1. General Provisions

1. This job description defines official duties, rights and responsibility of the head of the organizational and methodological department of a healthcare institution.
2. A person with a higher professional education and work experience in the field of organizational and methodological work or healthcare management for at least 5 years.
3. The head of the organizational and methodological department must know the basics of the legislation of the Russian Federation on health care; legal documents regulating the activities of healthcare institutions; the basics of organizing medical and preventive care in hospitals and outpatient clinics, emergency and emergency medical care, disaster medicine services, sanitary and epidemiological services, drug supply to the population and health care facilities; theoretical basis, principles and methods of clinical examination; organizational and economic foundations for the activities of health care institutions and medical workers in the conditions of budget-insurance medicine; fundamentals of social hygiene, organization and economics of healthcare, medical ethics and deontology; legal aspects medical activities; general principles and basic methods of clinical, instrumental and laboratory diagnostics of the functional state of organs and systems of the human body; etiology, pathogenesis, clinical symptoms, course features, principles of complex treatment of major diseases; rules for the provision of emergency medical care in a life-threatening condition of the patient; bases of examination of temporary incapacity for work and medico-social examination; fundamentals of health education; internal labor regulations; rules and norms of labor protection, safety measures, industrial sanitation and fire protection.
In his specialty, the head of the organizational and methodological department must know the basics of social hygiene and healthcare organization; the history of the formation and development of healthcare; organization of outpatient care for the population; organization of inpatient care for the population; organization of medical and preventive care for workers industrial enterprises; organization of specialized assistance to the population; organization of medical care for the rural population; organization of obstetric and gynecological care; organization of medical care for adolescents; organization of medical care for children; organization of emergency and urgent care to the population; organization of medical examination of the population; fundamentals of health care management; fundamentals of health planning and economics; theory and methods of sanitary statistics; population health statistics; health statistics; questions international statistics; fundamentals of medical cybernetics; demographic and economic features region (district); prospects for the development of the region (district); the state of health of the population in the region (district); sanitary-epidemic and ecological situation in the region (district); indicators characterizing the state of health of the population in the region (district); the main indicators characterizing the activities of the health care facilities of the region (district); functions, rights, obligations, organization of work of employees of the organizational and methodological department.
The head of the organizational and methodological department should be able to calculate the indicators of public health and the performance indicators of a medical institution, unit; draw up a draft plan for the development of health care in the region, district, institution to include it in the plan for the socio-economic development of the region (district); plan development based on an analysis of the specific situation in the region (district) various kinds medical assistance to the population; organize work on the introduction of best practices in healthcare institutions of the district; organize the introduction of elements of the scientific organization of labor in the medical institutions of the district; organize a system for monitoring the implementation of planned activities; to instruct health care facility workers on organizational and methodological work, methodological meetings, conferences for the exchange of experience; analyze and evaluate primary statistical information.
4. The head of the organizational and methodological department is appointed to the position and dismissed by order of the head of the institution in accordance with the current legislation of the Russian Federation.
5. The head of the organizational and methodological department is directly subordinate to the head of the institution or his deputy.

2. Job responsibilities

Organizes the work of the organizational and methodological department. Provides organizational and methodological assistance to employees of the institution, subordinate health care facilities and their employees. Provides consulting assistance in his specialty. Participates in the preparation statistical reports, incl. annual report, information and analytical materials. Organizes visits of medical specialists to subordinate health facilities. Supervises the work of secondary and junior medical personnel subordinate to him, facilitates the performance of his duties. Supervises the implementation of safety and labor protection rules by middle and junior medical personnel. Participates in training sessions to improve the skills of medical personnel in their specialty. Plans its work and analyzes the performance of its activities. Ensures timely and high-quality execution of medical and other documentation in accordance with established rules. Carries out sanitary-educational work. Complies with the rules and principles of medical ethics and deontology. Qualified and timely executes orders, orders and instructions of the management of the institution, as well as regulatory legal acts on his professional activities. Follows the rules internal regulations, fire safety and safety, sanitary and epidemiological regime. Promptly takes measures, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the healthcare institution, its employees, patients and visitors. Systematically improves his skills.

The head of the organizational and methodological department has the right to:
8. give orders that are obligatory for execution by employees of the organizational and methodological department;
9. participate in the selection and placement of personnel in their specialty;
10. make proposals to the management of the institution to encourage and impose penalties on the employees of the institution in their activities;
11. make proposals for the development and improvement of the activities of the institution;
12. ask management, receive and use information materials and legal documents necessary for the performance of their duties;
13. to take part in conferences and meetings that deal with issues related to its work;
14. pass certification in accordance with the established procedure with the right to obtain the appropriate qualification category;
The head of the organizational and methodological department uses all labor rights in accordance with Labor Code RF.

4. Responsibility

The head of the organizational and methodological department is responsible for:
9. timely and high-quality implementation of the duties assigned to him;
10. organization of their work, timely and qualified execution of orders, orders and instructions from higher management, regulatory legal acts on their activities;
11. rational and effective use material, financial and human resources;
12. compliance with internal regulations, sanitary and anti-epidemic regime, fire safety and safety;
13. maintaining the documentation provided for by the current regulatory legal acts;
14. providing, in accordance with the established procedure, statistical and other information on their activities;
15. Ensuring compliance with executive discipline and performance of their duties by employees subordinate to him;
16. readiness of the department to work in emergency situations.
For violation labor discipline, legislative and regulatory legal acts, the head of the organizational and methodological department can be brought in accordance with the current legislation, depending on the severity of the misconduct, to disciplinary, material, administrative and criminal liability.

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
CENTRAL SCIENTIFIC - RESEARCH INSTITUTE
ORGANIZATION AND INFORMATIZATION OF HEALTH CARE
APPROVE
First Deputy Minister
A.I. VYALKOV
October 15, 2002 N 2002/107
GUIDELINES
PLANNING ORGANIZATIONAL AND METHODOLOGICAL WORK
AND ORGANIZATION OF OUTSIDE ASSISTANCE OF MEDICAL -
TO PREVENTIVE INSTITUTIONS
These guidelines present methodological approaches tested in the administrative territories of Russia to planning organizational and methodological work in the main areas of public health protection and organizing outreach medical care.
The proposed approaches can be used by employees of regional institutions that provide organizational and methodological assistance to medical and preventive institutions of administrative territories, as well as municipal health officials, including chief physicians of the Central District Hospital.
The recommendations can be applied in the organization of the pedagogical process in the preparation of healthcare organizers and advanced training of management personnel, primarily specialists in organizational and methodological work.
Organization - developer:
Central Research Institute for Organization and Informatization of Healthcare of the Ministry of Health of the Russian Federation.
The authors:
Doctor of Medical Sciences, Prof., Corresponding Member RAMS V.I. Starodubov, MD, prof. Yu.V.Mikhailova, MD, prof. R.A. Khalfin, Ph.D. T.A. Siburina, MD Yu.A. Korotkov, MD, prof. A.A. Kalininskaya, Ph.D. T.I.Eremicheva, Ph.D. V.A.Magnitsky, Ph.D. S.I. Shlyafer, Ph.D. V.K.Popovich, MD G.Ch. Makhakova, Ph.D. E.M. Gudanova, Ph.D. N.P. Soboleva, M.D. Duganov, Ph.D. E.V. Mezentsev, V.I. Nazarov, M.Yu. Potemkina, MD, prof. V.N.Ektov, I.A.Sizova, D.N.Muraviev.
INTRODUCTION
Russian healthcare has changed significantly in the last decade. The reforms expanded the economic independence of the heads of medical and preventive institutions. The importance of organizational and methodological work in organizing and improving the quality of the medical and diagnostic process is growing. The reorganization of the management of organizational and methodological activities in accordance with the main strategic directions of the industry's development becomes extremely relevant.
In accordance with the Concept for the development of healthcare and medical science in Russian Federation further improvement of organizational and methodological work in healthcare is aimed at:
- improving the quality of medical care to the population, strengthening the preventive component in the activities of healthcare institutions;
- ensuring state guarantees in the provision of qualified medical care to the rural population through the strengthening of primary health care and the development of outreach forms of medical care;
- improving the efficiency of resource use, the formation of rational systems of phased medical care and the introduction of resource-saving technologies;
- expanding the influence of healthcare on the formation and implementation of state policy in the field of public health protection at all levels of government;
- coordination of interaction between various services and departments in solving complex medical - social problems.
The implementation of the goals set will require significant changes in the organizational and methodological work, which is an integral part of the management activities of the system of regional and municipal health management.
Planning organizational and methodological work is built in accordance with modern ideas about its essence. The concept of organizational and methodological work includes:
- implementation of analytical work to assess the state and dynamics of development of the healthcare system of the relevant administrative territory, the state of public health, the medical and demographic situation and other factors external environment that affect the level of public health;
- organization and improvement of the system of accounting and reporting on the activities of government bodies and health care institutions, the results of functioning, the dynamics of the state of health of the population;
- development of long-term and current plans for the activity of the healthcare system of the administrative territory, targeted programs in priority areas of development, organization of their implementation, control and evaluation of the effectiveness of implementation;
- organization and conduct of targeted inspections, expert evaluation of the activities of individual health services and institutions with the departure of experts to the field and the provision of organizational, methodological and advisory assistance;
- determination of the need for medical personnel in various forms of continuous training, planning, together with the personnel services of health authorities, work to improve the skills of medical workers, organizing and holding conferences, seminars, visiting boards, medical councils, meetings, etc.;
- organization of outreach assistance to rural residents.
In everyday practice, the role of analytical activity is significantly increasing, its quality level is increasing based on the use of modern technologies for collecting and processing statistical data, transferring medical information, methods of analysis, justification and formation of strategies.
Recent times the requirements for the organization of planned work are significantly increased on the basis of a more complete account of the influence of environmental factors, the conditions for the functioning and development of the industry, and the forecast of the most probable prospects. The strategic components of planning are being strengthened. Plans for current activities are built in accordance with the directions for the implementation of strategic goals. A system of plans is being formed that unites various levels of management. Planned activities are linked with their resource provision. The program-target approach continues to be widely used to solve complex or interdepartmental problems. At the planning stage, forms of control are determined and criteria are developed for evaluating the effectiveness of the implementation of planned activities used for their implementation of management mechanisms.
The need to intensify the diagnostic and treatment process requires the improvement of innovative activities in healthcare bodies and institutions, its organization on the basis of today's ideas about marketing, business planning of innovations, organizational forms ah and methods of implementation.
Increasing the level of medical and preventive and consultative and diagnostic assistance to the rural population in modern conditions provides for the strengthening of the material and technical base and human resources of rural health care, the development of an optimal model of medical care for the rural population in health care institutions at various stages of the provision of medical care and, as an additional measure, the use of mobile forms of targeted medical care.
Thus, one of the most important functions of the health management body is delegated to health care institutions (republican, regional, regional hospitals, central district hospitals) - the development of draft plans for the activities of the subordinate health care system, organization, control and evaluation of their implementation. In this aspect, the provision of organizational and methodological assistance to the rural population, including outreach assistance, being the main functions of the organizational and methodological departments of health care institutions of the indicated levels and fully corresponding to their area of ​​competence, is planned independently, and the procedure for adopting the plan reflects the procedure regulated for hospital departments.
Description (formula) of the method: an improved system for planning the organizational and methodological work of the regional health care facility and the Central District Hospital is proposed, which includes proposals for the composition of the main activities, requirements for the execution of planning documents, the adoption procedure, as well as a description of the mechanisms for their implementation and forms of monitoring implementation.
CONTENT AND STRUCTURE
PLAN FOR ORGANIZATIONAL AND METHODOLOGICAL WORK
The plan of organizational and methodological work (hereinafter PLAN) is a list of specific tasks, determines the order, timing, sequence of activities for the planned period of time, establishes specific performers and provides for resource, including financial, support for planned activities, its amount and sources of investment.
The plan consists of the main part and appendices.
The main part of the plan includes sections:
1. Development of the material and technical base of healthcare.
2. Training and advanced training of personnel.
3. Preventive work.
4. Organization of detection of socially significant pathology.
5. Improvement of diagnostic, medical, rehabilitation care and introduction of modern technologies.
6. Sanitary - hygienic education.
7. Scientific research.
8. Monitoring the implementation of the plan.
Applications should be a set of the following documents:
- Analytical information about the state of medical care to the population and the activities of health care institutions at the time of the development of the Plan.
- Report on the implementation of the Plan and targeted programs for the previous year.
- Conceptual provisions for the strategic development of health care for the long term.
- A list of the main planned indicators (landmarks) and justification of the likelihood of their achievement in the planning period.
- Draft regulatory documents required for the implementation of planned activities.
- Projects of new targeted comprehensive programs to address interdepartmental problems.
1. Development
material and technical base of healthcare
The section on the development of the material and technical base of health care covers measures to strengthen and maintain the fixed assets of health care institutions (buildings, vehicles, supply systems, technical and medical equipment, inventory), as well as a list of measures as part of the implementation of the strategy for restructuring the medical care system.
As the main activities for the first subsection, the following can be planned:
- construction of new institutions, buildings;
- carrying out capital and current repairs of buildings, premises;
- landscaping works;
- development of the vehicle fleet;
- technical re-equipment and updating of obsolete equipment, etc.
The second subsection may include activities for:
- liquidation (re-profiling) of low-capacity hospitals, not staffed with medical personnel, poorly equipped, medical institutions;
- strengthening the outpatient-polyclinic link through the opening of new institutions, offices, receptions, the development of new forms of service in polyclinics;
- introduction of hospital-replacing technologies (day hospitals, day hospitals, hospitals at home);
- differentiation of the bed fund according to the intensity of the medical and diagnostic process, the creation of beds (departments) for nursing care, hospices, the formation of institutions or departments of a medical and social nature.
Specification of planned targets should be carried out in accordance with the strategic goals of regional and municipal healthcare systems aimed at reorienting medical care from the inpatient to the outpatient level. Attention should be paid to the expediency of not only strengthening, but also modernizing the diagnostic, laboratory and rehabilitation base of outpatient clinics, opening specialized rooms for the profiles of medical specialties that meet the real needs of the population, changing the nature of the activities of existing rooms in accordance with the introduction of new medical technologies. services (outpatient surgery, specialized day hospitals, preventive units, etc.).
The urgency of the problem of supplying medical institutions with consumables also justifies the expediency of reflecting the methods of its solution in planning documents.
2. Training and advanced training of personnel
This section of the Plan includes a list of the main activities for the preparation medical personnel and other healthcare professionals (economists, accountants, medical equipment maintenance technicians, etc.):
- targeted training of specialists based on targeted orders from regional and municipal governments;
- advanced training of employees at central bases, in the GIDUV system, in foreign medical centers and other educational institutions with a break from work;
- advanced training on the job at cycle, intermittent, full-time - correspondence courses, seminars;
- holding medical and nursing conferences, congresses, meetings;
- organization of professional competitions;
- Participation in organizing the work of scientific societies.
The work on personnel training is planned by the organizational and methodological departments in coordination with the personnel health services in the region (municipality).
3. Preventive work
Planning of preventive work provides for the formation of a list of activities for the following subsections:
- vaccination;
- chemoprophylaxis;
- measures in the foci of infection;
- activities at agricultural facilities (livestock, dairy farms, etc.).
All activities included in this section of the Plan are carried out in contact with the state sanitary and epidemiological surveillance authorities in accordance with the current instructions and methodological recommendations according to the established schedule.
4. Organization of detection of socially significant pathology
Measures to organize the identification and medical examination of the population with socially significant diseases (tuberculosis; HIV / AIDS; sexually transmitted diseases (STDs); various forms of drug addiction; mental disorders) include:
- annual examination of contingents subject to periodic examinations and dispensary observation;
- accelerated clinical examination of persons with identified pathology;
- practical assistance of regional (district) institutions in surveying the population of districts;
- registration of the examined and police records of the identified pathology;
- conducting systematic consultations on the detection of diseases and the provision of advisory assistance on the diagnosis, treatment and rehabilitation of this group of patients, including in regional, district and central specialized institutions.
The plan is built in the context of the type of pathology in the listed areas of work.
5. Improving diagnostic, therapeutic,
rehabilitation assistance and the introduction of modern
technologies
The main directions of organizational activities of this section include:
- monitoring the quality of diagnostics and treatment based on the results of consultations conducted by highly qualified specialists in regional (municipal) institutions (subdivisions), as well as during visits to subordinate healthcare institutions;
- regulation of taking for dispensary observation and control of contingents of prophylactic patients;
- organization of centralized control over the correctness of registration of death certificates.
Planning can be carried out according to the objects subject to control (institutions, services, divisions, specialists), according to the forms of control (conducting an expert assessment of medical documentation), according to indicators characterizing the state of the care process (implementation of individual treatment plans, provision of successive medical care, timely hospitalization , consultation, on the validity of the selection of patients for treatment in institutions of a different level, on hospital-replacing technologies), on the activity of medical intervention (surgical treatment), on the results (restoration of the working capacity of patients, timeliness of referral to MSEC) and in the context of other performance indicators.
The implementation section highlights modern technologies for prevention, diagnosis, treatment, rehabilitation to be introduced into the activities of healthcare institutions and relevant organizational measures for implementation.
6. Sanitary and hygienic education
Activities covering health education may include:
- creation, distribution, control of activities, development of various organizational forms of health education of the population - "Health Universities", "Health Schools" in polyclinic institutions, "Schools for Convalescents" for inpatients;
- preparation of a profiled sanitary asset for the care of patients at home, primarily from among relatives;
- use of various forms of mass dissemination of hygienic knowledge among the population (speeches in the media, organization of exhibitions, publication of educational materials);
- organization of meetings with medical workers (lectures, conversations, explanations, recommendations);
- Spread modern forms attracting the population to a healthy lifestyle.
7. Scientific research
The planning of scientific research topics is carried out in accordance with the applied tasks of practical health care, which may include certain issues of public health, the provision of medical care and the development of strategically important directions for the development of the regional (municipal) health care system.
The process of preparing the draft Plan and its procedure
acceptance
The plan is developed with the participation of the main specialists of the corresponding level and, upon completion of the development, is endorsed by them. The purposefulness of plans and the effectiveness of planned targets depend on the correctness of setting goals, the choice of strategies for achieving them, and the concentration of efforts on the selected priorities.
Regional priorities for the development of medical care for the population are determined in accordance with the directions of state policy in the field of public health, taking into account regional characteristics and resource opportunities. Despite the regional differences in most subjects of the Russian Federation, the main areas are similar - tuberculosis; HIV AIDS; diabetes; vaccination; safe motherhood and childhood.
The plan of organizational and methodological work of the republican, regional, regional hospital, CRH is a structural component of the unified plan for the development of regional (municipal) health care, which determines the hierarchical system of long-term and current planning of the activities of governments and health care institutions of the region (municipality).
The procedure for adopting the plan includes its discussion at the medical council of the institution, either as an independent issue, or as an integral part of the discussion of the results of the institution's work, the progress in the implementation of targeted programs over the past period. The regulation of the procedure for adopting the plan provides for mandatory participation in the discussion of representatives of the apparatus of the health management body of the appropriate level, and for the Central District Hospital - representatives of the district administration. The optimal level of hearing for regional institutions is the collegium of the health authority, if the plan concerns only medical activities, and the regional government, if the plan is comprehensive.
After discussion, the comprehensive plan is approved by the head (deputy) of the administration of the corresponding level, and if the plan is intradepartmental, then by the head of the relevant health management body. The approved plan is a guiding document that is mandatory for execution.
8. Monitoring the implementation of the plan
The current control over the implementation of the plan by quantitative and qualitative criteria is carried out by the organizational and methodological department (office) of the organization that compiled it.
Sections of the plan, which provide a list of activities, levels of their implementation, deadlines, responsible, dates of planned execution, it is advisable to supplement columns for dates of actual execution and costs for their implementation. For control use the data of the state statistical reporting. It is verified on the spot by district curators during scheduled visits.
Transparency of activities is ensured by simultaneous public hearing of the curator and persons responsible for carrying out the planned events.
It is methodologically more effective to hear not one district on the maximum possible number of questions, but several districts on one issue. This makes it possible to cover the problem in a multifaceted way and choose the best approaches to its solution, arising from the accumulated practical experience.
An important instrument of control is the semi-annual (depending on the importance of the issue) interim hearing of the implementation of the plan in the health management apparatus of the region and the administration of the territory.
Examples of private hearing questions include:
- organization and effectiveness of examinations of the population and clinical examination;
- treatment of patients with chronic diseases;
- carrying out anti-epidemic measures;
- about the role of regional institutions as organizational and methodological centers;
- information about teaching aids;
- analysis of the work of institutions, etc.
Final report on the implementation of the plan
The final report on the implementation of the plan is compiled either in tabular or descriptive form by sections of it and includes the following headings:
- planned tasks to be solved;
- Baseline indicators at the beginning of the planning period;
- activities carried out (a, b, c, etc.);
- results of the current year;
- efficiency mark.
According to the report, an explanatory note is drawn up with an analysis of the results achieved, and in the absence or insufficient effectiveness of the measures taken, with an analysis of the causes, a critical assessment of the defects in the implementation of measures and possible measures to improve their quality.
A report on the implementation of measures according to the plan of organizational measures by the departments of the institution that supervise subordinate medical and preventive institutions is provided at the request of the organizational and methodological department (office) in deadlines according to the profile of the department, indicating the performers in the following aspects:
- preparation of questions for hearing at meetings, collegiums of the administrative apparatus (scheduled / unscheduled, level);
- writing business reviews on the profile of departments;
- release of methodological materials for the curation area (which ones);
- pedagogical work (courses, seminars, lectures, individual training of specialists);
- business trips to supervised territories (where, purpose, duration, scheduled / unscheduled, brigade / individual, what kind of assistance was provided);
- participation in meetings, conferences, congresses, etc. (which ones, the topic of the speech, the level of regional, interregional, international).
When analyzing the progress of the plan, they strive not so much to set new tasks, but to determine the effectiveness of already known approaches to solving the set ones.
Organizational and methodological assistance to institutions
health care
Organizational and methodological activities are carried out by the leading (head) institutions of the federal, regional and district levels of health care and it consists in providing practical assistance to supervised services and health care institutions on a wide range of issues related to the organization and improvement of the quality of the treatment and diagnostic process, improvement of prevention, technological improvement of activities , optimization of management, including improving the level of planning.
Institutions of federal subordination provide planned assistance primarily to institutions at the regional level, but, if necessary, at the level of districts. Leading institutions of the regional level provide organizational and methodological assistance to municipal institutions, practically help both the Central District Hospital (inter-district centers) and primary medical care institutions.
Diagnostic, therapeutic and rehabilitation medical care for patients who apply to institutions is regulated by the job descriptions of the relevant departments and the internal regulations of the institution. The plan of organizational measures coordinates the organizational, methodological and practical assistance provided by employees of all departments of the institution to supervised institutions both directly on the basis of the institution and during field trips. It outlines the terms of reference for the performance of the department's (office) own work.
The organizational and methodological department (office) of the leading (head) health care facility is designed to solve mainly three large blocks of tasks:
1. Formation of commissions and mobile teams from the employees of the institution. Organization of a planned departure of curators and teams of curators to the districts of the territories, inter-district centers for organizational, methodological, advisory and practical assistance; listening to their reports, taking into account the work done, creating and maintaining a regional card file of recommendations.
2. Development of materials of strategic (program), operational (plans), directive significance (orders) for the administrative apparatus of the regional (for regional institutions) or district level (for the Central District Hospital):
- to control the implementation of directive documents of the administrative apparatus of the federal, regional, district, municipal levels;
- on organizational support of the work of municipal councils, commissions (together with the administration of the institution, allocated responsible);
- to popularize best practices in improving the health of the population (together with leading experts).
3. Drawing up a consolidated annual report, analyzing it, drawing up conclusions based on the results of work, market reviews, collections of the main indicators of the work of medical institutions and public health (with the participation of leading experts).
Organization of on-site medical care for residents
rural areas
The low density of the rural population, employment in personal subsidiary plots, seasonality and urgency of the main agricultural work, the remoteness of medical (especially specialized) care from the places of residence of patients, the poor development of transport communications at significant distances, the high cost of travel - all this reduces the level of appeal and hospitalization of the rural population .
Unsatisfactory working conditions in the agricultural sector, in most industries that do not meet sanitary hygiene requirements due to non-compliance with sanitary norms and rules, they contribute to the emergence of diseases, which, with low detection and insufficient treatment, leads to the development of advanced cases, chronic pathology, and high mortality. Brucellosis, intestinal infections, diseases of the musculoskeletal system, diseases of the respiratory organs (dust bronchitis), vibration disease are more common in the countryside than in cities. This implies the need to intensify visiting forms of organizational, advisory and practical assistance from regional and inter-district institutions. At the same time, one should take into account the long separation of qualified specialists from the performance of their duties in their main work, the disorder of their life when they leave, irregular working hours.
Emergency and emergency care for patients with complex pathologies, in particular, requiring surgical interventions, is provided year-round by the department of emergency and planned advisory care of regional (regional, republican, district) hospitals or the Center for Disaster Medicine by means of air ambulance (airplane, helicopter) or fixed vehicles. 27% of rural residents in the population account for more than 67% of patients served by air ambulance. The average national indicator is 1.7 departures per 1000 rural population, the maximum level reaches 4.4.
Planned care is provided to specialists of the Central District Hospital, curators, specialists from hospitals and consultative polyclinics of the constituent entities of the Russian Federation.
To provide assistance to rural healthcare facilities, by order of the regional health management authority, both full-time and freelance specialists from regional (regional, republican) institutions are assigned to district and city healthcare facilities - hospitals (adults and children), a maternity hospital, dispensaries, centers for combating AIDS and medical prevention , State Sanitary and Epidemiological Supervision, as well as inter-district diagnostic and treatment centers.
The volume and nature of planned assistance to health care institutions for serving the rural population depends on the type of supervising institution and its financial capabilities. The provision of highly qualified specialized care is provided by the departments of emergency and planned advisory care of regional clinical hospitals.
All these structures provide assistance to the Central District Hospital, district hospitals, district hospitals, rural outpatient clinics, FAPs and feldsher points, nursing care hospitals, and district ambulance stations.
The content of assistance provided by regional institutions to district ones is:
- coordination of health care management;
- implementation of strategic decisions of the healthcare management apparatus;
- systematization of organizational and methodological work of municipal health care systems;
- practical assistance to the management and specialists of the Central District Hospital, other institutions of the municipal level;
- strengthening of intradepartmental quality control of medical care;
- strengthening expert work at all levels;
- holding seminars, etc.
The main tasks of the curators when visiting the districts are to determine how the agreements between the administration of the municipality and the regional health authority in the field of public health are being implemented; board decisions and orders; how the security regime is observed in the health care facility of the district. The curator provides organizational and methodological assistance and introduces standards of medical care, organizes control over their observance.
Chief specialists of regional institutions should introduce modern technologies and disseminate best practices. In addition to the visits of the main specialists, the curation of rural health facilities is carried out by specialists from regional institutions and departments of higher educational institutions of a medical profile.
In the constituent entities of the Russian Federation, various organizational forms of assistance are used by institutions of regional subordination to medical and preventive institutions of the districts. The division of assistance by type is conditional. One can only talk about the prevalence of one or another component: expert-advisory, organizational-methodical or directly practical participation in the treatment-diagnostic process.
Advisory assistance on the issues of diagnosis, treatment and rehabilitation of patients is provided in the clinics of the Central District Hospital, in district hospitals, at home, in a hospital. Noteworthy is the experience of the Novosibirsk region in organizing round-the-clock support by the Center for Remote Electrocardiography on the basis of the regional hospital for diagnostic and advisory work in all districts of the region and some district hospitals. In the Stavropol Territory, on the basis of inter-district deaf rooms and large central district hospitals, mobile teams of specialists from the centers of audiology, hearing aids and phoniatrics of the clinical hospital work.
Organizational and methodological assistance is provided by the main full-time and freelance specialists of the regional (territorial, republican, district) level. The most experienced, highly qualified specialists are involved in field work.
On the instructions of the administrative apparatus of the region (krai, republic, district), in the course of preparing medical councils, visiting collegiums, meetings, conferences, the quality of medical care for the rural population in municipal institutions (CRH, UB, FAPs) is controlled; the material-technical and personnel potential, the possibilities of licensing the services of the Central District Hospital are being studied; the results of responding to public complaints are monitored. At the same time, methodological assistance is also provided.
Visiting hospital medical councils with the participation of the heads of administrations and the medical community of the districts justify themselves, at which the results of an expert assessment of the activities of the district services according to a unified methodology are discussed, and consultative reception of patients by specialists of regional institutions is organized.
In order to improve the quality of nursing, to ensure normative acts with the participation of representatives of the regional Council of Sisters, conferences and inter-district reviews are organized (for example, in the Kursk region).
With the participation of the teaching staff of the departments of medical institutes, academies, universities, field conferences are held, incl. scientific - practical, seminars, meetings.
In the course of providing mainly practical assistance, complex, targeted, preventive examinations and medical examinations of the population are organized, expeditionary trips are carried out. The CRH specialists monthly examine the population served by district hospitals and FAPs.
Practical value has the participation of specialists from regional institutions in the work of draft commissions.
In the Stavropol Territory, experience has been gained in servicing people involved in harvesting. During the period of field work in the countryside, mobile teams are assigned to the field camps for preventive examinations of machine operators, field farmers, sanitary and educational work to prevent injuries, poisoning, and infectious diseases.
Teams of doctors from the Perinatal
center of the Lipetsk region for examination of women of childbearing age with
risk factors and pregnant women.
Of great practical importance are planned surgical operations, incl. outpatient, selection of patients for additional examination and treatment in adult and children's regional institutions.
Possible forms of field work:
- individual visits of specialists are often unscheduled - at the request of the municipal health care facility; the practice of emergency calling of the necessary specialists at the request of the head physician of the institution is expanding at the expense of the host;
- departures of brigades of 2-5 specialists (adults and children), who are given preference in planned work, as they are more cost-effective compared to individual visits; in the structure of trips - brigade 77% versus 23% - individual;
- mobile (field) outpatient clinics (polyclinics): the teams formed in their structure serve adult patients and children according to the plan approved by the chief physician and coordinated with the territorial health authorities.
This form of public service is firmly established. A team of 5-7 specialists is assembled taking into account the wishes of the districts and works on average for four days (the first and fourth - in the Central District Hospital, one each - in district hospitals). The population is notified in advance about the composition of the brigade through the media (regional newspapers, radio), through paramedics.
AT Voronezh region in the structure of planned outreach assistance, consultations account for 84.7%; participation in interdistrict conferences, seminars, meetings - 6%; educational and methodological assistance - 4%; on instructions from the main health department - 2.2%; conducting comprehensive inspections - 1.75%; licensing of healthcare facilities - 1.3%. Single trips - 33.8%. The share of trips of the main freelance specialists amounted to 6.2%.
On average, the strength of mobile teams consists of 5-6 people: specialists in therapeutic, surgical, pediatric, obstetric-gynecological, paraclinical profiles, in organizational and methodological work, a neurologist, an ophthalmologist. The composition of the team of specialists is completed taking into account the interests of the region, if necessary, it is expanded at the expense of other specialists, in particular, phthisiatricians, dermatovenereologists, etc.
In preparation for a planned trip to the regions of the region, an analysis of the epidemic situation in the region is carried out; study of the quality and effectiveness of outpatient care, in particular for the rural population, by levels (regional institutions, Central District Hospital, rural outpatient clinics); assessment of staffing of doctors and nursing staff, their qualifications.
In the districts of the region, before the arrival of the brigade, a flow of patients is formed, mainly a dispensary group, as well as groups for receiving prompt assistance from an ophthalmologist, traumatologist, oncologist at the rate of 2-3 operations per visit. It is necessary to equip traveling teams with equipment for examination and treatment of adults and children.
During the visit, patients are examined in the central district hospital, and, if necessary, at FAPs, in rural outpatient clinics and district hospitals.
The duration of travel work ranges from several hours to 10 days, averaging 2.4 days. According to the Samara region, each specialist has the opportunity to consult from 30 to 50 people in two days of work. At the same time, according to the data of the Republic of Khakassia, a consultation with a mobile team specialist costs 2.5 times more than a consultation with the same specialist, but in a consultative polyclinic.
The practice of replacing, at the request of the head physician of the corresponding health facility, for a long time (from 7 to 35 days) the absent specialists of the Central District Hospital, mainly of a surgical profile (vacation, study, specialization), is increasingly being used.
According to the plan - schedule, employees of the Central District Hospital provide assistance to the population assigned to district hospitals, medical outpatient clinics, FAPs. The brigades are staffed with CRH doctors in such a way as to provide from 6 to 12 trips to the rural area per year; they most often include a pediatrician, gynecologist, therapist, neurologist. During the trips, the specialists of the Central District Hospital provide, first of all, advisory assistance, first of all, to pregnant women and children. The number of consultations usually ranges from 25 to 30 per visit.
Dispensary observation of patients with peptic ulcer, diabetes mellitus, gastritis, nephritis, rheumatic heart disease, rheumatoid arthritis, etc. requires special attention. Purposeful departure of the brigade 2-3 times a year allows you to examine almost the entire dispensary group. During the visit, patients are also selected for therapeutic and surgical treatment in the Central District Hospital and in regional institutions, and in some cases practical assistance is provided directly on the spot. It is mandatory to analyze the work of rural medical workers, monitor the course of dispensary observation, the course of treatment after the previous consultation, and also give recommendations for improving medical care.
The introduction of telecommunication technologies makes it possible to use new principles for the transfer of medical information between clinical centers and the Central District Hospital, and contributes to the development of "Internet" technologies. The prospective value of this direction for public health is undoubtedly, although the organizational experience of its implementation and use is only accumulating.
It is also possible to work in such a form as visiting paramedical stations in order to ensure monitoring of patients in hospitals at home in sparsely populated areas, to deliver the necessary medicines to patients.
When assessing the nature and volume of organizational and methodological assistance, the following are taken into account:
a) information and analytical assistance in the preparation, publication and distribution of various materials: methodological recommendations, information letters, collections of health and work indicators, bulletins; preparation of reference materials at the request of higher organizations; information for health education of the population and patients through the media, incl. nosocomial, with the help of special stands;
b) consultations and participation in preventive examinations of the population, separately for adults and children, separately for the specialists involved in providing assistance, areas and the number of trips; the number of those examined with instrumental methods (endoscopy, ultrasound, ECG, etc.) is also taken into account.
The technical report of specialists is compiled in sections:
- inspected everything;
- of them sick were revealed;
- incl. with a diagnosis for the first time in life;
- outpatient treatment is recommended at the place of residence;
- inpatient treatment is recommended at the place of residence;
- sent to regional polyclinics for further examination;
- sent to regional polyclinics for dispensary registration;
sent to regional hospitals.
Efficiency of using the method
The recommendations are a generalization of the experience of organizational, methodological and field work of 42 administrative territories of the Russian Federation and the Southern District Medical Center of the Ministry of Health of the Russian Federation with 24 branches.
In the course of the analysis, it was found that among the main problems of organizational and methodological work to protect the health of the population of the administrative territories of the Russian Federation, the problem of qualification of personnel of organizers - methodologists is relevant. Its appearance is associated both with defects in basic training and improvement, and with a lack of information and methodological materials in the specialty.
Serious objective difficulties in organizing outreach assistance to municipal and district institutions are exacerbated by shortcomings in the organization, in particular, the lack of continuity in the outreach work of specialists from regional institutions of various profiles due to imperfect coordination of their activities in the districts.
Significant reserves for improving organizational work have been identified. So, if on average 0.48% of the financial support of the institution is spent on organizational and methodological work, then in a number of territories the funding is much higher (almost twice), indicating the recognition of the importance of this activity (the republics of Buryatia, Udmurtia, Khakassia; Kamchatka, Ulyanovsk regions, Yamalo-Nenets Autonomous Okrug). The structure of expenses for organizational and methodological work, the approximate level of service for the rural population by air ambulance has been established; proposals were made on the formation of field teams, the duration of field work.
All this makes it possible to improve the quality, efficiency and accessibility of medical care, primarily to the rural population.
Thus, a team of 6 specialists from the Voronezh Regional Clinical Hospital No. 1 travels according to the schedule once a week in a Gazelle utility vehicle for a distance of 50 to 300 km on average for one day. If the area is remote, the duration of the business trip is determined by the time spent on the road and the amount of work to be done.
Multidisciplinary teams of an average of 4 employees of the Southern District Medical Center of the Ministry of Health of the Russian Federation perform up to 7 trips per year with a range of 500 km to subordinate medical and preventive institutions of the Azovo-Volga-Don water basin to provide planned advisory assistance for an average of 2 days.

Appendix No. 1
CURATOR'S FOLDER OF MUNICIPAL INSTITUTIONS AND REGIONS
ADMINISTRATIVE TERRITORIES
The dossier on municipal and district health institutions includes sections:
1. Assessment of the health of the population of the city, district.
The section contains information about the demographic situation in the region, performance indicators of the municipal health management body; performance indicators of the municipal health management body according to the annual report. Materials of previous checks, recommendations. Written appeals from citizens.
2. Material and technical base.
The structure of municipal health care. state of institutions. Prospects for medical and technical equipment. Adaptation of the provisions of the concept of healthcare development at the level of the city, district.
3. Compliance with the security regime of health facilities.
The section reflects the results of inspections of the condition of buildings and its premises for the presence of suspicious foreign objects, the possibility of entry of foreign vehicles; checking the integrity and safety of seals and seals, locks in unused premises.
Leasing of buildings, structures and premises of healthcare facilities is recorded.
Interaction with ATC authorities is specified in terms of notification of cases of penetration of unauthorized persons into the territory or into the premises of health facilities; identification of persons undergoing inpatient treatment, whose identity is not confirmed by documents; treatment of persons with injuries and wounds, not excluding criminal origin, correction and instruction of the on-duty personnel of the institution to medical facilities.
In case of emergencies, the round-the-clock readiness of medical facilities to provide assistance to victims with injuries and burns, the presence of an irreducible supply of medicines and consumables are checked; composition, addresses and telephone numbers of teams to strengthen the duty service, the procedure for notifying and gathering employees in healthcare facilities.
Finally, the presence of an order from the hospital to limit visits of patients with relatives until 18:00 is being clarified.
4. Provision of the population with doctors and paramedical workers.
Of particular importance are the following questions: staffing of the administrative apparatus; work with a reserve; availability of job descriptions for employees (duties, rights, responsibilities); provision of housing for health workers; control of the personnel development plan (conferences, seminars, improvement courses).
5. Availability of organizing orders and control over their execution.
6. The state of fire safety (the presence of an order, a fire prevention plan, instructions, briefing, availability of fire extinguishing equipment).
7. Compliance with safety regulations: creation of an attestation commission for labor protection; the presence of an introductory briefing log when applying for a job; instructions; measuring the resistance of the ground loop and electrical wiring insulation; availability of an order for employees responsible for electrical facilities; operation of the oxygen economy under pressure.
8. Work with the administration of the city, district to protect the health of the population. The effectiveness of interdepartmental commissions on socially conditioned diseases.
9. Implementation of the decisions of the collegium of the territorial health authority.
10. Organizational and methodological work.
The section provides data on the distribution of responsibilities between officials; information support of the institution; the work of the medical council; control over the execution of directive documents; indicators and analysis of the activities of the institution for three years; availability of an approved plan of the main activities of the institution for the current year with annexes (holding a medical council, medical conferences, introducing new technologies, the work of mobile teams); work with the recommendations of specialists from regional institutions, incl. on the implementation of the Concept for the development of healthcare in the region; control over the implementation of existing orders.
11. Compliance with the sterilization and disinfection regime in the institution.
12. Therapeutic and preventive care.
Contains materials to evaluate:
a) the quality and availability of outpatient care:
- introduction of new technologies and forms of medical care (day hospitals, hospitals at home, day hospitals);
- the work of prevention and rehabilitation departments, the conversion of beds in district hospitals into nursing care departments, for the treatment of patients according to medical and social indications, medical outpatient clinics with a day hospital; timely transfer of patients in need of medical social assistance in houses - boarding schools;
- mode of operation of the institution; provision of paid services to the population, enterprises, organizations;
- continuity in the examination, treatment and rehabilitation of patients between the clinic and the hospital;
- restructuring of the hospital bed fund;
- equipping the hospital with diagnostic and medical equipment;
- a system of emergency care, hospitalization and discharge of patients;
- organization of drug supply;
- organization of resuscitation care for women and children, analysis of indicators of maternal and child mortality;
b) a system for controlling the circulation of narcotic drugs: an order, a permit from the Ministry of Internal Affairs, storage, a register of narcotic drugs and psychotropic substances in accordance with the requirements of the Ministry of Health of the Russian Federation; acceptance and destruction of used ampoules, the work of the commission on the use of narcotic and psychotropic substances; work with special prescription forms.
13. Organization of the quality of work of emergency and emergency medical care.
14. Organization of the work of the municipal health management body in the conditions of CHI and VHI:
- protocols of the licensing and accreditation commission, plan and implementation of recommendations;
- control of terms and quality of treatment of the insured;
- itemized monthly use of budget funds and CHI.
15. Implementation of standards for the volume and quality of medical care at various stages and levels of healthcare facilities of the city, district.
16. The work of the clinical - expert commission.
17. Work of auxiliary services (laundry, communication, transport).
18. Sanitary condition of health care institutions.
19. Conclusions and suggestions.
Note: When developing Appendix 1, the order of the Ministry of Health of the Saratov Region N 101-p dated 01/20/2001 "On supervision of municipal health care institutions of cities and districts of the region, regional health care facilities by the Ministry of Health for 2001" was used.

Appendix No. 2
REPORT
ABOUT THE SCHEDULED (UNSCHEDULED) DEPARTURE OF THE CURATOR (SPECIALIST)
TO PROVIDE METHODOLOGICAL AND PRACTICAL ASSISTANCE
MUNICIPAL, REGIONAL HEALTH INSTITUTIONS
1. Full name, position, place of work.
2. Date of departure.
3. Settlement, institution, which received assistance.
4. The purpose of the trip: the introduction of new methods, technologies; education; practical help; conducting inspections.
5. Results: filled in in accordance with the headings of the Curator's Folder within the competence of the specialist.
The nature of the help for the section:
- organizational and methodological work includes the results of inspections of outpatient, inpatient facilities, emergency medical care according to statistical indicators, according to ongoing documentation, standards for patient management, etc.;
- medical and advisory work - the number of consulted by age groups, industry, operations, manipulations, benefits is indicated;
- pedagogical work - its type is noted: lecture, conference, seminars, practical classes; topic, number of participants.
6. Recommendations.
The report is drawn up in duplicate and certified by the signatures of the seconded specialist and the heads of the institution to which assistance was provided. One copy remains in the health facility to implement the recommendations, the other is transferred to the organizational and methodological department of the institution that sent the employee on a business trip.

Important structural unit the central district hospital is organizational and methodological office, whose work is aimed at providing methodological guidance: analysis of the activities of medical institutions, implementation of measures to improve the quality of medical and preventive work, advanced training of specialists, organization of work on medical statistics and assessment of public health, study and dissemination of new modern forms of work on medical care, advanced planning health care development of the district, organization of work on extrabudgetary commercial activities and health insurance. The organizational method cabinet should be staffed by the most experienced medical specialists. Providing methodological guidance for accounting and statistical work and monitoring it of all institutions of the district is the most important function of the organizational method cabinet. The duties of the cabinets include receiving annual reports. On the basis of these reporting forms and a special analysis, the organizational methodical cabinet draws up an overview of the state of health various groups population* assesses health indicators. The organizational method rooms should contain information about district conferences and classes with doctors and paramedical personnel, about seminars with the participation of district specialists, specialization and advanced training of medical workers (which in rural areas should be held once every 5 years). Every month, quarterly, the office calculates the main indicators of the work of each medical institution.
An analysis of the qualitative indicators of activity in the Central District Hospital and in the district is carried out with the development of measures to improve them. Specialists organizational method of the department regulations are drawn up on the work of public councils of hospitals, on joint activities with deputy commissions on health with the work of the Red Cross societies, associations of medical workers, etc. An important task is to improve labor activity medical workers, reviewing their professional duties and job descriptions in relation to the types of medical activities, legal protection medical workers. bird).

73. Regional medical institutions, regional (regional, republican) hospital - structure and tasks in improving the medical provision of the population. The role of organizational and methodological departments. Republican dental clinic.

Regional Hospital is scientific, organizational, methodological and training center healthcare. Its main functions are: provision of highly qualified, specialized, consultative outpatient and inpatient medical care; provision of organizational and methodological assistance to medical institutions and emergency medical care modern means sanitary transport, up to air ambulance; management and control over statistical accounting and reporting of medical and preventive institutions of the region; analysis of indicators of morbidity, disability, general and infant mortality in the region, development of measures aimed at their reduction; carrying out activities for the specialization and improvement of doctors, paramedical personnel; introduction of new technologies and management methods, implementation of expert functions. Structural divisions of the regional hospitals are: a hospital, a consultative polyclinic, clinical and diagnostic units, medical and diagnostic, organizational and methodological departments with a department of medical statistics (in a number of hospitals - departments of clinic-expert and organizational and economic robots), an emergency department and; planned advisory medical care, a boarding house for patients, a hostel for medical workers. The chief specialists of the regional health committee (chief surgeon, internist, pediatrician) and freelance regional specialists (most often heads of specialized departments) take part in the organizational and methodological work of the medical institutions of the region. The bed capacity of the regional hospital depends on the population of the region. The most expedient and cost-effective regional hospitals for 700-1000 beds.

Organizational and methodological rooms function in many large polyclinics. However, analysis regulatory framework, regulating the activities of organizational and methodological rooms (departments) of polyclinics, revealed a number of inconsistencies. Thus, the order of the Ministry of Health and Social Development of Russia dated May 15, 2012 No. 543n “On approval of the Regulations on the organization of primary health care for the adult population” does not provide for the presence of a doctor-methodologist and medical statistician in each polyclinic. At the same time, orders of the Ministry of Health and Social Development of Russia dated November 22, 2004 No. 255 “On the Procedure for the provision of primary health care to citizens eligible for a set of social services”and dated November 22, 2004 No. 256 “On the Procedure for Medical Selection and Referral of Patients to Sanatorium-Resort Treatment” indirectly provide for the presence of such specialists. According to the orders, the organizational and methodological office of the polyclinic is entrusted with the mandatory functions of monitoring the medical care provided to citizens who are entitled to receive a set of social services.

It is noteworthy that the work on the systematization and processing of accounting and reporting data medical organization carried out by professionals with an average medical education- medical statistics. In accordance with the order of the Ministry of Health and Social Development of Russia dated July 23, 2010 No. 541n “On approval unified directory positions of managers, specialists and employees, section “ Qualification characteristics positions of workers in the field of healthcare”” the duties of a methodologist doctor include the calculation of indicators of the health of the population and indicators of the activities of a medical organization, departments. Therefore, the methodologist of the organizational and methodological office can and should coordinate and control the activities medical statisticians. The table shows the provisions of the regulatory and administrative documents governing the functioning of the organizational and methodological office of the clinic. In order to illustrate the "functional interface" of the duties of a methodologist (with a higher medical education) and a medical statistician (with a secondary medical education), the duties of these specialists are presented.

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Regulatory requirements for the activities of the organizational and methodological office of the polyclinic

Functions and states organizational and methodological office (division) of the polyclinic

Russian health care has undergone significant changes over the past decade. Organizations providing primary health care under the program of state guarantees of free medical care must carry out their activities on the basis of the requirements of the law, primarily the Federal Law of November 21, 2011 No. as well as the needs in terms of organizational and methodological support, taking into account the capacity of the polyclinic and the staffing of medical personnel.

Based on our experience, in our opinion, organizational and methodological office (division) of the polyclinic(with the number of attached adult population of at least 100 thousand people) must carry out the following functions:

1. Analytical work to assess the state and dynamics of the organization's development, analysis of the medical and demographic situation, collection of information on environmental factors that affect the formation of public health.
2. Maintaining and improving the system of accounting and reporting on the activities of the organization, monitoring the health status of the assigned population; coordination of activities of medical statisticians.
3. Participation in the development of long-term and current plans for the activities of a medical organization, monitoring and evaluating the effectiveness of the polyclinic, specialists (by position, structural divisions, etc.).
4. Implementation and implementation of the system internal control quality and safety of medical activities (quality management of quality control of medical care at the organization level).
5. Determining the needs of medical personnel in various forms lifelong learning; planning with personnel service measures to improve the skills of medical workers; organization and holding of conferences, seminars; informing the staff about the fulfillment of planned targets (government order); clarification of the reasons for not achieving the threshold values ​​of the indicators and the development of measures to eliminate them.
6. Organizational and methodological support for working groups formed on behalf of the medical commission to prepare draft organizational and administrative documents for managing the quality of the polyclinic.

Physicians-methodologists of the organizational and methodological office should ensure monitoring and control of the effectiveness of the following types works (services):

1. Provision of state social assistance to citizens entitled to receive a set of social services (drugs, sanatorium and rehabilitation treatment), as well as medical examination of the population, immunization, dispensary observation for socially significant diseases. Preventive help. Analysis and assessment of population satisfaction with medical and social care.
2. Control of the volume and quality of the treatment and diagnostic process. The activities of the medical commission. Participation in the work of rationing the work of medical workers, taking into account specific organizational and technical conditions. Evaluation and analysis of the use of the working time fund by position. The use of scientifically based methods of labor rationing using mainly the calculation and analytical method. Analysis and assessment of public satisfaction with medical care in the treatment of socially significant diseases.
3. Development of hospital-replacing technologies. Analysis and evaluation of the economic, medical and social effectiveness of the use of hospital-replacing technologies, including rehabilitation treatment. Analysis and assessment of population satisfaction with hospital-replacing types of medical care in a polyclinic.
4. Diagnosis of motivational problems of staff, for example, monitoring dynamics motivational profile employees, expectations of employees regarding the properties and personality traits of the manager, monitoring staff satisfaction professional activity. In this plane of tasks, methodological support includes conducting sociological surveys and testing personnel.

When approving the staff of the organizational and methodological cabinet (department), it should be borne in mind that the number of positions to be introduced must be calculated taking into account:

• volume and quality of work;
• specific organizational and technical conditions
• the possibility of staffing the positions being introduced by individuals;
• the need for their rational use.

A regulation on the organizational and methodological office (department) should be developed, job descriptions and functional duties of medical personnel, additionally introduced into the staff of the polyclinic of methodologists and medical statisticians, should be approved. An important condition is economic justification expediency of introduction of positions; submission of calculations of labor costs to determine the need for positions and the number of personnel of the organizational and methodological office (department); carrying out organizational and other measures that ensured internal sources funds for additional posts; redistribution functional duties management personnel taking into account the change in the scope of work with the introduction of positions of methodologists.

The organizational structure of the polyclinic management, formed taking into account the necessary division of managerial labor to fulfill the goals and objectives set by the management, provides for a high level of independence of the head of the organizational and methodological office and, as a result, responsibility for the proper performance of the managerial functions assigned to him. The diagram shows one of the elements organizational structure polyclinics, which determines the relationship between the leaders who provide the main activities of the medical organization.

Conclusion

Achievement of medical, social and economic efficiency the work of the clinic is determined by a variety of factors, including external and intrinsic motivation personnel, their qualifications, effective strategic planning, the presence of an effective system for monitoring and evaluating the implementation of planned activities. Planning, analysis and evaluation of the results of the polyclinic are ongoing interrelated processes aimed at coordinating and rational use organization resources.

In modern conditions, the medical activities carried out by the clinic must have professional organizational and methodological support, therefore, the organizational and methodological office (department) should become a mandatory structural unit of the clinic, with established functions and staff.

We also believe that the term "organizational and methodological support" is legitimate to use in the practice of healthcare management. In this case, organizational and methodological support is understood as a system of registration, organizational, diagnostic, training activities for medical workers, management and patients; the purpose of these measures is to create optimal conditions for the functioning of a medical organization, providing an opportunity to improve the provision of medical care, conduct medical examinations, medical examinations and other medical examinations, sanitary and anti-epidemic work, interaction between all subjects interested in high quality and health care safety, at the organizational level. Organizational and methodological support should be carried out by specialists - methodologists under the guidance of the chief physician and his deputies.

Unlike the city hospital, in the regional hospital the functions of the organizational and methodological department are much wider. In fact, it serves as a scientific and methodological basis for the state health management body for the introduction into practice of advanced organizational forms and methods of medical care for the population.

Functions of the organizational and methodological department:

analysis of the activities of the health care facilities of the region;

organizational, methodological and advisory assistance to the health authorities and institutions of the region;

study of indicators of health-population of the region;

organization of increasing the codification of personnel;

work planning.

Organizational and methodological work of medical institutions of the region is attended by:

chief full-time (chief surgeon, internist, pediatrician, obstetrician-gynecologist) specialists of the state health management body.

freelance (most often heads of specialized and highly specialized departments) specialists of the state health management body.

Exit forms of work.

In order to bring specialized medical care closer to the rural population, teams of outpatient medical care, which are created on the basis of the Central District Hospital and regional hospitals, are becoming important. The field team is formed by the chief doctor of the hospital from among the staff doctors and secondary medical staff. workers. It may include honey. employees of other medical institutions (city hospitals, maternity homes, dispensaries, etc.).

Scheduled field consultations of medical specialists at the regional (regional) hospital are organized and conducted by the consultative polyclinic together with the department of emergency and planned advisory care.

Types of exit forms of medical care:

mobile medical outpatient clinics,

clinical diagnostic laboratories,

fluorographic equipment,

dental offices.

The main tasks of mobile forms of medical care for the population:

Performing a large amount of preventive and curative work.

Bring the provision of medical care to rural residents closer, make it more accessible and timely.

Providing advisory assistance.

Pediatric service.

The main medical and preventive institution providing assistance to children, at the level of the subject of the Russian Federation, is children's regional (regional, district, republican)hospital (DOB). And in its absence - a regional (regional, republican, district) hospital, which includes one or more children's departments.

DOB structure:

pediatric departments;

advisory polyclinic for children who arrived from the region;

a boarding house for visiting children with parents for the period of their consultations and examinations;

a hostel (hotel) for nursing mothers whose children are on inpatient treatment.

pediatric teams as part of the department of emergency and planned advisory care.

Dental service.

The regional (regional) dental clinic is designed to provide highly qualified dental care to the territorially attached population, consultative and diagnostic assistance to patients referred from medical institutions of the region (region), as well as for organizational and methodological management of dental departments and offices located in the structure of other health facilities edges (regions).

In the regional (regional) polyclinic, the rural population receives consultative and medical assistance in the direction of specialists from regional dental institutions. Consultative and medical assistance is provided by specialists of regional (regional) polyclinics, also during scheduled visits to the regions.

In regional dental clinics for rural residents, it is necessary to provide for an extraordinary appointment not only in the doctor's office, but also in diagnostic and physiotherapy rooms and laboratories.

An important section of the regional dental service is the provision of organizational and methodological guidance for dental institutions of the region (region), including:

development and implementation of basic measures for the prevention of dental diseases,

carrying out medical and recreational activities among the population,

analysis and assessment of the state of the dental service and the work of dental institutions.

For this purpose, as part of the regional (regional) dental clinic, organizational and methodological departments (offices) are created that integrate and analyze information on the activities of the entire dental service of the region (region), organize and conduct a study of morbidity among the population, develop organizational and methodological materials on the most important sections of the work and bring them to the heads and employees of the institutions of the region (region), check the accounting and reporting.

July 17, 1999 N 178-FZ FEDERAL LAW ON STATE SOCIAL ASSISTANCE (as amended federal laws dated 08/22/2004 N 122-FZ (as amended on 12/29/2004), dated 11/25/2006 N 195-FZ, dated 10/18/2007 N 230-FZ)

This Federal Law establishes the legal and organizational framework for the provision of state social assistance to low-income families or low-income citizens living alone.

The subject of regulation of this Federal Law is not relations related to the provision of benefits and measures to citizens. social support established by the legislation of the Russian Federation.