local. In practice, there are always local ones, which are developed on the basis of standard, industry and other centralized norms of a recommendatory nature.

The production rate is the amount of work established in units of production, work operations, which the employee must perform per hour, day (shift), month, working year.

The rate of time is the amount of working time (in hours, minutes) for the production of a unit of output or a work operation; it is used to calculate, determine production rates and other labor rates.

Service standards are the volume of servicing of production mechanisms, machine tools, and areas established for one employee. A variety of them is the control rate - the number of workers in a given production, who must be managed by one manager (foreman, site manager, foreman, etc.). This is also a calculated standard for determining the staff of managers who manage labor.

The number of workers is the established number of working personnel of a certain profession, qualifications for performing work in a given production area, for example, repair workers for servicing machines or all workers in a shop, department, enterprise, institution, organization.

The headcount rate and the service rate are interrelated, since the number of employees is determined by the service rate, and vice versa.

The enlarged and comprehensive norms used in the collective work of the production team in a single outfit are calculated for the entire team of the team, that is, this is the amount of work that the team must perform per day, week, month.

With a piece-rate wage system, a piece rate is applied - this is payment for a unit of product made (work operation) of proper quality (without marriage). The piece rate under a simple piece rate system is always the same, no matter how much the worker produces; under a piece-rate progressive system, it is the same within the limits of production, and for products made in excess of the norm, it progressively rises (but this system is rarely used, since it affects the cost of production). Piece rates are set by the administration and are also revised with a revision of labor standards.

The normalized task is the total amount of work per working day (shift) for an employee or a team, established under a time-based wage system based on time rates and production rates, and is used to improve the efficiency of workers with time-wages. Depending on the time for which the task is set, the daily (shift) and monthly standardized tasks are distinguished. In essence, this is a special production rate applied to time workers.

Functions, tasks, meaning and principles of labor rationing

The main functions of labor rationing are distribution according to work, scientific organization of labor and production, production planning, assessment of the labor activity of individual workers and collectives, which serves as the basis for moral and material encouragement and dissemination of advanced experience.

Labor rationing includes:

¾ study and analysis of working conditions and production possibilities at each workplace;

¾ study and analysis of production experience to eliminate deficiencies, identify reserves and reflect best practices in labor standards;

¾ designing a rational composition, method and sequence for performing the elements of the labor process, taking into account technical, organizational, economic, physiological and social factors;

¾ establishment and implementation of labor standards;

¾ systematic analysis of the implementation of labor standards and revision of outdated standards.

The main tasks of labor rationing are to:

¾ substantiate the necessary and sufficient amount of labor time spent on a unit of production in specific conditions;

¾ design rational labor methods;

¾ systematically analyze the fulfillment of labor standards to reveal production reserves;

¾ constantly analyze the fulfillment of labor standards to reveal production reserves;

¾ constantly study, generalize and disseminate production experience, revise labor costs as working conditions change.

The solution of these tasks will make it possible to facilitate the work of workers, increase labor productivity and increase the volume of production.

Labor rationing is the basis of the scientific organization of labor. With the help of the methods used in the regulation of labor, losses and unproductive expenditures of working time are distinguished. By studying labor movements, the most economical, productive and least tiring methods of work are developed. This contributes to the growth of labor productivity. Further improvement of the organization of labor is impossible without improving its regulation.

Also, labor rationing is the basis for organizing wages. The establishment of labor standards pursues the goal of guaranteeing a certain labor productivity to the society, and a certain level of wages to the employee. According to the fulfillment of labor standards, the labor activity of each employee is assessed and his labor is paid. Without labor rationing, it is impossible to implement the economic law of distribution according to labor.

Labor rationing is an important means of organizing production. Organization of production is the management of the process of production of material goods, i.e. establishing interaction between labor and means of production to achieve maximum economic effect in specific conditions. Through the organization of labor, the influence of labor rationing on the organization of production is manifested.

Scientifically based labor standards allow us to evaluate the results of the labor activity of each employee, each team and compare their results. Only by comparison are the leaders and the laggards revealed.

Scientifically based labor standards, correctly reflecting specific conditions, ensure an increase in labor productivity. If labor standards are understated, they can generate complacency or pessimism, which negatively affects productivity results, if the norms are overestimated, they are impracticable. In both cases, the growth of labor productivity will be inhibited. Thus, all changes in the organization of labor and production, technology and work technology are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor at the enterprise.

Labor rationing is the basis of labor planning. For long-term, current and operational planning, a whole system of norms is used: rates of consumption of materials, fuel energy, rates of machine productivity, rates of expenditure of working time. Thus, labor standards play an important role in the system of norms used in planning in the enterprise.

Drawing up a work plan and establishing labor costs in accordance with the volume of production is impossible without scientifically based labor standards. The greater independence of enterprises in matters of labor planning increases the interest of collectives in the implementation of scientifically based labor standards.

Labor rationing should be based on the following principles:

¾ scientific validity of labor standards;

¾ equal intensity of labor standards for identical jobs in identical conditions;

¾ preservation of the main productive force of society - the working people;

¾ participation of workers in the establishment of labor standards.

The labor rate acts not only as the amount of necessary expenditure of working time, but also as an expression of the labor duties of each participant in production.

Procedure for the introduction, replacement and revision of labor standards

According to Art. 160 of the Labor Code of the Russian Federation, labor standards should be established in accordance with the achieved level of technology, technology, organization of production and labor.

The introduction, as well as the replacement and revision of labor standards are formalized by the organization's local normative acts (order, order, regulation on rationing, etc.) and taking into account the opinion of the representative body of workers (trade union body, labor collective council, etc.).

The most rational and preferable method of designing regulatory materials is the analytical-calculation method, since it is the most perfect and cost-effective.

To develop labor standards, the following activities are organized and carried out:

1. Preparatory and organizational-methodical work.

In the course of the work, the goals and objectives of the development of normative materials for the regulation of labor are determined, the types of norms are specified, a technical task is drawn up.

The terms of reference are developed by the organization executing the normative research work and approved by the customer organization.

The current technology, instructions, regulations, organizational and technical conditions and methods of performing work at workplaces are studied, equipment passports are selected, the characteristics of the tools, devices, raw materials, materials, equipment operating modes, the content of technological and labor processes are selected; the possibility of developing normative materials with the use of time standards, including microelement ones, the use of electronic computers for the design of rational work processes and the calculation of labor standards is established.

A methodological program of work on the development of a regulatory document is being developed, reflecting the following issues:

¾ selection of enterprises (institutions, organizations), their structural divisions, on the basis of the organization of production and labor of which progressive technological (labor) processes and rational organizational and technical conditions for their implementation will be developed, provided for in the design of labor costs;

¾ use of existing normative materials for labor rationing, including microelement standards;

¾ determination of factors affecting the time spent in performing individual works and ensuring the highest accuracy of standards and norms with the least complexity and laboriousness of their development;

¾ instructing workers who observe and analyze the costs of working time and design norms and standards, the use of devices, video equipment, computer equipment for this work, statistical, operational and other reporting data;

¾ checking the draft of normative materials in production conditions;

¾ preparation of the collection of normative materials as a whole.

2. Studying the cost of working time at workplaces.

These works include:

¾ preparation for observations: performers are selected, whose work will be monitored, the compliance of the technology, organization of the workplace and its maintenance with the designed ones is specified;

¾ Carrying out direct measurements of working time (timing, photographs of working time, video filming of work processes, etc.) or instant observations; at the same time, the materials associated with the establishment of labor costs at the selected enterprises are used to the maximum;

¾ Carrying out technical calculations, experimental and other research work, processing the collected materials.

3. Processing of collected materials.

These works include:

¾ analysis and generalization of the results of studying the costs of working time, the development of standards (norms) of labor costs;

¾ clarification of the main factors affecting the amount of labor costs; derivation of empirical (based on experience) formulas of dependencies between the values of influencing factors and the values of labor costs;

¾ preparation of a draft normative document in the first edition, as well as instructions on the procedure for its verification directly at the enterprise;

¾ determination of specific enterprises (institutions, organizations), their structural subdivisions for conducting inspections of regulatory materials on them;

¾ sending the draft normative document with instructions on the procedure for conducting its verification to the selected enterprises (institutions, organizations), to their structural divisions.

4. Verification of normative materials in a production environment.

The purpose of the check is to identify the nature of the clarifications and additions to be made to the project.

5. Preparation of the final version of regulatory materials.

The analysis and study of the results of checking the draft normative document in production conditions, generalization of the received reviews, comments and suggestions are carried out.

The established labor standards in accordance with Art. 160 of the Labor Code of the Russian Federation may be revised as the improvement or implementation of new equipment, technology and organizational or other measures are taken to ensure an increase in labor productivity, as well as in the case of the use of physically and morally obsolete equipment.

It should be noted that there cannot be a reason for revising the previously established norms, the achievement of a high level of production (provision of services) by individual workers through the use, on their initiative, of new methods of work and improvement of workplaces (that is, advanced methods and forms of labor organization).

Replacement and revision of uniform and standard norms is carried out by the bodies that approved them. The revised norms are formalized by a local regulatory act of the organization and are communicated to employees no later than two months before the introduction.

Verification of the labor standards in force at the enterprise (institution, organization) is carried out by certification commissions approved by the heads of enterprises (institutions, organizations).

Based on the results of the check for each standard, a decision is made: to certify or not to certify. Technically justified norms are recognized as certified, corresponding to the achieved level of technology and technology, organization of production and labor.

Outdated and erroneously established norms are recognized as not attested and are subject to revision. Outdated, in particular, should be considered the norms in force at work, the labor intensity of which has decreased as a result of a general improvement in the organization of production and labor, the growth of professional skills and the improvement of production skills of workers and employees. Norms can be considered erroneous if the organizational and technical conditions were incorrectly taken into account or inaccuracies were made in the application of normative materials or in the calculations.

When checking the norms of labor costs, the administration is obliged to ensure a thorough check of the implementation of the technology provided for by the norms in all operations of the labor process, the compliance of the actually performed volume of work with the volumes laid down in the calculation of the norms. At the same time, the administration, based on specific production conditions, is obliged to rationalize the technological processes of those operations, the conditions for the implementation of which, provided by the norms, do not correspond to the achieved level of organization of production and labor, and advanced experience.

The revision of outdated norms is carried out within the time frame and in the amount established by the management of the enterprise in agreement with the trade union committee. Revision of erroneous norms is carried out as soon as they are revealed in agreement with the trade union committee.

The basis for the application of correction factors to the norms and standards may be the development of production capacities, new equipment, technology, new types of products or the discrepancy between the actual organizational and technical conditions of production provided for in the newly introduced norms and standards.

Labor rationing methods

Types of labor rationing methods

Improving medical care to the population requires not only building up the material and personnel base of health care, but also further improving the style and methods of work, organizational activities at all levels, taking into account the economic efficiency of the activities. One of the important tasks for the further improvement of health care is the rational use of all resources. Determining the scope of activities of a particular group of medical personnel, establishing a direct relationship between indicators and wages, calculating the cost of providing medical care to the population as a whole and its individual types is especially important during the period of introduction of economic management methods in health care and the transition to insurance medicine.

Labor rationing is an important tool for solving these problems. To date, the needs of the population in certain types of medical care remain insufficiently studied, scientifically grounded proposals on a number of health care institutions, their structural divisions and positions of medical personnel, as well as recommendations on rational forms of labor organization, have not been developed.

The method of labor rationing is a set of techniques for studying and analyzing labor processes, determining the cost of working time, identifying and accounting for norm-forming factors, designing a rational organization of labor and developing standards.

The regulation of the work of medical workers is the most difficult issue, reflecting the specifics of the industry and requiring a careful approach and scientific justification when solving it. In health care, as in other sectors of the national economy, there are two types of labor rationing methods: analytical and summary (Fig. 1).

Figure 1- Methods of labor rationing

The analytical method provides for the division of the labor process into separate components. Depending on the methods of developing labor standards, this method is divided into analytical-research and analytical-calculation.

The analytical research method is a method in which the labor rate is established on the basis of studying the cost of working time using photo-timing observations directly at the workplace. It involves a detailed study of the production process and labor costs by its constituent elements. On the basis of these data, the most rational technological modes of equipment operation and the organization of the workplace and labor are designed.

The analytical and computational method provides for the calculation of time consumption according to predetermined time standards, equipment operation modes, as well as formulas for the dependence of time on factors affecting the duration of the operation. This method sets the standardized number of auxiliary workers, managers, specialists and technical executors.

The total method of labor rationing establishes the expenditure of working time as a whole per unit of production of a specific work process without analyzing the latter. The way the work is done is determined by the employee. The types of the summary method are experimental, statistical and comparative methods.

Experienced method. The expert gets acquainted with the workplace, means and working conditions and intuitively, on the basis of his subjective impressions and previous experience, determines the labor standard. The established labor rate is not an average value, but only a partial value of the possible expenditure of working time. Its validity, compliance with the conditions of the workplace depends entirely on the experience of the expert. This method is not able to provide the same intensity of norms. Moreover, it only reflects past experiences. Practice shows that labor standards established by an experienced intuitive method, as a rule, are of low quality. This is evidenced by the significant overfulfillment of such norms by the majority of workers.

Statistical method. Labor standards are established primarily on the basis of statistical reporting data on the volume of work. This method can be used only if the doctor is confident that, on the one hand, there is no shortage of working time, and on the other hand, the technology of the treatment and diagnostic process is observed, and the patient is provided with proper medical care in full.

The comparative method for establishing labor standards is used when the technology of personnel work is similar to that for which there are already standard indicators. For example, the activities of medical registrars, statisticians, etc. are homogeneous in all types of institutions.

The total method, which does not fully take into account the content and organization of the labor process, the rational use of working time, cannot be recommended for widespread use in the development of labor standards. At the same time, its simplicity and cost-effectiveness in some cases makes one give preference to this particular method.

Thus, at present, for the centralized development of labor standards, it is advisable to apply mainly the analytical and research method. In health care institutions, in order to determine the number of personnel required for a particular volume of work, the establishment of a number of standard indicators, the calculation and analytical method should be widely used. In cases where there are no developed standards for the workload of personnel, for example, when introducing new types of instrumental studies, when organizing a new service, it is possible to apply summary methods of standardization to establish temporary standards in order to carry out their scientific basis.

Methods for studying the cost of working time

There are 4 methods for studying the cost of working time (Fig. 2).

Figure 2 - Methods for studying the cost of working time

Let's consider each of them.

Timing, methodology.

Timing is a method of studying the cost of working time by measuring the recurring elements of an operation.

Its main purpose is to identify the most optimal methods of work and determine the corresponding norms of time. Timing allows you to assess the organization of the workplace, differentiate to study the structure of an individual operation and the conditions for its implementation. The timing process includes three stages.

At the first (preparatory) stage, the operation is divided into separate elements using fixing points. The fixation point is a distinct external sign, perceived by the eye or by ear, signaling the beginning and end of one or another element of the operation. At the same stage, the worker is instructed and the workplace is studied. This is documented in the front side of the timekeeping-observational card, where the data on the operation are entered, the amount of products produced at a certain time, the types and condition of the means of labor, the nature of the process, the qualifications and length of service of the performer, the applied wage system are indicated.

At the second stage, observation and time recording is carried out. Time measurements are made collectively and cumulatively using a two-hand stopwatch. The observer must record the time by fixing points and enter the stopwatch readings in the observation sheet of the time-keeping chart, monitor the order of the operation.

At the third stage, the data are processed and the duration of the operation element is determined. The obtained values of the duration of the operation element are recorded in the timing variation series, where the upper line is a variant - these are measurements in ascending (decreasing) order of the duration of measurements (t), and the lower line of frequencies (p) - shows how often this variant occurs in the time series. The total sum of frequencies should be equal to the number of measurements. Inaccurate (defective) measurements are preliminarily excluded and then the quality of the time series is assessed.

Photography of working hours, types and methods of carrying out

A photograph of working time is the observation, measurement and sequential recording of all, without exception, the time spent during a work shift or other period.

If the observation period coincides with the duration of the working day, it will be a photograph of the working day.

A photograph of working time is used to identify losses of working time and the reasons that cause them, as well as to establish the relationship between certain types of time expenditures. The obtained data are used as input for standardization.

The subject of a photograph can be workers, machines, or the production process in general. If the object of observation is one worker, then the photograph of the working time is an individual one, and if a group of workers is a group one. When the costs of working time are recorded by the worker himself, a self-photograph of working time takes place in order to study the losses of working time and their causes.

The photograph of the working time is carried out in three stages.

At the first stage, a preliminary study of the work is carried out, the choice of an object of observation. The object is selected depending on the purpose of observation. If it is necessary to obtain stable indicators of exemplary work, then the best worker is selected, and if it is necessary to study the reasons for non-fulfillment of norms, then the lagging workers are selected.

The second stage includes direct observation and study of all time costs with an accuracy of up to one minute. The results are recorded in special observation sheets. In this case, the types of work and breaks, as they are registered, are entered in the column "Name of time expenditures", and the moment of their completion - in the column "Current time".

At the third stage, based on the data from the observation sheet, a table of costs of the same name and the actual balance of working time are compiled. In conclusion, the analysis of the results of the observations is carried out, irrational costs and direct losses of working time are established, which are excluded when drawing up the projected balance, and the coefficient of a possible increase in labor productivity is determined by eliminating losses and irrational costs of working time.

Photo timing

Photo timing is a type of observation in which simultaneously with the photograph of working hours taken during the shift, timing is carried out in its individual periods. It is advisable to use it when studying the time spent on individual elements of work that do not repeat cyclically during the working day.

In the practice of work on labor, individual and group photo-timing are used. Thus, it is recommended to carry out group photo-timing when establishing the composition of the brigade and distributing functions among its members, the individual elements of which do not have cyclical repetition.

Observations and measurements are carried out by the accepted methods of processing the results of observations, the analysis of the data obtained and the design of rational work processes during photochronometry are carried out separately according to the data of time observations and photographs in the prescribed manner.

Momentary observation method

The method of instant observations allows you to register and take into account during the observation period the costs of the same working time of a group of performers or the time of work and breaks in the work of various numbers of equipment and, on this basis, determine the specific weights and absolute values of the time costs. The method is characterized by insignificant labor intensity and ease of observation and processing of the results obtained, the efficiency of the study, a wide coverage of observation of various objects, as well as the involvement of personnel in research with the simultaneous performance of their main work, etc. The disadvantages of the method include: obtaining only average values of the expenditure of working time and equipment usage time; lack of data on the sequence of execution of the studied processes, as well as possible changes, etc.

When conducting research, it is recommended to use analogue hour devices (watches, one- and two-hand stopwatches), special equipment that automatically fixes both the time and the content, structure and method of performing normalized processes (oscillography, photo-video and film equipment).

Filming ensures objectivity and high accuracy of registration of all elements of the labor process in time and space, as well as the conditions determining it, the completeness of the characteristics of the process under study (trajectory and speed of movements, distances of movement of objects of labor, sequence and degree of combination of techniques, actions and movements, etc. .)

Rationing of work of middle and junior medical personnel

Labor rationing of middle and junior medical personnel in outpatient clinics

The positions of middle and junior medical personnel in outpatient clinics are established according to the number of positions of outpatient doctors of a particular specialty (to calculate the number of positions of nurses and nurses in the corresponding offices). The positions of outpatient doctors include all positions of doctors of outpatient clinics, except for the positions of doctors of clinical laboratory diagnostics, bacteriologists, radiologists, radiologists, physiotherapists, reflexologists, manual therapy, endoscopists, anesthesiologists-resuscitators, statisticians, doctors of points (departments) of medical care at home , in physiotherapy exercises, sports medicine, functional or ultrasound diagnostics, health centers, city and district pediatricians, as well as medical leaders of all ranks.

The need to allocate medical posts for outpatient admission is due to the fact that, depending on their number, according to staff standards, the number of posts of doctors and nurses in auxiliary and some other medical and diagnostic units is determined:

· The total number of positions of outpatient doctors: nurses in the treatment room, medical registrars (to calculate the number of positions of nurses in the treatment room, medical registrars);

· The total number of positions of doctors (to calculate the number of medical statisticians);

· Change of work of a subdivision or institution (for calculating the number of nurses in procedural, vaccination rooms, registry);

· The number of the population and its individual contingents (for calculating the number of nurses in vaccination rooms, nurses for collecting breast milk, etc.);

· Mixed procedure for establishing positions: to calculate the number of paramedics or filter nurses in the children's city polyclinic (change of work and the number of children).

Most of the current standard standards for outpatient clinics were approved more than 25 years ago: the standard standards for city and children's city clinics located in cities with a population of more than 25 thousand people are determined by order of the USSR Ministry of Health dated 10.11.1982 No. 999, in cities and urban-type settlements with a population of up to 25 thousand people. by order of the Ministry of Health of the USSR No. 900 dated September 26, 1978. In 2001, an order was approved according to the standard standards of children's polyclinics, which are part of city and children's city hospitals, medical units with hospitals (order of the Ministry of Health of Russia dated October 16, 2001 No. 371), however, the lack of substantiation of the main provisions of this order makes it unacceptable for health care practice.

By the nature and scope of activities of nursing staff assigned to outpatient doctors in various specialties, these positions can be divided into the following groups:

· Nurses carry out outpatient reception of patients together with the doctor;

· Along with outpatient appointments, together with a doctor, nurses of district general practitioners, pediatricians, general practitioners (family medicine) also fulfill the doctor's prescriptions for the provision of appropriate medical, diagnostic and preventive care at home to the population of the district.

Nurses of surgeons, orthopedic traumatologists carry out dressings, application and removal of plaster, etc.

The first group includes most of the nursing positions of outpatient doctors. The normative ratio of middle and medical personnel in this group is, as a rule, 1: 1, that is, one position of a nurse is planned for one doctor's position. At the same time, in such specialties of doctors as neurology, endocrinology and dentistry, this ratio is violated and in accordance with the current staffing standards, 0.5 positions of a nurse are established for one position of a doctor in these specialties. It is difficult to find a logical explanation for such standards, and in the absence of appropriate recommendations at the sectoral level, the heads of health care institutions, on the basis of the rights granted to them to form the number of personnel in health care facilities, it is advisable to establish the number of nursing staff positions in these specialties, corresponding to the medical one. By order of the Ministry of Health and Social Development of Russia dated April 14, 2006 No. 289, this provision for the children's dental clinic has been amended, and the positions of nurses in medical offices are established at the rate of 1 position for each position of a pediatric dentist, dentist-surgeon and orthodontist. This standard is fully consistent with modern technologies of the therapeutic and diagnostic process in dentistry with the use of modern composite materials, four-handed work and ethical and legal norms for admitting a patient in a separate office.

In recent years, in connection with the introduction of compulsory medical insurance in the territories where payment is made for certain medical services, classifiers of medical services have been developed and approved, which establish the appropriate time standards for a doctor and a nurse. The feasibility of such a separate establishment of time norms for those specialties where the norms define an equal number of doctors and nurses raises serious doubts. So, for example, in one of the classifiers for otolaryngology, where, according to the staffing standards, one position of a nurse for one position of a doctor is established, the time spent on anterior nasal tamponade (including after bleeding) is determined in the amount of 2.0 UET for a doctor and 1.5 UET for a nurse, i.e. 20 and 15 minutes, respectively. It is unlikely that a nurse, having finished the procedure before a doctor, will provide assistance to another patient without an appropriate medical examination and prescriptions. The situation becomes more complicated when the indicated expenditure of a doctor's working time is less than that of a nurse. For example, to replace the cystostomy drainage, the urologist is set at 3.0 EVEN, i.e. 30 minutes, and for the nurse - 4.0 EVEN, i.e. 40 minutes. After completing this operation, the doctor will accept the next patient without a nurse, which may lead to a violation of the technology of the treatment and diagnostic process, which provides for the joint work of a doctor and a nurse, or wait for the nurse to complete this labor operation within 10 minutes.

Thus, the establishment of different norms of time for separate labor operations for a doctor and a nurse contradicts the sectoral labor standards that determine the ratio between the number of positions of nurses and outpatient doctors in a particular specialty.

Moreover, as noted in the Recommendations, the determination of the time spent on individual labor operations, as well as on simple and complex medical services, can be considered only as an intermediate stage for the formation of standard costs for a more consolidated indicator recorded in the reporting and accounting documentation of a healthcare facility, i.e. to visit.

The normative number of junior medical personnel positions is also differentiated according to the specialties of outpatient doctors. So, in city polyclinics located in cities with a population of over 25 thousand people, the positions of nurses are established at the rate of 1 position for each position of a surgeon, traumatologist, orthopedist, infectious disease specialist; for every 2 positions of physiotherapy physicians, allergists-immunologists; for every 3 positions of other outpatient doctors.

Rationing of work of middle and junior medical personnel of hospital institutions

The rationing of the work of middle and junior medical personnel in hospital institutions has certain features, which are listed below:

· The need to provide round-the-clock service for patients in the hospital;

· The indicator that serves as the basis for calculating the number of posts is the number of beds;

· Establishment of load (service) standards for the day of the patient's stay in the hospital or shift.

The standards for the number of middle and junior medical personnel in hospital institutions are expressed in the number of beds per position, or per one round-the-clock post. Depending on this, the norms of time are set either for the day the position is open, or for the day.

Stage I. The standard costs of working time of medical personnel in hospital institutions are determined per 1 patient per day or per day. The stay of the patient in the hospital for the calculation of standard indicators for labor is differentiated as follows:

· Day of admission;

· Day of treatment;

· Day of discharge.

The time spent is usually set on the basis of timing.

The calculation of the weighted average indicator of the costs of the working time of a nurse or nurse working daily on the day of the patient's stay in the hospital (Tday) is carried out according to the formula:

Tday = (tp + tl x 0.825 (m - 2) + tv) / (m x 0.825), (1)

where tp is the time spent by a nurse or doctor per patient on the day of admission;

tl is the time spent on a patient during the treatment period per day;

tв - time spent on the patient on the day of his discharge;

m is the average duration of inpatient treatment (in days).

A coefficient of 0.825 has been introduced into the formula, showing a reduction in the number of days of work of a nurse or a nurse during the entire period of stay due to holidays and weekends. When calculating the coefficient, 12 holidays and 52 days off are taken into account when working on a six-day working week: (365-52-12) / 365 ≈ 0.825.

Under the specified regime, that is, nurses are working daily, providing individual care for seriously ill patients, dressing room, procedural room, barmaid attendants, nurses.

Calculation example

The time spent by a nurse for the organization of individual care for seriously ill patients, calculated for 1 day of the patient's stay, is 100 minutes on the day of admission, 80 minutes daily during the treatment period and 70 minutes on the day of discharge. The weighted average with an average length of stay of a patient equal to 13 days, calculated according to formula 1, is 83.5 minutes.

(100 + 80 × 0.825 × (13 2) + 70) / (13 × 0.825) ≈ 8.4.

There are about 10% of seriously ill patients in the department, therefore, this indicator per one hospitalized person is 8.4 minutes (83.5: 10).

Most nurses and nurses in hospitals work around the clock. In this case, a 2 or 3 power service system is introduced.

The use of a 2-stage system provides for the care of patients by a doctor and a nurse. At the same time, the ward nurse fully and directly serves the patient, and the sanitary cleaner performs only sanitary and hygienic functions in the wards and utility rooms. The forced performance by ward nurses of the functions of junior medical personnel, for example, cleaning premises in the absence of an adequate number of nurses, undoubtedly worsens the quality of medical care and contradicts sanitary and hygienic requirements.

In a 3-degree system, a doctor, a nurse and a nurse are involved in patient care.

The calculation of the weighted average costs of the working time of a nurse or a nurse per day of hospital stay (Tsut) is calculated using a formula similar to formula 1, but without taking into account the coefficient 0.825:

Tsut = (tp + tl x (m - 2) + tv) / m, (2)

All designations correspond to formula 1, calculated not for a day, but for a day of a patient's stay in the hospital.

The weighted average time spent is calculated separately for patients admitted as planned and for emergency indications, and for surgical departments, in addition, for operated and non-operated patients. Then, taking into account the proportion of emergency hospitalization and operational activity, an indicator of the average time spent by a nurse or a nurse per patient is determined. This method of calculation makes it possible to model an effective indicator of the average time spent per patient according to the department profile, depending on changes in the basic working conditions: an increase or decrease in the volume of emergency hospitalization, the number of surgical interventions, changes in the average length of hospital stay, etc.

Calculation example.

The cost of a nurse's working time per patient per day by periods of hospital stay, admitted on an emergency basis and in a planned manner.

Calculations of the time spent on one patient per day, carried out according to formula 2, show that for those admitted as planned, with an average length of stay equal to 12 days, they will amount to 40.8 minutes:

(73.8 + 34.6 (12 2) + 70.2) x 12 ≈ 40.8.

Working hours for patients admitted on an emergency basis, with an average length of hospital stay of 8 days, will amount to 107.4 minutes: (396.6 + 60.8 (8 2) + 97.8) / 8 ≈ 107, 4.

The average time required for a 10% emergency hospitalization is 47.5 minutes: (107.4 x 10 + 40.8 x 90) / 100 ≈ 47.5.

The average time required for a 30% emergency hospitalization is 61.8 minutes: (107.4 x 30 + 40.8 x 70) / 100 ≈ 61.8.

Thus, an increase in the proportion of hospitalizations for emergency indications from 10 to 30% leads to an increase in the cost of a nurse's working time per patient per day from 47.5 to 61.8 minutes, i.e., by 30%.

Stage II. The calculated load (service) norms for medical personnel of hospital institutions are expressed in the number of patients served per day or per day according to the formula:

NB = (B x k) / T, (3)

where Nb - norms of the load on the hospital's medical staff;

B - daily working hours of medical personnel (in a six-day working week) or daily working hours;

k is the coefficient of using the working time of nursing staff for the main and auxiliary activities;

T is the average time spent per patient per day (from formula 2).

The main activity of medical personnel is, as a rule, work carried out directly with the patient, that is, the time of direct contact of the personnel with the patient, namely, the performance of various kinds of procedures and manipulations. However, some categories of medical personnel do not have any contact with patients at all, for example, a cleaning nurse with a two-level service system, therefore, their main activity is to perform a direct production task.

All the preparatory work done to perform the main activity and carried out both in the presence and in the absence of the patient is an auxiliary activity: preparation and cleaning of the workplace, preparation for manipulation, procedure, transfer to another department, etc.

During the working day, the staff needs a short rest, eating, and carrying out sanitary and hygienic measures. These costs are related to the personal time required.

Interdisciplinary teaching materials recommend to devote about 10% of the working time to personal necessary time. The experience of labor rationing in health care shows that the coefficient of working time for main and auxiliary activities for most positions of medical personnel (except for auxiliary medical and diagnostic services) is 0.923, that is, out of 6.5 hour working day, about 30 minutes are allocated to other types of work. : (6.5 - 0.5) / 6.5 = 0.923.

For further calculations, you can take a coefficient of 0.9.

Calculation example.

The calculated norms of the load of a nurse for the organization of individual care for seriously ill patients with the cost of working time per hospitalized person is 8.4 minutes; The load (service) rates, calculated according to formula 3, are 42 hospitalized:

(6.5 × 60 × 0.9) / 8.4 ≈ 42.

Calculation example.

The calculated load norms for a nurse with a working time per patient per day equal to 47.5 minutes, determined by formula 3, are 27 hospitalized: (24 × 60 × 0.9) / 47.5 ≈ 27,

and at a cost equal to 61.8 minutes - 21 patients: (24 × 60 × 0.9) / 61.8 ≈ 21.

Stage III. The standard for the position of medical personnel of a hospital institution, expressed in the number of beds per position, is calculated by the formula:

Nk = (Nb x 365) / R, (4)

where Nk is the number of beds per position;

Nb - load in the number of patients per day (from formula 3);

R is the planned number of days the bed will work in a year.

The value of the indicator R in formula 4 is:

· For city, regional hospitals - 330–340 days;

· For hospitals located in rural areas - 320 days;

· For infectious diseases hospitals - 310 days;

· For maternity hospitals - 300 days.

Calculation example.

The norm for the position of a nurse for the organization of individual care for critically ill patients of a department of a city hospital, calculated according to formula 4, with a time expenditure per patient per day equal to 8.4 minutes and the number of patients served equal to 42, is 45 beds ((42 x 365 ) / 340) for one position.

Calculation example.

To ensure the activities of the ward nurse of the department in the conditions of a city hospital with a working time per patient per day equal to 47.5 minutes, and an estimated load of 27 patients, a 24-hour post with 29 beds is required ((27 x 365) / 340), and at a cost equal to 61.8 minutes and a load rate of 21 patients, there is a 24-hour post for 23 beds ((21 x 365) / 340).

The calculation of the number of posts to ensure the work of a round-the-clock post is carried out according to the formula:

Dpost = (24 × 60 × 365) / B, (5)

where Dpost is the number of posts to ensure the work of a round-the-clock post;

B - the annual budget of the working time of the position.

The annual budget of working time (B in formula 5) is calculated according to the formula presented in the Methodological Recommendations "Development of technology for the regulation of labor in health care":

B = m × d - n - z,

where B is the annual budget of working time;

m is the number of hours of work per day for a five-day working week;

d is the number of working days in a year for a five-day working week;

n is the number of hours of shortening the working day or shift on pre-holiday days (throughout the year);

z is the number of working hours per vacation period, which is determined by multiplying the weekly working hours by the number of vacation weeks.

In accordance with Art. 350 of the Labor Code of the Russian Federation for medical workers, a reduced working week is established - no more than 39 hours. By Decree of the Government of the Russian Federation of February 14, 2003 No. 101, in connection with the special working conditions for a number of categories of medical personnel, a shortened working week was established, amounting to 24, 30, 33 and 36 hours.

In accordance with the clarification of the Ministry of Labor of Russia dated December 29, 1992 No. 5, approved by Resolution No. 65 of December 29, 1992, the daily working time is calculated according to the estimated schedule of a five-day working week with two days off on Saturday and Sunday. The length of the working day is determined by dividing the weekly working hours by 5 days.

In accordance with Art. 95 of the Labor Code of the Russian Federation, the duration of a working day or shift immediately preceding a non-working holiday is reduced by 1 hour.

If a day off and a non-working holiday coincide, the day off is transferred to the next working day after the holiday. For the purpose of rational use of weekends and non-working days by employees, the Government of the Russian Federation has the right to postpone weekends to other days. As a rule, as a result of such transfers during the year there are 7 or 8 pre-holiday days. Currently, the number of non-working holidays in the Russian Federation is determined by the Law of the Russian Federation of December 29, 2004 No. 201 "On Amendments to Article 112 of the Labor Code of the Russian Federation":

When calculating the number of working days, holidays, non-working days and pre-holidays in a year, it is advisable to use the Production calendar.

In 2009 - 250 working days in a five-day working week, 7 pre-holiday days.

In connection with the adoption of the Labor Code of the Russian Federation, a transition was made to the calculation of labor leave in calendar days (Article 115 of the Labor Code of the Russian Federation), but the duration of the vacation remained the same. In calculating the annual budget, it is advisable to determine the vacation time as the product of the weekly working time by the number of weeks.

Calculation example.

The annual budget of the working time of the position of a nurse in a city hospital with a 39-hour working week, 28-day leave (in the number of calendar days), calculated for 2009, is 1787 hours: (39/5) × 250 - 7 - 4 × 39 = 1787 h, or 107 220 min (60.0 × 1787).

Calculation example.

The number of positions of nurses to support the work of a 24-hour post with an annual budget of working hours equal to 1787 hours, calculated according to formula 5, is 4,916 positions ((24 x 366) / 1787)

The calculation of the number of posts in a particular department is carried out according to the formula:

Dotd = (Dp × K) / P, (6)

where Dotd is the number of posts in the department;

Дп - the number of posts per 1 post;

K is the number of beds in the department;

P is the number of beds per 1 post (according to the standard).

Calculation example.

In a department with 30 beds, with a standard indicator of 20 beds per 1 post, and the number of positions of a nurse (ward) to ensure the operation of one round-the-clock post, equal to 4.916 positions (with a 39-hour working week and 28-day leave), 7.374 ward nurse positions: (4.916 × 30) / 20 = 7.374.

The calculation was carried out according to formula 6.

Features of the regulation of work of middle and junior medical personnel in day hospitals

In recent years, hospital-substituting types of care have been significantly developed. The staffing standards of the medical personnel of day hospitals establish the position of a senior nurse (regardless of the total number of beds). The positions of nurses are introduced at the rate of 1 position for 15 beds, the positions of ward nurses or junior nurses for patient care are established in accordance with the positions of nurses (order of the Ministry of Health of Russia dated 09.12.1999 No. 438).

The volume of work of middle and junior medical personnel is associated with the need to organize care and fulfill medical appointments during the daytime, and in different institutions, the hours of the day hospital are determined depending on the specific local conditions and range from 5 to 9 hours daily. In some cases, two-shift work of the day hospital is practiced. When calculating, it is necessary to take into account the number of days of work of the day hospital in a year: on a five-day or six-day working week, without days off and holidays, etc.

The calculation of the number of nursing and junior medical personnel in day hospitals can be performed based on the data of photo-timing observations. However, given the laboriousness of photo-timing observations to determine the norms of time in health care institutions, it can be recommended to use the existing normative base for labor for these groups of personnel in hospital institutions, but taking into account the working hours of the day hospital.

The planning of the number of ward nurses, junior nurses for patient care, ward nurses, ward cleaners of hospital institutions is carried out by establishing round-the-clock posts for a certain number of beds. When organizing the work of this personnel, the load (service) rates in the daytime, as a rule, increase, at night - they decrease. For example, when planning one post for 20 beds in the daytime, you can set the load to 15 beds, and at night - 40-50 beds.

However, the differences in the composition of patients in the day hospital as compared to the conventional hospital department, the mobility of patients and the ability to self-service make it possible to take the total value of the indicator of the number of beds per post as the basis for planning the number of nursing and junior medical personnel in the day hospital.

The calculation of the number of positions of ward nurses, ward nurses in the day hospital is carried out according to the formula:

Ddays = Dpost x (T / W) x (K / N), (7)

where Ddnevn is the number of positions of ward nurses and nurses in the day hospital;

Dpost - the number of positions of nurses or nurses to ensure the work of a round-the-clock post;

T is the number of hours of work of the day hospital during the year;

W is the number of hours of operation of the round-the-clock post per year;

K is the number of beds in the day hospital;

N is the standard number of hospital beds with round-the-clock stay for 1 post.

Calculation example.

The day hospital of a therapeutic profile with 25 beds is open from 10 am to 6 pm, that is, 8 hours daily for 303 days (in a six-day working week).

Therefore, T = 2424 h (8 × 303). A 24-hour post of a ward nurse in the therapeutic department of a city hospital is installed for 20 beds, cleaning attendants - for 30 beds (with a two-stage service system). To ensure the work of a 24-hour post, 4,916 positions are required (with a 39-hour work week and 28-day vacation). Calculations according to formula 7 show that in this day hospital in 2009, 1,696 positions of nurses and 1,131 positions of nurses are needed.

In accordance with the procedure for rounding off posts, 1.75 posts of a ward nurse and 1.25 posts of a ward nurse-cleaner can be introduced into the staffing table.

Conclusion

The formation of a socially oriented market economy and its development is impossible without developed labor relations. The material basis of any society is the labor activity of people. Labor is a condition of human existence, independent of any social forms, and constitutes his eternal natural necessity. All areas of work require regulation. In this regard, the regulation of labor in health care becomes even more urgent.

Currently, there is no unified labor regulation base for medical and prophylactic institutions, which affects the quality of medical services provided. All the developed materials in the field of labor regulation, which are used in the organization of labor in health care institutions, were either developed in the late 1980s, or were published several years ago without serious revision, taking into account the current situation in the modern health care system of the Russian Federation. The modern organization of labor rationing in health care requires improvement in terms of determining and using in further calculations the coefficients of using working time for main and other activities, as well as for operational and auxiliary time.

As can be seen from the work done, scientifically grounded labor standards, correctly reflecting specific conditions, ensure an increase in labor productivity. If labor standards are underestimated, they can generate pessimism, which negatively affects productivity results, if the standards are overestimated, they are impracticable. In both cases, the growth of labor productivity will be inhibited. Thus, all changes in the organization of labor and production, technology and work technology are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor at the enterprise. Labor rationing is the basis of labor planning.

In health care organizations, work on labor rationing should be carried out in a timely manner in order to further reduce the time spent on providing medical services to the population, taking into account the use of new labor methods, best practices, as well as the improvement of workplaces and equipment used. The result of using the proposed methodological recommendations will be the developed rational load norms for the medical personnel of medical and preventive institutions.

Bibliography

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7. Methodical recommendations "Development of technology for labor rationing in health care", approved by the Ministry of Health and Social Development of Russia on 20.12.2007 No. 250-PD / 704. The authors and developers are employees of the State Institution National Research Institute of Public Health of the Russian Academy of Medical Sciences: O.P. Shchepin, A. L. Lindenbraten, V.M. Shipova, V.V. Kovalev, N.K. Grishina, V.I. Filippova, S.M. Golovina, O. A. Kozachenko, N.B. Solovyov.

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9.Margulis A.L., Shilova V.M., Gavrilov V.A. - M .: Agar, 1997.

annotation scientific article on economics and business, the author of the scientific work - Kadyrov F.N.

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