Labor rationing in health care. The current state of labor rationing in health care. The relationship of labor rationing with the general standard of living

Service standards (provision of medical services) are established for the work of medical personnel - in units of time - the average time during which a medical worker must carry out his activities. - speed of work - the average number of actions completed over a certain period of time.

At present, the staffing standards for the main types of healthcare institutions have a 25-30 year limitation period of their approval and, therefore, they do not correspond to the changed structure and level of morbidity of the population, new technologies for diagnosis and treatment, new organizational forms of provision and mechanisms of payment for medical care.

In health care, the following normative indicators for labor are applied: Estimated time norms - the regulated duration of a unit of work by personnel or a group of personnel in standardized organizational and technical conditions. The time norms for outpatient doctors are expressed in the number of minutes per visit. Load (service) rates - a set amount of work performed per unit of time by personnel or a group of personnel in certain organizational and technical conditions of activity. The load (service) rates are expressed for outpatient doctors in the number of visits per hour, year. Staffing standards - the required number of personnel to perform all the functions assigned to a particular institution (department) and a specific amount of work, determined by standard indicators and their combinations, calculated values.

Methods of rationing The analytical, or element-by-element, method is based on the differentiation of the labor process into separate components, the determination of the normative time spent on them and the formation of labor standards, taking into account the rational organization of the labor process as a whole, the volume and quality of work performed. The total method does not provide for a change in labor costs for individual components of the labor process, while this method determines the labor costs for actually performed work according to the technology used in the institution. Comparative rationing is applied if the technology for carrying out a specific work is similar to that for which there are already labor standards. With the expert (experimental) method of labor rationing, the indicators are established on the basis of the past experience of the standard developer. The statistical method is used when there is statistical data on the amount of work, for example, the number of visits or certain procedures, research and the number of people actually doing the work.

The classification of labor costs of medical personnel includes 7 types of activities: the main auxiliary other activities; work with documentation; office calls; personal time required; unloaded time;

In health care, two types of timing are used: timing measurements timing observations To determine the time spent on a specific type of activity, timing measurements are used; to study, along with the time spent on the structure of the working day, possible non-productive costs, timing observations are used.

A health care institution, using a scientifically grounded organization of labor, manages to increase the effectiveness of all its activities, increase the productivity of its employees, and achieve an increase in the effectiveness of medical personnel performing their duties. In turn, this leads to an increase in the remuneration for the work done in the form of wages and thus to an increase in purchasing power.

Labor rationing must be applied in determining and planning the number of medical personnel. It has a direct impact on the remuneration of the main and auxiliary medical personnel of health care institutions.

This direction now plays a key role in the formation of the strategy for the development of health care institutions. The efficiency of the work of the entire healthcare institution as a whole depends on how optimally the composition of the medical personnel is formed.

In accordance with the job descriptions of the doctor of the admission department and the established practice of work in this state health institution, the doctor of the admission department performs the following work. Medical work: collecting anamnesis and complaints in the pathology of various organs and systems; visual examination in the pathology of various organs and systems; palpation in pathology of various organs and systems; percussion in the pathology of various organs and systems; auscultation for pathology of various organs and systems; anthropometric research; studies of the function of internal organs; the appointment of drug therapy for the pathology of various organs and systems; the appointment of dietary therapy for the pathology of various organs and systems; the appointment of a therapeutic and health-improving regimen for the pathology of various organs and systems.

Work on servicing patients by category (the number of patients is taken on average per day, calculated from the total weekly number): urgently arriving; released from among those delivered to the emergency department and from among those who independently sought medical help; provision of emergency consultations in hospital departments (5 people per day).

Current work on duty in the hospital: on duty days of the hospital (2 days a week), the work of doctors of the admission department per shift in the amount of 2 pcs. units ; on ordinary days, the work of doctors of the admission department per shift in the amount of 1 pc. units

Household and managerial work: organization and coordination of activities at the level of a healthcare institution (organization); organization and coordination of activities at the level of a subdivision of a healthcare institution (organization); organization and coordination of activities at the level of individual employees of a subdivision of a health care institution (organization); control of activities at the level of individual employees of the unit; interaction with patients and their relatives to resolve administrative issues; organization of activities in an emergency situation, in wartime conditions and mass influx of victims.

... 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.

Calculation example The time spent by a nurse for organizing 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). A coefficient of 0.825 has been introduced into the formula, showing a reduction in the number of days a nurse or a nurse worked 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: (36552 -12) / 365 ≈ 0.825.

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.

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 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 methods of labor rationing, methods for studying the costs of working time and approximate calculations of rationing the labor of middle and junior medical personnel.

The work uses various sources, publications, educational literature.

The work consists of several sections. The first section characterizes the concepts 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 for 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: the 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 work operation, it is used to calculate, determine the rates of production 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 calculation norm 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 people is determined by the service rate, and vice versa.

The enlarged and complex 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; with a piece-rate progressive system, it is the same within the limits of output, 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 the 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:

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

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

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;

establishment and implementation of labor standards;

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

The main tasks of labor rationing are to:

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

design rational working methods;

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

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

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.

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, it makes it possible to determine the direction of development processes, 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 1300 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 protection 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, the 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 Bashkortostan 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, ambulance 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

Introduction

The work uses various sources, publications, educational literature.

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

Functions, tasks, meaning and principles of labor rationing

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 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 regulations (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 used, devices, raw materials, materials, equipment operation modes, the content of technological and labor processes; 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 attestation 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 standards 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 regulatory 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 for by the norms, do not correspond to the achieved level of organization of production and labor, best practices.

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 simplicity of observation and processing of the results obtained, the efficiency of the study, wide coverage of various objects by observation, as well as the involvement of personnel in the research with the simultaneous performance of their main work, etc. The disadvantages of the method include: obtaining only average values of labor 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 records 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 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 (to calculate the number of nurses in a procedural, vaccination room, 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 polyclinics located in cities with a population of over 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 doctor's prescriptions for providing 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 posts of nursing staff in these specialties, corresponding to the medical one. By order of the Ministry of Healthcare and Social Development of Russia dated April 14, 2006 No. 289, this provision for a children's dental clinic was 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. Such a 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 standards 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 within 10 minutes for the nurse to complete this labor operation.

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 integrated 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 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, i.e., 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 ((27 x 365) / 340) is required, 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.

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

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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2. F.N. Kadyrov Incentive pay systems in health care. M .: Grant, 2000.

3. Organization and regulation of labor / Ed. V.V. Adamchuk. - M .: ZAO Finstatinform, 1999.

4 . V.M. Shipova Organization of labor rationing in health care / Ed. acad. RAMS O.P. Shchepina. M .: Grant, 2002.

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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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Magazine "Chief Nurse"

Topic: General issues of personnel work, Remuneration of medical workers and motivation, Labor protection, social protection, pension provision
Source: Chief Nurse # 8-2008

The main tasks of labor rationing in health care are to determine labor costs, workload and the number of personnel, to find optimal proportions for its various groups when performing a particular work, planning certain areas of health care development.

The current state of labor rationing in health care is determined by the following trends:
decentralization of labor rationing management;
lack of timely revision of existing labor standards and new regulatory documents;
expanding the scope of use of labor standards, for example, their application in pricing practice, as well as in the economic justification of territorial programs of state guarantees for the provision of free medical care to Russian citizens, the preparation of municipal orders, etc.

These positions dictate the need to determine the technology of labor rationing in health care, a methodological apparatus for the design of labor standards used at the municipal, regional and federal levels of government (appendix).

General methodological issues of labor rationing *

In health care, as in other sectors of the economy, they use well-known methods of labor rationing, which are widely presented in the special literature. These methods are divided into two groups: analytical and summary (Fig. 1).

The analytical, or element-by-element, method provides for the differentiation of the labor process into separate components, the establishment of standard labor costs for each element and the design of labor standards, taking into account the rational organization of the labor process as a whole, the quality of the work performed.

Depending on the methods of developing labor standards, the analytical method is divided into analytical-research and analytical-calculation.

The analytical research method consists in measuring the time spent on all components of the labor process in optimal organizational and technical conditions, corresponding to the modern technology of the treatment and diagnostic process. The method is associated with timing and is used due to its significant labor intensity, duration, the need for special training for its implementation, as a rule, in scientific organizations when developing industry standards for labor.

Depending on the objectives of the study, either timing measurements are used to establish the duration of individual repetitive labor operations, or a photograph of working time in order to clarify and eliminate the irrational use of working time, redistribution of functional responsibilities, etc.

The method of photo-timing observations includes a combination of timing measurements with photographs of working hours.

The timing methodology provides for the observance of the rules for its conduct, the main of which are listed below.

1. It is necessary to observe the technology of the treatment and diagnostic process: the organizational forms of work must correspond to the current state of health care, and the specialist whose activities are being monitored must have sufficient work experience and high qualifications.

2. A highly qualified specialist who is well aware of the technology of the treatment and diagnostic process and is able to conduct an examination of the volume and quality of the assistance provided is involved in timing.

3. Before timing, it is advisable to compile a list (dictionary) of individual labor operations and types of work included in the functional duties of the observed, which makes it possible, during statistical processing of materials, to identify the performance of work that is not characteristic of a particular group of personnel.

The classification of labor costs of medical personnel includes

7 types of activities: main, auxiliary, other activities, work with documentation, official conversations, personal necessary and unloaded time.

4. Timing should be sufficient to obtain representative data on labor costs for all labor operations.

The required number of time measurements is determined by the formula recommended by the Research Institute of Labor:

N = 2500 x ((K² x (Ku - 1) ²) / (C² x (Ku + 1) ²)) (1)

Where n is the number of time measurements;

K is the coefficient corresponding to a given confidence level (with a probability of 0.95 K = 2);

Ku - standard coefficient of chronosequence stability;

С - required observation accuracy (%).

In a number of cases, for example, to take into account the amount of remuneration of personnel when calculating cost indicators, 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 as a whole. This situation is typical for the blood service, when carrying out a set of works for the issuance of one or another conclusion by the institutions of the State Sanitary and Epidemiological Supervision, etc. In this case, along with determining the time spent on individual labor operations, they fill in the flow chart.

When carrying out normative research work, the choice of a normative indicator for labor is extremely important.

The main requirements for the normative indicator for labor are as follows:
taking into account the modern level of technology of the treatment and diagnostic process, the form of organization of medical care, methods of work;
correspondence in terms of the degree of consolidation to the conditions and nature of the activity inherent in a particular type of institution;
coverage of the most common options for performing work;
convenience for calculating headcount standards, compliance of the indicator with the accounting and reporting documentation kept in the institution;
ensuring the required accuracy when calculating the number of personnel.

The following indicators correspond to the specified requirements:
visit, case of outpatient services (SPO) in outpatient clinics;
bed-day, hospitalization, bed in hospital facilities, patient-day in day hospitals;
specific types of research, procedures, manipulations carried out by the medical personnel of the auxiliary medical and diagnostic service.

Determining the time spent on a more differentiated indicator for labor rationing, for example, for individual labor operations in dentistry, simple and complex medical services, can be considered only as an intermediate stage for the formation of standard costs for the indicated aggregated indicators recorded in the accounting and reporting documentation of the healthcare facility.

When designing time norms, the following mathematical and statistical methods are used: calculation of average values; graphic-analytical processing of initial data, calculation of normative regression equations (formulas) by the method of multiple correlation; calculation of normative regression equations (formulas) taking into account the influence of qualitative factors by the method of multiple correlation using the theory of pattern recognition, etc.

When designing labor standards, one should take into account the so-called norm-forming factors, the degree of influence of which makes it possible to carry out organizational, technical, psychophysiological and economic substantiation of normative indicators.

The presence or absence of a connection between the studied factors and their values is established by conducting a correlation analysis, with the help of which it is possible to determine to what extent this value depends on changes in other factors.

The method of correlation analysis in the selection of factors provides for the calculation of the coefficients of pair correlation, mutual (partial) correlation, multiple correlation, described in detail in the special literature on mathematical statistics.

When statistically processing timekeeping materials, the costs of a particular type of work are calculated by the formula:

Pt = Σti × ki, (2)

Where Tch is the time spent on a certain type of work;

Ti is the time spent on individual labor operations;

Ki is the frequency of repetition of individual labor operations.

The frequency of repetition of individual labor operations is established according to actual data with a possible correction of this indicator by expert means.

In health care institutions, and in some cases - in the design of labor standards at the federal level, the analytical and computational method is used. With this method, the calculation of the number of personnel is carried out on the basis of sectoral indicators of labor costs for a particular type of work and the actual volume of activity.

The total method of labor rationing does not imply the division of the labor process into components; it can be used due to its simplicity and availability for the prompt determination of labor costs, as well as for rarely performed work. The total method is subdivided into statistical, experimental, comparative (interpolation and extrapolation). The main disadvantage of the summary method is the lack of analysis of the internal content of the labor process on the basis of its separate organization.

The development of labor standards must be carried out according to certain rules and stages of carrying out regulatory research work.

At the initial stage, on the basis of the available methodological and regulatory materials, special publications, a research methodology is developed. The main directions of work are determined based on the materials of a special study of the organizational forms of the work of the institution (unit), personnel, the need for one or another type of medical care, technologies of the medical and diagnostic process, etc.

The main stage of regulatory research is the measurement of the costs of working time and statistical processing of the collected materials, the preparation of a draft regulatory document.

The final stage is associated with the economic substantiation of the labor standard, discussion with specialists and its experimental verification.

When discussing and finally adopting the value of the normative indicator for labor, a number of factors are taken into account, and first of all, the technology of the treatment and diagnostic process and the prospects for its implementation in healthcare practice, the provision of modern equipment, the possibility of using recommendations for the management of patients set out in the standards (protocols) of treatment, and etc.

Of all the normative indicators for labor (time norms, load (service) norms, headcount norms), time norms are fundamental, the rest of the data are calculated.

The stages of calculations, the ratio of these indicators and the necessary data for their calculations are schematically shown in Fig. 2.

When forming the norms of time, approved in different years in a centralized manner, certain types of activity (main, auxiliary work, personal necessary time, etc.) were included in different proportions. Thus, the calculated norms of time for a visit included the main and auxiliary activities, and the norms of time for research carried out in the radioisotope diagnostics room included all types of activities, including personal required time. In this regard, the coefficient of the use of working time for the main activity of different positions takes on different values, presented in table 1.

Rice. 2. The stages and the necessary data for calculating the standard indicators for labor

Table 1

The ratio of using the working time of the position on the main activity
Job title
The value of the coefficient (in fractions of 1.0)

Outpatient doctor, hospital physician
0,923

Clinical laboratory diagnostics doctor
0,800

Laboratory assistant, paramedic laboratory assistant
0,750

Ultrasound diagnostics doctor, functional diagnostics doctor, endoscopist, nurses of the corresponding offices, physiotherapy instructor
0,850

Radiologist
0,900

Radiologist
1,000

Physician in physiotherapy exercises and sports medicine, instructor-methodologist
0,692

Massage nurse
0,770

Physiotherapy Nurse
1,124

The annual budget of the working time of the position is determined by the established legislation of the Russian Federation, as well as by the mode of work and rest. It is calculated by the formula:

B = m × d - n - z, (3)

Where B is the annual budget for working hours;

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

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

N - the number of hours of reducing the duration of 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.

Calculation example No. 1

The annual budget of the working time of a functional diagnostics doctor with a 39-hour working week, 28-day vacation (in the number of calendar days), calculated for 2007 according to formula 3, is 1780.2 hours (39/5 x 249 - 6 - 4 x 39) or 106,812 min (60.0 x 1780.2).

The presented general methodological approaches to labor rationing are used in all types of health care institutions. However, the organizational and technical conditions of their functioning determine the need to consider the specifics of labor rationing for the main types of institutions and groups of personnel.
Rationing of work of middle and junior medical personnel

RATING OF LABOR OF SECONDARY AND JUNIOR MEDICAL PERSONNEL

The need to allocate medical positions for outpatient admission is due to the fact that, depending on their number, according to staff standards, the number of positions 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 physician positions (to calculate the number of medical statisticians);
change in the work of a unit or institution (to calculate the number of nurses in a procedural, vaccination room, 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).

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 together with the doctor carry out outpatient reception of patients;
Along with outpatient appointments, together with a doctor, nurses of district general practitioners, pediatricians, and 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 posts of nursing staff in these specialties, corresponding to the medical one. By order of the Ministry of Healthcare and Social Development of Russia dated April 14, 2006 No. 289, this provision for a children's dental clinic was 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 treatment and diagnostic process in dentistry with the use of modern composite materials, “four-handed” work and the ethical and legal norms of 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 3.0 EVEN, i.e. 30 minutes, and 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 within 10 minutes for the nurse to complete this labor operation.

RATING OF LABOR OF SECONDARY AND JUNIOR MEDICAL PERSONNEL IN 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 to patients in the hospital;
the indicator that serves as the basis for calculating the number of posts is the number of beds;
setting norms of load (service) for the day of the patient's stay in the hospital or shift.

The rationing of the work of medical personnel in hospital institutions is carried out in stages according to the scheme shown in Fig. 2.

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

Tday = (tp + tl x 0.825 (m - 2) + tv) / (m x 0.825), (4)

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;

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

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

(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 No. 2

(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. At the same time, a 2 or 3-stage service system is introduced.

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 4, but without taking into account the coefficient 0.825:

Tsut = (tp + tl x (m - 2) + tv) / m, (5)

All designations correspond to formula 4, calculated not for a day, but for a day of the patient's stay in the hospital.

The weighted average cost of time 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 No. 3

The costs of a nurse's working time per patient per day by periods of hospital stay, admitted for emergency indications and in a planned manner, are shown in Fig. 3.

Calculations of the time spent on one patient per day, carried out according to formula 5, show that for those admitted in a planned manner, with an average duration 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.

Rice. 3. The cost of working hours of the ward nurse

Working hours for patients admitted on an emergency basis, with an average 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 percent emergency hospitalization is 47.5 minutes:

(107.4 × 10 + 40.8 × 90) / 100 ≈ 47.5.

The average time required for a 30% emergency hospitalization is 61.8 minutes:

(107.4 × 30 + 40.8 × 70) / 100 ≈ 61.8.

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, (6)

Where Nb - norms of the load on the hospital 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 5). 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.

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.

(6,5 - 0,5) / 6,5 = 0,923.

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

Calculation example No. 4

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 (example of calculation No. 2). The load (service) rates, calculated according to formula 6, are 42 hospitalized:

(6.5 × 60 × 0.9) / 8.4 ≈ 42.

Calculation example No. 5

The calculated load norms for a nurse with a working time per patient per day equal to 47.5 minutes (calculation example No. 3), determined by formula 6, 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, (7)

Where Nk is the number of beds per position;

Nb - load in the number of patients per day (from formula 6);

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

The value of the indicator R in formula 7 is:
for city and 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 No. 6

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 7, with the time spent per patient per day equal to 8.4 minutes (example No. 2) and the number of patients served equal to 42 (example of calculation No. 4), is 45 beds ((42 x 365) / 340) per position.

Calculation example No. 7

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 (example of calculation No. 3), and the calculated load norms of 27 patients (example of calculation No. 5), a 24-hour post is required for 29 beds ((27 x 365) / 340), and at a cost of 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, (8)

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 8) is calculated according to formula 3, presented in the Methodological Recommendations "Development of technology for labor rationing in health care."

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":
January 1, 2, 3, 4 and 5 - New Year's holidays;
January 7 - Nativity of Christ;
February 23 - Defender of the Fatherland Day;
March 8 - International Women's Day;
May 1 - Spring and Labor Day;
May 9 - Victory Day;
June 12 - Day of Russia;
November 4 - National Unity Day.

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 2008 - 250 working days in a five-day working week, 7 pre-holiday days.

Calculation example No. 8

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 2008 according to formula 3, is 1787 hours: (39/5) × 250 - 7 - 4 × 39 = 1787 h, or 107 220 min (60.0 × 1787).

Table 2 presents the final data for calculating the annual budget of the working time of the positions of medical personnel for different modes of work and rest.
table 2

The annual budget of the working time of medical personnel positions in 2008 for different modes of work and rest
Working week duration, h
Annual budget (h) for vacation duration (in calendar days)

28
35
42
49
56

24
1097
1073
1049
1025
1001

30
1373
1343
1313
1283
1253

33
1511
1478
1445
1412
1379

36
1649
1613
1577
1541
1505

39
1787
1748
1709
1670
1631

Calculation example No. 9

The number of nursing posts to ensure the work of a 24-hour post with an annual budget of working hours equal to 1787 hours (example calculation No. 8), calculated according to formula 8, is 4,916 posts ((24 x 366) / 1787)

Table 3 shows the final data for calculating the number of positions of medical personnel for different modes of work and rest to ensure the work of a round-the-clock post in 2008.

Table 3

The number of positions of medical personnel with different modes of work and rest to ensure the work of a round-the-clock post in 2008
Length of the working week (h)
The number of posts per post with the duration of the vacation (in calendar days)

28
35
42
49
56

24
8,007
8,186
8,374
8,570
8,775

30
6,398
6,541
6,690
6,847
7,010

33
5,813
5,943
6,079
6,221
6,370

36
5,327
5,446
5,570
5,700
5,837

39
4,916
5,025
5,140
5,260
5,386

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

Dotd = (Dp × K) / P, (9)

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 No. 10

(4.916 × 30) / 20 = 7.374.

The calculation was carried out according to formula 9.

SPECIFIC FEATURES OF LABOR RATING OF SECONDARY AND JUNIOR MEDICAL PERSONNEL IN DAY HOSPITALS

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), (10)

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 No. 11

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). According to table 3, 4,916 positions are required to ensure the work of a 24-hour post (with a 39-hour work week and 28-day leave). Calculations according to formula 10 show that in this day hospital in 2008, 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.

RATING OF LABOR OF THE MIDDLE AND JUNIOR MEDICAL PERSONNEL OF AUXILIARY THERAPEUTIC DIAGNOSTIC SERVICE

Labor rationing for middle and junior medical personnel of the auxiliary medical and diagnostic service is carried out mainly in the same stages as for other personnel, but it has certain features.

Stage I consists in determining the estimated time norms for individual studies, manipulations, and procedures.

The currently valid normative documents defining these indicators for labor, as a rule, were approved 15-20 years ago. A list of normative documents is given in the appendix to this publication. The development of a regulatory document before its approval takes about 3-5 years, therefore, the data presented in them correspond to the equipment used in health care institutions more than 20 years ago. At the same time, in a number of services there is a rather intensive replacement of equipment, especially in recent years in connection with the implementation of the national project "Health." changes in the labor costs of personnel for their implementation, and these changes can be in the direction of both increasing and decreasing the norms of time.All this determines the necessity and urgency of carrying out normative research work on the development of norms of time for diagnostic studies on modern equipment.

Unfortunately, such work at the federal level is currently not being carried out.

Stage II. The norms of workload (service) of the medical personnel of the auxiliary medical and diagnostic service are expressed in the number of examinations or in the time budget for which it is possible to carry out the normative number of examinations, procedures, manipulations per job change, month, quarter, year. Typically, an annual time frame is used.

The load (service) norms for nursing staff, for whom the time norms for individual studies, the procedures of the auxiliary medical and diagnostic service, are determined by the formula:

N load auxiliary = B × k, (11)

Where N load auxiliary is the load norm of the auxiliary medical and diagnostic service;

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

K is the coefficient of using the working time of the position.

These positions include laboratory assistant, laboratory assistant, massage nurse, physiotherapy nurse, functional research department nurse.

The annual budget (B in formula 11) can be expressed both in time units (min, h), and in conventional units.

The coefficient k in formula 11 has different values for each service and is directly dependent on the structure of the estimated time norms and the ratio of different components of this indicator. For example, only the main activity is included in the estimated norms of time for laboratory research, while 20% of the working time is allocated to the laboratory assistant for other types of work. The value of the coefficient k is presented in table 1.

Calculation example No. 12

The annual budget for the working time of the position of a massage nurse with a 39-hour working week and 28 calendar days of vacation is 107,220 minutes, or 10,722 conventional massage units (1 conventional massage unit = 10 minutes). The load (service) rate, calculated according to formula 11, is 8256 conv. units (10,722 x 0.77).

Stage III. The calculation of the number of posts by the volume of work is carried out according to the formula:

D = T / N load auxiliary, (12)

Where D is the number of posts;

T - the cost of working time for research, procedures for a certain period of time, as a rule, for a year;

N load auxiliary - calculated norms of load (service) from formula 11.

The expenditure of working time for a particular position of the support service for a particular period of time (T in formula 12) is determined by summing the products of the time spent on each study by the number of these studies, carried out, as a rule, during the year. The number of studies is established by copying the necessary information from the primary documentation or in the process of current accounting. Such a methodological technique is due to the fact that the reporting documentation contains a grouping of studies, procedures, manipulations, and standard indicators for labor are set for each specified unit.

Calculation example No. 13

The massage nurse performed 1000 procedures of segmental massage of the cervicothoracic spine, 500 - hand and forearm massage, 8000 - neck massage during the year. The time spent on the first of these types is 3.0 conventional massage units, for the second and third - 1.0 conventional massage units. The total cost is 11,500 conventional massage units (3.0 × 1000 + 1.0 × 500 + 1.0 × 8000). The calculation carried out according to formula 12 shows that in order to perform this volume of work, 1,393 positions of massage nurses (11,500: 8256) must be entered into the staffing table, rounded - 1.5 positions.

The indicators for planning the number of posts of nursing staff of the auxiliary treatment and diagnostic service in accordance with the staffing standards are:
the number of positions of outpatient doctors or the number of beds (for calculating the positions of laboratory assistants, paramedics, laboratory assistants, massage nurses, physical therapy instructors); the number of positions of doctors of the auxiliary service of the corresponding specialty (for calculating the positions of X-ray technicians, nurses of ultrasound diagnostics);
amount of work (for calculating the positions of massage nurses, physical therapy instructors);
population size (for calculating the positions of nurses in the functional diagnostics room during medical examination of the population);
the presence of an appropriate office (to establish the position of a nurse in a functional diagnostics office); institution (to establish the position of a laboratory assistant in the center of general medical (family) practice);
job change to calculate the positions of X-ray technicians.

The indicators for establishing the number of positions of junior medical personnel of the auxiliary medical and diagnostic service are:
the number of medical and (or) paramedical personnel of the relevant unit; for example, the position of a laboratory nurse is established at the rate of 1 position for 4 positions of doctors and laboratory assistants, a nurse of an X-ray room - according to the positions of radiologists; nurses of the physiotherapy department (office) - at the rate of 1 position for 2 positions of physiotherapy nurses (for most types of institutions);
number of beds; for example, the positions of the nurse of the X-ray room (department) of regional, regional hospitals are established at the rate of 1 position for 300 beds;
availability of a corresponding office; for example, the position of a nurse in a functional diagnostics room at a local hospital is established at the rate of 1 position for each office;
job change; for example, the position of a nurse in the X-ray room of a city polyclinic is assigned to the X-ray room on a shift.

Thus, the application of the outlined methodological approaches to the standardization of work of middle and junior medical personnel makes it possible to scientifically substantiate sectoral labor standards, to calculate the number of personnel in health care institutions in accordance with specific local conditions, forms and methods of organizing medical care for the population and will contribute to a rational arrangement and use of frames.