Over the past five years, against the backdrop of the myth of free and poor medical clinics, it began to be understood that the medical business (even paid services in a public hospital) is a profitable business, and the profitability of at least 14% turned out to be higher than in a neighboring supermarket. And for many entrepreneurs, the moment has come when medical clinics have become the object of investment analysis, studying all the features this business and first of all professional management. And here the opinions of investors, managers, experts were divided. Some of them believe that the laws of management are the same for enterprises in any industry (and it is difficult to argue with this, especially after F. Taylor in his report to the US Congress in 1912 as an example “ scientific management” brought a medical clinic), and it makes no sense to talk about any fundamental features in the management of a medical organization. Others believe, on the contrary, that health care is such a specific service sector that, along with traditional management, one must also know the healing itself and the health care system well. Not one other kind entrepreneurial activity does not weave so deeply into one inseparable tangle professional (i.e. medical), psychological, ethical principles and principles of management, giving rise to a new specific type of management, which was "christened" as "medical management". From the level of this management, which actually provides not only services, but also medical services, sometimes not only our health, but also life depends. So what is so special about running a healthcare facility? The doctor as the main employee of the enterprise. The task of management is to ensure the joint and effective work of doctors. What could be easier? This is where the test for the manager begins. The doctor, and Michel Foucault wrote about this in his work “The Birth of the Clinic”, is a representative of a free profession, which implies that he historically “worked” only for himself, helping the suffering. The psychology and self-identification of a doctor (and even a modern one) do not fit well into the status of a hired, forced laborer working for the owner. That is why even today in the labor market we see the behavior of doctors shocking traditional managers: constant migration in search of an ideal clinic, fear of doctors from academies and universities to switch to permanent job in a new, well-equipped private clinic, the desire of doctors behind the doors of the office to resolve issues of remuneration for their consultation directly with the patient, bypassing the cash desk or free examinations of their relatives using expensive equipment, "star" disease, the rejection of accepted traditional forms of contract, etc. In many In clinics, doctors openly talk about freeloaders - accounting, executive management, IT specialists - they sincerely do not understand where the money they earn goes and why they receive a salary of no more than 30% of the money received for a consultation. How, given these "innate traits" of the modern doctor, how to build a profitable medical business? Leaders - champions of strict discipline, surveillance and informing fail - doctors, having received knowledge, certificates and a patient database from them, flee to another institution, others come in their place for 2-4 months, etc. and so on in a circle. Others are already desperate to fight, and especially in dentistry, where there is a growing trend of renting out clinic space to medical staff. And only rare leaders try to build truly new generation clinics, where the quality of treatment meets the best international standards. It is no secret that in most organizations the spirit of competition between employees dominates, and the informal atmosphere encourages individualism. All this can move the development of an enterprise in another area, but it is detrimental to a medical organization, where the manager's task is to build a system of information exchange and cooperation. It is no coincidence that in the medical tradition there is such an institution as a consultation, which involves the discussion of a difficult situation by several doctors and the search for an optimal solution. Yes, and the patient has the right to demand it, which is enshrined in the Fundamentals of Legislation on the Protection of the Health of Citizens of the Russian Federation (Article 30.). With all the negative features of Dr. House, the hero of the American medical series of the same name, his indisputable advantage was that he was able to ensure the joint and effective work of the doctors of his diagnostic department, giving them the opportunity to realize their goals to the maximum extent possible. strengths and neutralize their shortcomings. The result is one of the best diagnostic departments in the US. Very often, as a management consultant for private clinics, I am asked what is the key to the commercial success of a medical enterprise. And I always illustrate my answer with an example from one clinic, where they fought for commercial secrets by creating a situation in which everything was called a secret, from equipment to the price list. Unfortunately, they did not understand that the biggest secret in healthcare lies in a different plane, in how a doctor can communicate with a patient and provide high-quality modern medical services. The key to the commercial success of the entire clinic lies in the doctor's office, in the “mystery” that takes place between the doctor and the patient, on which the entire medical business has been based since the time of King Hammurabi.

The fundamental role of the mission of the clinic in the medical business. Questions collide sharply and devilishly temptingly in a medical clinic financial profit and quality medical care. The information asymmetry in which the patient stays at the doctor's appointment makes him an easy prey for doctors who are not burdened by ethical and professional principles and who want to earn money. Who wants to become a victim of an ambulance doctor who takes him to the hospital that pays him for each “brought” or receive a prescription for an absolutely unnecessary medicine, but prescribed by a doctor sponsored by a pharmaceutical company? In the medical business, an enterprise becomes a hostage of a doctor, and sometimes the loss of trust in a doctor is a loss of trust in the entire, even ideal, clinic, in its reputation. And the medical business is, first of all, trust. Therefore, the role of management is so important, which is responsible not only to shareholders, but also to its patients, and which must create the main thing at the design stage of a new medical business - the ideology of the clinic and formulate a clear, understandable and capacious mission. For a store or a restaurant, the absence of a mission is bad, but the lack of a mission for a clinic is turning it into a gathering of part-time doctors who want to earn extra money on paid patients. And this is dangerous for our health. Many patients, having visited well-equipped, renovated, advertised clinics, have become convinced that there is no respect for the rights of patients, there are no quality medical services, there is no certainty that you will be assigned only the studies you need, and behind the beautiful walls lies the usual "scoop".

Special requirements for the head of the clinic. There are several leadership models that have developed in our practice. In the first, everything is in charge CEO, having no medical education and subordinate to him is the chief physician responsible for all medicine. In my opinion, this is not the most best situation, because the person responsible for the entire enterprise does not fully know all the specifics of the business he manages, which increases the risk of making wrong decisions, falling under the influence and dependence of his medical environment and the head doctor, who actually oversees the main activity and determines the range of services provided. Famous example, when the director's chair of the Mikhailovsky Theater was taken by one of the richest people in Russia - businessman Vladimir Kekhman, who had previously worked in the wholesale of fruit. He first of all entered the course of the Faculty of Theater Studies of the St. Petersburg Theater Academy with a degree in theater manager. It is unlikely that for such a busy person this is only an image step, but rather an understanding that there is an objective need for a classical and serious study of the theater business and an opportunity to better understand the theater and its artists. I don't know of examples when one of the heads of clinics went to get medical education, in many respects, probably, because they already have the feeling that they know everything. At the dawn of the emergence of private business, when there were only a few doctors who knew the basics of management, this option of appointing a “non-medical” manager as the head was the most common. But now the situation is changing. More and more doctors are purchasing additional professional education in management, receive an MBA degree. A manager with two degrees sees his company more systematically, and there are positive examples in the city of how the acquisition of management knowledge by the chief physician made it possible to qualitatively change the clinic. But objectively evaluating the labor market, we can say with regret that there are only a few managers who can successfully manage a clinic in the 21st century and understand the peculiarities of management in healthcare. We do not have a serious and professional school specializing in this area, and short-term courses in medical management can only indicate directions for independent and in-depth study of the subject. The head of the clinic has another difficult task - interaction with shareholders - investors who have invested money to make a profit, and sometimes they are not interested in how it turns out. And here it is very easy to cross the line when, in order to maximize profits, the quality of medical services will decrease, equipment will not be updated and properly maintained, reusable instruments will be used, technological cycles will be disrupted, and treatment regimens will be simplified. In countries where there is transparency and strict control, including from the side of the medical community united in the Association, such behavior of the clinic will quickly lead to its closure. And in our country, we should rely more on the decency of clinic managers and the reputation of the clinic than on regulatory authorities and Roszdravnadzor. Innovation management- the basis for the development of the clinic. Management in the clinic should enable growth and development of both the enterprise itself and its doctors and nurses. In medicine, where scientific and technological progress is being introduced into practice faster than anywhere else, and is changing the technologies for diagnosis, treatment, rehabilitation, it is important to be aware of everything and quickly put into practice the most modern and perfect. The robot surgeon Da Vinci (http://www.davincirobot.ru) has already become a reality, working in private clinics in London and operating on the prostate gland, heart defects, performing gynecological operations, isolating tumors with amazing accuracy, providing low trauma. In the medical business, following advanced technologies is one of the most important factors of competitive advantage, because the patient is looking for and choosing the best that is in the field of diagnostics and treatment. Lifelong learning doctors are required to create a self-learning organization in the clinic, while this is not strategic objective manager (as in enterprises of another sphere), this is the task today. Legal aspect in the management of the clinic. Medical activity is a licensed type of activity and one of the most “regulated” types of business, where there are strict requirements for fire regulations, sanitary and epidemiological regime, storage of medicines, certification of personnel, equipment and technologies. It is no coincidence that a number of multidisciplinary clinics single out specialists who deal only with these issues due to their great importance and “bureaucratization”. Medical activity is also a colossal responsibility to patients. In accordance with our law, the responsibility for the provision of medical services lies with entity, which means that the clinic is financially responsible for all the “sins” of its doctors, which, moreover, can be deprived of a license to engage in medical activities. Patients now know their rights and insist on their observance, which requires every doctor, and not just the leader, to know and comply with all legal norms in the provision of medical services.

The difficulty of assessing the quality of work. Clinical performance is difficult to measure. And the peculiarity of medical enterprises is that it is extremely important to choose the right criteria for them. effective work and assessment of the quality of medical care provided. It is difficult to create a system of quality control and personnel motivation in the clinic, not only because organizational issues, how much due to the specifics of medical activity. The introduction of the principles of evidence-based medicine and standards throughout the world makes it possible to more objectively evaluate the work of doctors in terms of providing medical services. Existing standards diagnosis and treatment allow you to choose the best method in terms of result and financial costs. In addition, the quality of medical services is closely related to the quality of management, so it is no coincidence that 2 dental clinics in the city have already received ISO 9001 certification of their management. short review features of management in medical clinics, I would like to emphasize once again that many investors are beginning to understand that building and equipping a clinic is the easiest thing, but to make sure that the clinic provides medical services that meet the highest standards, successfully uses the most modern technologies for diagnosing treatment, rehabilitation and doctors worked in it as one team - a difficult task.

Management is an activity aimed at improving the forms of management, increasing the efficiency of production using a set of principles, methods and means that activate labor activity, intelligence and motives of behavior, both individual employees and the entire team.

Management occurs when people come together to perform some activity together. The managing party (the subject of management), the managed - the objects of management (collectives, individual workers). The basis of managerial activity is the ways in which managers influence objects of management. Management analysis is determined by the principles, methods, functions and goals of management.

There are the following management principles:

Organizational, coordinating and operational, which are aimed at activating and strengthening the motivation of each employee and the entire team. Among them: power and responsibility; unity of command; unity of leadership; centralization; linear control; order; stability; initiative.

Development principles aimed at optimizing relationships and increasing the efficiency of collective activities. These are discipline, justice, subordination of individual interests to common ones, cooperative spirit, staff constancy, rewards, etc.

Management methods are organizational and administrative, economic and economic, legal and socio-psychological.

Management methods include:

methods of reinforcement and stimulation;

behavior regulation methods;

methods for optimizing the labor process and increasing the responsibility of employees;

development of employees' initiative and improvement of individual skills.

Control functions are determined by the level of the control system. The control system of any object has 3 levels - strategic, tactical and operational. At the strategic level, goals and possible outcomes are defined in the future. The tactical level allows you to optimally define specific tasks, organization, phased implementation and control of results. Operational level ensures efficient execution production processes with optimal use of available resources. This level includes accounting, control and analysis of the activities of already functioning structures.

The main management functions are as follows:

Technical operations - production. For medical institutions to production functions include diagnostics, examination, rehabilitation, preventive measures, etc.

Commercial - purchase, sale, exchange; for medical institutions - this is a sale certain types medical services.

Financial transactions - raising funds and disposing of them for the implementation of activities.

Insurance - insurance and protection of property and persons.

Accounting - accounting, accounting, statistics, etc.

Administrative - long-term program-target planning, organization, coordination, administrative functions and control.

Management goals can be: innovative, problem solving, implementation of specific responsibilities, self-improvement.

The goals and functions of management correspond to a certain installation (technical, commercial, administrative, financial, accounting, insurance). Each installation focuses on a group of qualities and knowledge, determined by such parameters as physical health, mental abilities (prudence, flexibility of mind, level of outlook), moral qualities (energy, consciousness of responsibility, sense of duty, sense of dignity, kindness, tact, honesty), special (professional) knowledge and work experience.

The management process includes: planning, organization, command, coordination, control, analysis, performance evaluation, decision making, recruitment, motivation and optimization individual activities, representation and negotiation and transactions.

Algorithm (sequence management decisions:

Setting goals and objectives (program-targeted planning).

Gathering the necessary information.

Modeling and preliminary examination of possible solutions;

Making a management decision;

Organization of execution;

Execution control;

Evaluation of effectiveness and adjustment of results;

The effectiveness of managerial decisions is influenced by a number of factors, including competence, information support, balanced decision, timeliness of the act of management.

Management is seen as an optimization technological solutions and psychological attitudes.

Motivation (motivated activity and commitment of the staff), a combination of production, physiological and psychological guidelines are important for effective management. Among the qualitative methods of influencing the team in management, an important role is played by the leadership style (a set of management methods and management psychology).

Successful leader leadership is possible when using various styles guides.

Federal Agency for Education State educational institution of higher professional

Education St. Petersburg State Polytechnic University

Faculty of Humanities

Sociology and Law

Course work by discipline

"Management in social sphere»

Topic: "Peculiarities of management in healthcare"

Completed by: student of group Z 5121/20

Fedorova M.A. Checked:

senior lecturer E.I. Budarina

St. Petersburg 2012

INTRODUCTION 3

. Management functions 4

. Management in modern healthcare. 7

. Management in health care on the example of medical clinics. 17

. budget institutions. 24

. Find differences 25

. What type of institution to choose? 28

. About control 30

CONCLUSION 32

References 35

INTRODUCTION

AT modern society successful development of any sphere human activity unthinkable without effective management. Management in health care is an activity aimed at increasing efficiency with the help of a set of principles, methods and means that activate labor activity, intelligence and behavioral motives, both for individual medical workers and for the entire team.

Health care in the system of socio-economic relations occupies a special position in terms of importance and complexity, which is due to the objectively existing features of the main object of medical activity - a person. Among these features, the main one is the uncertainty that permeates all medical activities: the uncertainty of the dynamics of human health, the uncertainty of the result of medical intervention.

The problem of quality is of paramount importance in healthcare medical care, which is difficult to overestimate, since it is associated with health, and sometimes with human life. The problem of quality can be solved only if the management of the medical care system is optimized at all levels. In addressing these issues, priority is given to the managerial staff of health care institutions. The development and improvement of management, its adaptation to a specific situation is one of the main levers for improving the performance of medical institutions.

Management risks are its natural internal state. The problem is to learn them, develop ways to overcome and adapt to the area where the manager works.

1. Management functions

Each person performs at least one of the management functions. Depending on how many functions a person performs, he occupies a higher level of the leadership ladder:

1. Technical operations - directly production. For a medical institution - diagnostics, treatment, prevention, examination, patient care, etc.
2. commercial function: purchase, sale, exchange.

1. Gathering the necessary information.
2. Organization of execution;
3. Execution control;

• inability to influence people;
• inability to control oneself;
• snatching;
• lack of a sense of duty;
• optional;
• disorganization;
• dishonesty;

In the system of practical health care, the democratic style is most often used. The process of managing any institution takes place in a certain political, social, economic environment, and changes in these conditions entail changes in the management style.

2. Management in modern healthcare

Management is an activity aimed at improving the forms of management, increasing production efficiency with the help of a set of principles, methods and means that activate labor activity, intelligence and behavioral motives, both for individual employees and for the entire team.

Management occurs when people come together to perform some activity together. The managing party (the subject of management), managed - the objects of management (teams, individual workers). The basis of managerial activity is the ways in which managers influence objects of management. Management analysis is determined by the principles, methods, functions and goals of management.

There are the following management principles:

1. Organizational, coordinating and operational, which are aimed at activating and strengthening the motivation of each employee and the entire team. Among them: power and responsibility; unity of command; unity of leadership; centralization; linear control; order; stability; initiative.
2. Development principles aimed at optimizing relationships and increasing the efficiency of collective activities. These are discipline, justice, subordination of individual interests to common ones, cooperative spirit, staff constancy, rewards, etc.
3. Principles of increasing the image, authority, representation of the institution.

Management methods are organizational and administrative, economic and economic, legal and socio-psychological.

Management methods include:

• methods of reinforcement and stimulation;
• behavior regulation methods;
• methods for optimizing the labor process and increasing the responsibility of employees;
• development of employees' initiative and improvement of individual skills.

Control functions are determined by the level of the control system. The control system of any object has 3 levels - strategic, tactical and operational. At the strategic level, goals and possible outcomes are defined in the future. The tactical level allows you to optimally define specific tasks, organization, phased implementation and control of results. The operational level ensures the efficient execution of production processes with the optimal use of available resources. This level includes accounting, control and analysis of the activities of already functioning structures.

The main management functions are as follows:

1. Technical operations - production. For medical institutions, production functions include diagnostics, examination, rehabilitation, preventive measures, etc.
2. Commercial - purchase, sale, exchange; for medical institutions - this is the sale of certain types of medical services.
3. Financial transactions - raising funds and disposing of them for the implementation of activities.
4. Insurance - insurance and protection of property and persons.
5. Accounting - accounting, accounting, statistics, etc.
6. Administrative - long-term program-target planning, organization, coordination, administrative functions and control.

Management goals can be: innovative, problem solving, implementation of specific responsibilities, self-improvement.

The goals and functions of management correspond to a certain installation (technical, commercial, administrative, financial, accounting, insurance). Each installation focuses on a group of qualities and knowledge, determined by such parameters as physical health, mental abilities (prudence, flexibility of mind, level of outlook), moral qualities (energy, consciousness of responsibility, sense of duty, sense of dignity, kindness, tact, honesty), special (professional) knowledge and work experience.

The management process includes: planning, organization, command, coordination, control, analysis, performance evaluation, decision making, recruitment, motivation and optimization of individual activities, representation and negotiation and transactions.

Algorithm (sequence of management decisions:

1. Setting goals and objectives (program-targeted planning).
2. Gathering the necessary information.
3. Modeling and preliminary examination of possible solutions;
4. Making a management decision;
5. Organization of execution;
6. Execution control;
7. Evaluation of effectiveness and adjustment of results;

The effectiveness of managerial decisions is influenced by a number of factors, including competence, information support, balanced decision, timeliness of the act of management.

Management is considered in the form of optimization of technological solutions and psychological attitudes.

Among the factors hindering the development of individual qualities in specialists - managers, we can distinguish:

• lack of personal value orientations;
• lack of personal interest;
• inadequate professional qualification;
• inability to influence people;
• inability to improve oneself;
• inability to control oneself;
• snatching;
• lack of a sense of duty;
• optional;
• disorganization;
• dishonesty;
• inability to subordinate personal interests to the tasks and attitudes of group, collective, etc.

Motivation (motivated activity and commitment of the staff), a combination of production, physiological and psychological guidelines are important for effective management. Among the qualitative methods of influencing the team in management, an important role is played by the leadership style (a set of management methods and management psychology). There are 6 main leadership styles:

1. The leadership style, when the leader is guided by the principle "do as I say", keeps employees under control and encouragement, punishment, initiative are used as a driving force.
2. The leader-organizer is a strict but fair leader. Gives subordinates clear instructions, influences persuasion, tells everyone his assessment of his qualities and achievements.
3. Personal style, when the leader follows the motto "first of all people, and business - then." Trusts people, appreciates good relations in the team. As an incentive, it provides employees with additional benefits, a sense of comfort, security, peace of mind.
4. Democratic style when the leader adheres to the principle of "one person - one vote". Such a leader encourages employees to actively participate in decision-making, everyone is personally controlled and encourages active action.
5. The desire to set the pace of work. The self-motivated leader takes on many tasks, works hard, expecting others to follow suit, and empowers many to plan and work on their own.
6. Mentoring style, when the leader is guided by the principle "you can do it." This type of leader helps the members of the "team" and encourages them to perform better, giving them the opportunity for personal development.

Successful leader leadership is possible by using a variety of leadership styles.

Problems of intellectual and personnel management health care

Any social system in its natural development at a certain time reaches such a highest level at which existing forms and methods of managing such a system exhaust adequate resources of intellectual and human resources.

There comes a time that requires the search for new forms and methods of management. And not within the framework of a quantitative change in these forms and methods of management - their intensive development, but in the form of a qualitative transformation as an intellectual component of the decision-making function as well as the very forms, techniques and methods of management.

In the last decade, all over the world and in Russia in particular, interest in the problems of organization and management in healthcare has noticeably increased. One of the reasons for such attention of researchers and practitioners in the field of public health is the natural integration processes taking place in healthcare systems, a certain consolidation of structures that, to one degree or another, ensure the preservation and improvement of public health: hospitals, clinics, insurance and pharmaceutical companies, government bodies, social protection institutions, etc. The noted processes are typical both at the level of national health care systems and in the international sphere.

In the context of the priority of the economic components of the development of states, the unique nature of health care, as part of the social structure of society, is also manifested in the fact that institutions and subjects of the health care system, being the largest employers, ensure the economic stability of the population, and, as medical structures, carry no less important the share of responsibility for labor productivity, the health of the nation, the defense capability of the state.

Modern systems health care, functioning and developing in the conditions of a liberal structure of society, in the conditions of the existence of civilized markets and specific marketing relations, inevitably feel the influence of the processes that characterize such relations. At the same time, this process of mutual influence is certainly two-way: healthcare systems around the world are increasingly affected by market fluctuations and the integration of marketing and political structures.

Today, no country in the world, including Russia, can manage the healthcare system without taking into account the impact that the organization and activities of this system of government can have on both domestic and world markets, both domestic and international. world health status.

The road to improving the efficiency of healthcare as a system goes first of all through improving the quality of management. Of course, the reforms of any country depend on the history of this country, on economic and social infrastructures, but even the initial reflection on reforms, not to mention their creation and implementation, should begin with a rethinking of the role and functions of management. Constructive management, backed by knowledge of economics, is the center of any healthcare reform that includes everything necessary to improve the health of the population without increasing the cost of services

Despite the general understanding and acceptance of the fact that effective management is the cornerstone of both industrial and social prosperity of society, unfortunately, the issue of building effective system education and quality production of health care managers. AT recent times on the pages scientific publications special attention is given to the problem of training health managers.

When discussing issues related to the deterioration of the health status of the Russian population, some critics, among other things, highlight the following, often cited, reasons for this unfavorable situation:

§ low standard of living of the majority of the country's population

§ negligent attitude to their health on the part of the majority of the population;

§ extremely unsatisfactory industrial safety conditions;

§ vitamin deficiency associated with inadequate food quality and reduced purchasing power of the population;

§ the imperfection of legal mechanisms that ensure control over the quality of domestic and imported products;

§ low water quality.

Specified reasons can rightly be attributed to factors in varying degrees affecting the state and level of health of the population. It has become rather trivial to think that the resolution of problems generated by such factors is not necessarily related to issues of health and medical care. Moreover, according to the results of research by the World Health Organization, medical care and the system of its organization have a decisive influence on the course of the disease only in 10-15% of cases. In the remaining 85-90% of cases, when ensuring the preservation of public health, it is necessary to take into account such factors as epidemiological, social, environmental, rules and norms of personal hygiene, sanitary education of the population, sanitary and hygienic conditions at home and at work, the general stressful background of life, accessibility and quality of medical care, etc. The degree and depth of all these factors, as a rule, are determined by the political and economic climate of the state.

It is our deep conviction that some of the reasons for the unfavorable state of healthcare in Russia are the following:

· the weakness of the political will in the country for the desired and effective reform of the public health system;

· the lack of a modern personnel potential of managers capable of evolutionarily modifying the conservative forms of the outdated system of providing medical care, first to form structures and relationships in healthcare based on economic, market patterns, and then to ensure the management and regulation of medical services markets.

· imperfection, and sometimes elementary ignorance in practical healthcare of modern forms and methods of management; insignificant use of science-based management methods based on artificial intelligence systems in the management of the industry;

For the evolutionary transformation of the healthcare system Russian Federation and management of the industry in the new conditions, along with other methods and forms of management decisions, the implementation of a set of tasks in two interrelated strategic directions is considered.

Direction one:a qualitative increase in the intellectual component of management in healthcare - a gradual transition from intuitive, experimental and pragmatic methods of managing the industry as a whole and its constituent structures to truly scientifically based methods and forms of classical management.

Direction two:formation and use in the management of the industry, in modern conditions of the priority of economic relations in medicine, a qualitatively new human resource of health managers.

Practical implementation The first direction is conceived within the framework of the “Industry Strategic Situation and Simulation Center of the Healthcare System of the Russian Federation”, which we conditionally named. The purpose of creating such a subdivision of the Ministry of Health and Social Policy could be to set and solve the problems of managing the industry using modern and promising methods of situational modeling based on computer technology and artificial intelligence systems.

Based on statistical information and analytical work modern facilities artificial intelligence already today allow to provide situational modeling economic efficiency the health care system in general and the activities of medical institutions in a particular area.

The expected result of the functioning of such a center is that the situational modeling programs will allow dynamically and quickly simulating various scenarios for the development of events, searching for optimization states of the control system and predicting with a high degree of probability the result of certain managerial actions.

The solution of the second task is presented within the framework of the formation of an industry-specific multi-level structure of medical and social management.

The purpose of creating the proposed system within the healthcare industry can be the formation, training and retraining of human resources for solving managerial problems in the production and consumption of medical services based on the creation and operation of the institution of managers at all levels of the healthcare system of the Russian Federation.

The result of the functioning of such a permanent system of training managers and, subsequently, the use of these personnel in practical healthcare will allow for the evolutionary transfer of the healthcare industry from the service-budgetary structure of the state to modern industry adequately integrated into the domestic and global health markets.

Figuratively speaking, the solution of the designated tasks implies a kind of “dispatching” of managers into the healthcare system; managers - who have received modern knowledge of how to classical theory management, and management, marketing, economics, law, information technology; managers - armed with a modern artificial intelligence tool based on advanced information technologies, managers - relying on evidence-based management methods, and not just on intuition and practical experience.

Without a qualitative change in the form, methods and content of public health management, it will be extremely difficult to modify the existing, in some way, conservative management model, both at the level of a particular medical institution and the healthcare system as a whole.

3. Management in healthcare on the example of medical clinics

Over the past five years, against the backdrop of the myth of free and poor medical clinics, the understanding began to come that the medical business (even paid services in a state hospital) is a profitable business, and the profitability of at least 14% turned out to be higher than in a nearby supermarket. And for many entrepreneurs, the moment has come when medical clinics have become the object of investment analysis, the study of all the features of this business and, above all, professional management. And here the opinions of investors, managers, experts were divided. Some of them believe that the laws of management are the same for enterprises in any industry (and it is difficult to argue with this, especially after F. Taylor in a report to the US Congress in 1912 cited a medical clinic as an example of "scientific management"), and about any There is no point in talking about fundamental features in the management of a medical organization. Others believe, on the contrary, that health care is such a specific service sector that, along with traditional management, one must also know the healing itself and the health care system well. No other type of entrepreneurial activity so deeply interweaves professional (i.e. medical), psychological, ethical principles and management principles into one inseparable tangle, giving rise to a new specific type of management, which was “christened” as “medical management”. From the level of this management, which actually provides not only services, but also medical services, sometimes not only our health, but also life depends. So what is so special about running a healthcare facility? The doctor as the main employee of the enterprise. The task of management is to ensure the joint and effective work of doctors. What could be easier? This is where the test for the manager begins. The doctor, and Michel Foucault wrote about this in his work “The Birth of the Clinic”, is a representative of a free profession, which implies that he historically “worked” only for himself, helping the suffering. The psychology and self-identification of a doctor (and even a modern one) do not fit well into the status of a hired, forced laborer working for the owner. That is why today in the labor market we see the behavior of doctors shocking traditional managers: constant migration in search of an ideal clinic, the fear of doctors from academies and universities to move to a permanent job in a new, well-equipped private clinic, the desire of doctors behind the doors of the office to resolve issues of remuneration for their consultation directly with the patient, bypassing the cash desk or free examinations of their relatives on expensive equipment, "star" disease, rejection of accepted traditional forms of contract, etc. In many clinics, doctors openly talk about freeloaders - accounting, executive management, IT specialists - they sincerely do not understand where the money they earn goes and why they receive a salary of no more than 30% of the money received for a consultation. How, given these "innate traits" of the modern doctor, how to build a profitable medical business? Leaders - champions of strict discipline, surveillance and informing fail - doctors, having received knowledge, certificates and a patient database from them, flee to another institution, others come in their place for 2-4 months, etc. and so on in a circle. Others are already desperate to fight, and especially in dentistry, where there is a growing trend of renting out clinic space to medical staff. And only rare leaders try to build truly new generation clinics, where the quality of treatment meets the best international standards. It is no secret that in most organizations the spirit of competition between employees dominates, and the informal atmosphere encourages individualism. All this can move the development of an enterprise in another area, but it is detrimental to a medical organization, where the manager's task is to build a system of information exchange and cooperation. It is no coincidence that in the medical tradition there is such an institution as a consultation, which involves the discussion of a difficult situation by several doctors and the search for an optimal solution. Yes, and the patient has the right to demand it, which is enshrined in the Fundamentals of Legislation on the Protection of the Health of Citizens of the Russian Federation (Article 30.). With all the negative features of Dr. House, the hero of the American medical series of the same name, his indisputable advantage was that he was able to ensure the joint and effective work of the doctors of his diagnostic department, giving them the opportunity to realize their strengths to the maximum extent and neutralizing their shortcomings. The result is one of the best diagnostic departments in the US. Very often, as a management consultant for private clinics, I am asked what is the key to the commercial success of a medical enterprise. And I always illustrate my answer with an example from one clinic, where they fought for commercial secrets by creating a situation in which everything was called a secret, from equipment to the price list. Unfortunately, they did not understand that the biggest secret in healthcare lies in a different plane, in how a doctor can communicate with a patient and provide high-quality modern medical services. The key to the commercial success of the entire clinic lies in the doctor's office, in the “mystery” that takes place between the doctor and the patient, on which the entire medical business has been based since the time of King Hammurabi.

The fundamental role of the mission of the clinic in the medical business. In a medical clinic, the issues of financial profit and quality medical care are sharply and devilishly tempting. The information asymmetry in which the patient stays at the doctor's appointment makes him an easy prey for doctors who are not burdened by ethical and professional principles and who want to earn money. Who wants to become a victim of an ambulance doctor who takes him to the hospital that pays him for each “brought” or receive a prescription for an absolutely unnecessary medicine, but prescribed by a doctor sponsored by a pharmaceutical company? In the medical business, an enterprise becomes a hostage of a doctor, and sometimes the loss of trust in a doctor is a loss of trust in the entire, even ideal, clinic, in its reputation. And the medical business is, first of all, trust. Therefore, the role of management is so important, which is responsible not only to shareholders, but also to its patients, and which must create the main thing at the design stage of a new medical business - the ideology of the clinic and formulate a clear, understandable and capacious mission. For a store or a restaurant, the absence of a mission is bad, but the lack of a mission for a clinic is turning it into a gathering of part-time doctors who want to earn extra money on paid patients. And this is dangerous for our health. Many patients, having visited well-equipped, renovated, advertised clinics, are convinced that there is no respect for the rights of patients, there are no high-quality medical services, there is no certainty that you will be assigned only the studies you need, and the usual “scoop” is hidden behind beautiful walls.

Special requirements for the head of the clinic. There are several leadership models that have developed in our practice. In the first, the general director, who does not have a medical education, is in charge of everything, and the chief physician responsible for all medicine is subordinate to him. In my opinion, this is not the best situation, because. the person responsible for the entire enterprise does not fully know all the specifics of the business he manages, which increases the risk of making wrong decisions, falling under the influence and dependence of his medical environment and the head doctor, who actually oversees the main activity and determines the range of services provided. A well-known example, when one of the richest people in Russia, businessman Vladimir Kekhman, who previously worked in the fruit wholesale trade, took the director's chair of the Mikhailovsky Theater. He first of all entered the course of the Faculty of Theater Studies of the St. Petersburg Theater Academy with a degree in theater manager. It is unlikely that for such a busy person this is only an image step, but rather an understanding that there is an objective need for a classical and serious study of the theater business and an opportunity to better understand the theater and its artists. I don't know of examples when one of the heads of clinics went to get medical education, in many respects, probably, because they already have the feeling that they know everything. At the dawn of the emergence of private business, when there were only a few doctors who knew the basics of management, this option of appointing a “non-medical” manager as the head was the most common. But now the situation is changing. More and more doctors are acquiring additional professional education in the field of management, getting an MBA degree. A manager with two degrees sees his company more systematically, and there are positive examples in the city of how the acquisition of management knowledge by the chief physician made it possible to qualitatively change the clinic. But objectively evaluating the labor market, we can say with regret that there are only a few managers who can successfully manage a clinic in the 21st century and understand the peculiarities of management in healthcare. We do not have a serious and professional school specializing in this area, and short-term courses in medical management can only indicate directions for independent and in-depth study of the subject. The head of the clinic has another difficult task - interaction with shareholders - investors who have invested money to make a profit, and sometimes they are not interested in how it turns out. And here it is very easy to cross the line when, in order to maximize profits, the quality of medical services will decrease, equipment will not be updated and properly maintained, reusable instruments will be used, technological cycles will be disrupted, and treatment regimens will be simplified. In countries where there is transparency and strict control, including from the side of the medical community united in the Association, such behavior of the clinic will quickly lead to its closure. And in our country, we should rely more on the decency of clinic managers and the reputation of the clinic than on regulatory authorities and Roszdravnadzor. Innovative management is the basis for the development of the clinic. Management in the clinic should enable growth and development of both the enterprise itself and its doctors and nurses. In medicine, where scientific and technological progress is being introduced into practice faster than anywhere else, and is changing the technologies for diagnosis, treatment, rehabilitation, it is important to be aware of everything and quickly put into practice the most modern and perfect. The Da Vinci robot surgeon has already become a reality (#"justify"> The complexity of assessing the quality of work. The efficiency of a clinic is difficult to measure. And the peculiarity of medical enterprises is that it is extremely important to choose the right criteria for effective work and assess the quality of medical care provided. the system of quality control and staff motivation in the clinic is difficult not so much because of organizational issues, but because of the specifics of medical activity.The introduction of evidence-based medicine principles and standards around the world makes it possible to more objectively evaluate the work of doctors in terms of providing medical services.Existing diagnostic and treatment standards allow choose the method that is optimal in terms of results and financial costs.In addition, the quality of medical services is closely related to the quality of management, so it is no coincidence that 2 dental clinics in the city have already received ISO 9001 certification of their management. In some clinics, I would like to emphasize once again that many investors are beginning to understand that building and equipping a clinic is the easiest thing, but to make sure that the clinic provides medical services that meet the highest standards, successfully uses the most modern technologies for diagnosing treatment, rehabilitation and doctors worked as one team - a difficult task.

. Budget institutions

The main cardinal changes that will affect public health care institutions in 2012 is a change in their type, which will entail a change in the management style and thinking of the head.

Law No. 83-FZ normatively establishes the existence of three types of institutions: budgetary, autonomous and state-owned. It provides for changes legal status most existing state and municipal institutions. In this regard, before all authorities state power and local government, which are in charge of state (municipal) institutions, a number of questions arise:

· how do new institutions (budgetary, state, autonomous) differ from the current ones;

· what measures and how quickly should be taken in connection with the adoption of this law;

· how to correctly distribute existing institutions between types;

· what legal acts should be adopted in the subjects of the Russian Federation and municipalities in order to comply with the provisions of Law No. 83-FZ;

· how to competently organize interaction with budgetary and autonomous institutions in the conditions of minimizing preliminary control over their spending budget funds etc.

In order to answer these questions, it is necessary to carefully study some of the most significant provisions of Russian legislation, namely:

· new edition of the Federal Law "On non-profit organizations”, which now applies to budgetary and state-owned institutions, and partially to autonomous ones;

· new edition Budget Code;

· a new version of the Federal Law of November 3, 2006 No. 174-FZ "On Autonomous Institutions" (hereinafter - Law No. 174-FZ);

· for local governments - a new version of the Federal Law "On general principles organizations of local self-government in the Russian Federation”;

· articles 30, 31 and 33 of Law No. 83-FZ.

5. Spot the differences

So, the first question is: what is the difference between autonomous, state and budgetary institutions of a new type from existing institutions (see Table 1)

Table 1. Comparison of state, budgetary and autonomous institutions

Positions for comparisonPublic institutionsBudgetary institutionsAutonomous institutionsComposition of fixed propertyReal estate, movableReal estate, movable, especially valuable movableLimits of liability of an institution Responsible for its obligations in cash Responsible for its obligations with all property, except for those fixed on the right operational management real estate and especially valuable movable property Responsible for its obligations with all property, with the exception of real estate fixed on the right of operational management of real estate and especially valuable movable property Responsibility of the owner Subsidiary (in case of insufficient Money the owner is responsible for the obligations of the institution) The owner is not liable for the obligations of the institution Application of Law No. 94-FZ Applies Not applicable state order(including payment of taxes on real estate and land), subsidies for other purposes, funds from the budget for execution public obligations, income from the provision of paid services Subsidies from the budget for the implementation of the state task (including the payment of taxes on real estate and land), taking into account measures aimed at the development of autonomous institutions, the list of which is determined by the founder, income from the provision of paid services Volumes of budget financing The volume of financial support for the task does not depend on type of institution (Article 20 of Law No. 174-FZ) subsequentSubsequentIndependent auditNot conductedAnnuallyGovernment bodiesHeadHead, collegiate bodies (artistic council, etc.)Head, supervisory board, collegiate bodiesAccountingBudget accountingBudget accounting according to KOSGU codesAccountingReport budgetary reporting, statistical reportingBudget reporting, statistical reportingAccounting reporting, statistical reportingReport on activities and use of property The owner is not responsible for the unfulfilled obligations of the institution. Obligations are fulfilled only at the expense of the property with which the institution is liable for obligations. The owner is not liable for unfulfilled obligations of the institution

State institutions in their own way legal status, responsibility for obligations, mechanisms of budgetary financing are budgetary institutions that are deprived of the right to receive income from income-generating activities. Budgetary institutions of a new type, in turn, acquired a significant number of features of autonomous institutions:

· they will receive subsidies for the fulfillment of the state (municipal) task, the expenditure of which will not be subject to preliminary control, and the balance will be withdrawn at the end of the financial year;

· the amount of subsidy for the fulfillment of the task of the founder will be determined on the basis of standard costs;

· for budgetary institutions, not an estimate, but a plan of financial and economic activity will be drawn up;

· as part of the movable property of budgetary institutions, especially valuable movable property will be allocated;

· budgetary institutions will be liable for their obligations with all their property, with the exception of immovable and especially valuable movable property assigned to the institution by the owner;

· the owner will not bear responsibility for the obligations of budgetary institutions;

· in a special order - in agreement with the founder - budgetary institutions will carry out big deals and related party transactions.

At the same time, the budgetary institutions of the new type retain the features of the existing budgetary institutions:

· accounts of budgetary institutions will be opened in the treasury or financial authorities;

· budgetary institutions will retain the possibility of receiving funds from income-generating activities;

· as at present, the founders will approve state (municipal) assignments for institutions;

· the purchase of goods, works, services for budgetary institutions will be carried out in accordance with federal law No. 94-FZ "On placing orders for the supply of goods, performance of work, provision of services for state and municipal needs" (hereinafter - Law No. 94-FZ);

· budgetary institutions will not need to create additional management bodies (similar to the supervisory board of an autonomous institution);

· there is no requirement to conduct an annual audit in relation to budgetary institutions.

All institutions, regardless of type, will prepare and post on the Internet a report on the results of activities and on the use of property.

6. What type of institution to choose?

When deciding on the distribution of institutions between types, it is first necessary to ensure compliance with the requirements of the law, namely the definitions of budgetary, state and autonomous institutions, paying attention to the following features:

· budgetary and autonomous institutions, by definition, perform work and provide services, while state-owned institutions can also perform functions, for example, conduct examinations, carry out other legally significant actions, engage in control and supervision activities (hence, if an institution performs functions, it should be classified as a state-owned );

· the composition of the areas of activity of budgetary institutions is not closed, while for autonomous institutions, the new edition of Law No. 174-FZ provides for a limited list of areas, and the activity of autonomous institutions in other areas is possible only if it is provided for by federal law (currently such a possibility stipulated in the City Planning Code).

Further, the following circumstance should be taken into account: whether the institution receives income from income-generating activities. That is, it should be borne in mind that these funds will be credited to autonomous and budgetary institutions to their own accounts and spent on the rights of independent disposal. In turn, the income received by state institutions will be credited to the budget, and the main managers of budget funds on the basis of paragraph 22 of Art. 30 of Law No. 83-FZ will have the right to distribute budget appropriations between subordinate state institutions carrying out income-generating activities, taking into account the volume of income from such activities credited to the relevant budget. Thus, if importance have the volume of receipts from income-generating activities and the efficiency of their subsequent spending, as well as the personification of sources of income and institutions (for example, when receiving parental payments in preschool educational institutions), then institutions should not be transferred to state-owned ones. A similar recommendation can be given if the institution receives charitable contributions, especially targeted ones: the receipt of such contributions to budget revenues (which will happen in the case of a state-owned institution) will deprive the benefactor of interest in transferring funds, and the institution will deprive the institution of an important additional source of income. It should be borne in mind that the new version of Law No. 174-FZ lifted the ban on the creation by changing the type of autonomous institutions in the healthcare sector. It is likely that for some health care institutions this opportunity will be of interest. Taking into account the above approaches, it would be most expedient to keep the majority of budgetary institutions in the status of budgetary institutions or transfer them to autonomous ones. Only in isolated cases it is expedient to transfer institutions to state-owned ones. Moreover, if over time it is determined that the selected type of institution is not optimal, this type can be changed in the manner established by the Government of the Russian Federation, the highest executive body of state power (local administration), while maintaining all licenses and other permits available to the institution.

7. About control

Fears related to the fact that control over the spending of budgetary funds and, in general, the activities of budgetary and autonomous institutions will be significantly reduced and the owners will lose their former influence on institutions, are somewhat exaggerated. Firstly, with regard to the spending of other subsidies by budgetary institutions, preliminary control over their intended use remains. The lack of an estimate is compensated by the presence of a financial and economic activity plan, within which it is possible to form a kind of cash plan for an institution describing, to the required degree of detail, the financial flows of the institution not only as a whole for a year (three years), but also for intermediate periods (for example, quarters) . Reporting on the implementation of the state (municipal) task, reporting on the implementation of the financial and economic activity plan, budget reporting for budget institution and accounting for an autonomous company together can provide the founder with information on how the institution spends budgetary funds and whether there are overdue accounts payable. It should be noted: overdue accounts payable is an indirect evidence that the received budgetary funds were spent irrationally or directed by the institution for purposes not provided for in the plan of financial and economic activity. It is also necessary to take into account the following fact. In paragraph 27 of Art. 30 of Law No. 83-FZ establishes that a public authority ( government agency), a local self-government body exercising the functions and powers of the founder of a budgetary institution, when concluding employment contract with the head of a budgetary institution, it provides, among other things:

· indicators for evaluating the effectiveness and efficiency of its activities;

· condition on termination of the employment contract at the initiative of the employer in accordance with Labor Code if a budgetary institution has overdue accounts payable exceeding the maximum allowable values ​​established by the body exercising the functions and powers of the founder.

Consequently, the responsibility for the economically competent organization of the work of the institution rests with its head, and this will ensure a more responsible spending of budgetary funds by the institution.

CONCLUSION

Management - one of the oldest arts - permeates all spheres of human activity, is present in all systems of society. Moreover, management can also be considered as a science: it has its own methods, principles and concepts.

But management, being an art, cannot rely only on experimental methods of research. It has at its disposal another amazing tool - intuition.

In complex, constantly changing conditions ( internal factors in the organization and the external environment), the leader must accept the only the right decision which is required in this moment. Only with the help of intuition, a creative approach to management, it is possible to successfully implement managerial activity.

The economic stability of the organization, its survivability and efficiency in the conditions of market relations are inextricably linked with its continuous improvement and development. At the same time, the improvement of the organization should be carried out according to the principle of adaptation to the external environment.

Today, the factors that determine the need for continuous improvement and adaptation of the organization are clearly visible. It:

sales market for manufactured or sold products and types of services;

supplier market or consumer market of raw materials, energy, goods and services;

financial market;

labor market;

natural environment.

Without taking these factors into account, it is impossible to plan a development strategy. Therefore, the success of any enterprise or organization and the possibility of their survival depend on the ability to quickly adapt to external changes. In an ongoing effort to keep the organization fit external environment is the principle of adaptive control. It manifests itself in the dynamic development new products, modern engineering and technology; application of progressive forms of labor organization, production and management, continuous improvement of human resources.

In the conditions of the dynamism of modern production and society, management must be in a state of continuous development, which today cannot be achieved without researching trends and opportunities, without choosing alternatives and directions for development.

The enterprise management system must meet modern market conditions:

have a high production flexibility, allowing you to quickly change the range of products (services). This is because life cycle products (services) became shorter, and the variety of products and the volume of production of one-time batches - more;

be adequate to a complex production technology that requires completely new forms of control, organization and division of labor;

take into account the serious competition in the market of goods (services), which has radically changed the attitude towards product quality, requiring the organization of after-sales service and additional branded services;

take into account the requirements for the level of customer service quality and contract lead time, which have become too high for traditional production systems and mechanisms for making managerial decisions;

take into account changes in the structure of production costs;

take into account the need to take into account the uncertainty of the external environment.

This is not a complete list of the problems that many organizations face. To implement them, there is an objective need for research and analysis of the current situation. management healthcare medical

For the successful operation of organizations in modern conditions, it is necessary to periodically conduct research in order to improve existing management systems. Research is integral part management of the organization and are aimed at improving the main characteristics of the management process.

System analysis is used to identify the specifics of the work of organizations and develop measures to improve production and economic activities. main goal system analysis is the development and implementation of such a control system, which is selected as a reference system that best meets all the requirements of optimality.

References

1. Anufriev S.A. Peculiarities of management in medical clinics // Management in medicine. - 2010. - No. 4. - S. 12-16.

Blinov A., Vasilevskaya O. The art of personnel management. - M.: Gelan, 2011.

Kisilev S.V., Sabitov N.Kh., Vakhitov Sh.M. et al. Specificity of the economy and healthcare management. - Kazan: Medicine, 1998.

Kotler F. Marketing management. - St. Petersburg: Peter, 2009.

Krivokora E.I., Krivokora Yu.N. Problems of evaluation of labor results management personnel// Economy. - 2011. - No. 11. - S. 19-23.

Reshetnikov A.V. Health Economics. - M.: GEOTAR-MED, 2009.

Travin V.V., Dyatlov V.A. Fundamentals of personnel management. - M.: Delo, 2011.

8.Internet resources

Internet resources

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One of the most significant changes in the modern medical business, it was private enterprises that were affected. There was a transformation of the chief doctor, a specialist, into a manager, which led him to the need to solve managerial tasks and improve related skills. Advantage private clinic in that the management of this business is flexible and adaptable, but mistakes are more critical. Let's look at what mistakes are most common and what you should pay attention to in the medical management of a private clinic.

Features of medical management

According to statistics, the minimum profitability of the medical business is 14%. These figures are even higher than the profitability of supermarkets. Given this, investors are increasingly considering the dental business as an investment. However, a definite opinion on how to optimize the management of the clinic and form effective medical management has not yet been formed.

According to some experts, management medical business in the field of dentistry must obey general rules management, and there are simply no fundamental differences with the management of a medical center of any other direction.

INTERESTING!
There is an opinion that, since dental services are more in demand among other health services, management dental clinic differs from the management of any other clinic by higher competition, which means that the knowledge of basic management in the case of dentistry will not be enough.

Experts who share this opinion are convinced that it is possible to talk about a well-formed medical management only when there is an understanding of the essence of dental services and the dental health of patients in general. In fact, dentistry is a service at the intersection of medicine, psychology, ethics and the successful management of a medical business. It is these nuances that are the fundamental differences, and they are absolutely necessary. Actually, this is true not only for dentistry.

Developments in the field of successful management of the medical business have led to the emergence of such a term as "medical management". Its goal is to consolidate the specifics of the management and management of medical centers of any direction. The management of a medical center of any type is equally related to both the quality of service and the quality of medical services provided, and the degree of quality of these two parameters directly affects and successful work medical business, and the state of dental health of clients.

In order for a medical institution to successfully fulfill its tasks, the doctors working in the clinic must work smoothly and efficiently. But how to properly organize their work? Since ancient times, doctors have worked individually, not as a team. And echoes of this are periodically felt even now.

Peculiarities medical marketing quite closely related to the nuances of the behavior of doctors. Often, such employees constantly change clinics in search of the best, in their opinion, conditions. Some want to receive payment directly from the client for the services they provide, ignoring the institution's cash desk. There are doctors who use the equipment of a medical clinic to conduct free examinations or treat close friends or relatives, and in this case they ignore the conclusion of the contract.

Often, some doctors are affected by the "star disease" caused by the fact that they consider themselves central figures within the walls of their institution. Such employees often believe that representatives of all other professions working in the same clinic (for example, programmers, receptionists, accountants, nurses or IT specialists) practically live off all the work that doctors themselves do in the clinic. The fight against such a worldview of doctors is also important for the proper management of a dental clinic.

The main question clinic owners want to answer is how to make their clinic successful. However, here too, “excesses” are possible. For example, in one of the clinics, the struggle for the preservation of trade secrets was so tightly fought that absolutely everything was considered secret in it - from the models of the equipment used to the prices for services. trade secret, of course, is important, but the basis of success in the work of the clinic is the interaction and mutual understanding between the doctor and the patient, and with such a strict regime of secrecy, this is hardly possible...

Management in the medical business: options

There are several directions in the management of a dental clinic. The first option is when a person who has not received a medical education becomes the head of the clinic. In this case, he must be subordinate to the chief physician who controls the solution of all medical issues. The disadvantage of such a scheme for managing the medical business is that the head of the clinic is too unfamiliar with the specifics of the business itself. The consequences are that such a leader cannot fully assess the correctness of the decisions made by his deputy.

Moreover, a leader who does not have sufficient medical knowledge, may fall under the influence of the specialists of their team, who will actually determine the direction of the clinic and influence the range of services provided. That is, in fact, the team will begin to manage the leader, which, of course, is fundamentally unacceptable.

You may be interested

• The work of the head of the clinic: managerial literacy, difficulties in achieving results and responsibilities

For doctors who want to become owners of their own clinics, the issue of business management in medicine is also relevant, but medical knowledge is also not enough for this. Only after receiving education in the field of management or independently studying the process of managing a medical business can one become a truly competent leader.

Successful management in medicine guarantees precisely the combination of knowledge. Only this synthesis allows us to most accurately assess the situation in a medical institution, make the necessary changes in the process of managing a medical center in time, and achieve a higher quality of work.

Unfortunately, until now, management in medicine in general, as a separate area of ​​management and management of medical institutions, can be attributed to little-studied areas. It can be stated that there is a shortage of specialists in the labor market who are able to efficiently manage the clinic. A worthy professional school of "medical managers" has not yet been formed, and short-term management courses can only provide the most basic knowledge.

Another important nuance of modern medical management is potential cooperation with shareholders and investors. The main goal of investors and shareholders is to make a profit. When investing in the medical business, they usually want to get the most out of it. Preferably with maximum efficiency. However, as a result of this type of investment, the quality of medical services may begin to decline, renewal and maintenance issues will become less important. medical technology, the required completeness of treatment may not be adequately controlled. Trade-offs between profitability and decent patient care is one of the most pressing challenges in managing a medical business, and this issue usually falls on the shoulders of the head of a medical center or clinic.

Proactivity in the management of medical activities

When managing a dental clinic, the manager must take care not only of the development of the organization and its services as a whole, but also of the professional growth of each medical worker. Be aware of new ways of diagnosing and treating diseases, be able to use modern equipment– any of the clinic staff must meet these criteria. Training and professional development in a private clinic should be an ongoing process.

Evaluation of the performance of a private clinic is also one of the aspects of the management of medical activities. To begin with, it is necessary to choose the right criteria according to which the quality of medical services and the work of the clinic as a whole will be assessed. The assessment should be objective, and the process of monitoring the effectiveness is clearly built into the management system of the medical center. Just this process is assigned to the top managers of medical institutions. And since the relationship between the quality of management and treatment of patients is the most direct, many Russian private clinics are beginning to certify their management according to the European ISO system.

If competent principles of medical business management are not followed, ethical problems with far-reaching consequences are possible. Let's take a look at typical managerial mistakes during the work of the dental clinic.

Management mistakes in the medical business

The first mistake. The management of a dental clinic does not imply sufficient control over the ethical side of the activities of employees, as a result of which both managers and dentists ignore the interests of clients.

Most common mistakes arising in the management of the medical business - orienting clients to purchase the most expensive services. In clinics with such an error, there is no attractive system of discounts, a guarantee for services. Often you can find an inattentive attitude towards the health of patients. Dentists may even neglect to draw up a treatment plan. When managing a clinic, the manager convinces employees to sell the most expensive, arguing this high quality. The high price is explained by partnership with foreign companies, ordering materials for dentistry from European manufacturers.

Due to this type of management of the dental clinic, doctors are forced to provide clients with false information about suppliers, etc. Clients in such a situation usually feel pressure, realize that the goal of the clinic is to sell expensive services, and not to select the right treatment. As a rule, most then simply leave and do not return.

When studying the statistics of the work of such clinics, it is noticeable that the percentage of clients who returned to them again or came on the recommendation of a client who had previously contacted this clinic is extremely low. The plan in such clinics is made only because in Russia there is a high percentage of people who need treatment from dentists.

Second error. Top managers in conflict situations do not take into account the interests of customers

In one of the dental clinics, during the course of treatment, a doctor with a long experience in the treatment of complicated caries first voiced one amount for the treatment, but then saw that more work would be required than originally expected. He informed the client about the need for additional work, but did not mention the cost of this work.

As a result, the client at the reception saw the amount in the bill by a third more than previously announced. The client was outraged that the doctor did not inform about the change in cost. When he explained the situation to the chief dentist, he realized that the dentist had violated the rules for the provision of paid services.

But the director of dentistry, to whom the patient also complained, did not support the patient. As a result, the head physician resigned because he did not agree with the director's policy, then the dentist who provoked the conflict also resigned, since the number of clients did not grow (the case was not an isolated one, the reputation of the clinic was gradually falling, doctors were dissatisfied with the salary).

So the mismanagement of the medical business caused a series of layoffs, gradually the entire clinic to collapse.

Error three."Divorce" visitors for money

Management of the clinic based on the directed strategy of "doctors" active sales also cannot be called the correct method. For example, doctors do not inform patients about all possible treatment options, but immediately offer the most expensive services and materials. Cheaper dental treatments are described as unreliable. In an even more uncomfortable situation, patients who came under compulsory medical insurance may find themselves in a situation where the clinic is working in this direction.

Some clinics may require patients to take duplicates of an examination already done if it was carried out in another medical institution. Management of a dental clinic, built only on receipt by doctors maximum profit, is usually characterized by the oppression of those professionals who are not capable of "breeding" clients. They are accused of a stable inability to earn money. As a result, with the wrong management of the medical business, really good specialists leave the clinic.

Mistake four. Installation for doctors financial plan workings. Requirement of certain financial results and reaching them by any means is also the wrong way to run a dental clinic. Doctors who fulfill the plan are encouraged, those who do not cope - on the contrary, they begin to morally or even materially oppress.

If the production standards are not met, sometimes they can even be fired, although this seems extreme. As a result - again the departure of good specialists, conflicts between doctors and management and a difficult situation in the team itself.

Moreover, an unscrupulous manager in the management of a medical business often uses such a plan as a way to reduce the salaries of doctors. However, doctors usually quickly realize that the required output is too high. This can lead to serious scandals.

Mistake five. Self-setting of prices for work by doctors in the management of a medical business. It would seem that when each doctor himself determines the cost of his services and is responsible for their quality, should everything be honest?

However, even here there are pitfalls - some doctors overprice too much; and clinic administrators who do not have a single price list will not be able to promptly inform clients about the cost of services. Moreover, patients may find themselves in a situation where several dental specialists for the same treatment in the same clinic voice different prices, which can undermine the reputation of the institution itself.

Mistake six. Who is always right - the client or the doctor? When running a dental clinic, executives ignore the need to build good relationships with clients.

The clinic does not train specialists to behave correctly, they do not teach them to pay attention to the patient's personality, they do not control whether the clinic employees show sufficient care for the client. Very important in dentistry psychological aspects medical work, and if they are not taken into account, all investments in the management of the medical business may eventually turn out to be in vain.

Error seven. Savings should not be excessive.

After visiting the clinics, visitors should not consider that its management saves on every possible detail - because in this case they may think that the clinic saves on the treatment itself too!

The impression is made up of little things - even the paper on which contracts and other documents are printed can play a role. If the clinic does not have magazines on the table in the waiting room or a TV, the patient has the right to feel offended. A very good move when managing a medical business is arranging beautiful children's corners, updating toys, and so on.

Remember, the more you care about the welfare of your clients when running a medical business, the more they care about your welfare. This is an interconnected process, and it is not possible to achieve one without the other. That is why in managing a medical business, you need to take into account all the little things and nuances that will help you become even more successful.