Labor rationing in budgetary healthcare institutions. Regulations on labor standards in healthcare

Who establishes the labor standardization system in healthcare institutions?

The labor standardization system in healthcare institutions is established by the employer on the basis of standard labor standards. By virtue of Art. 161 of the Labor Code of the Russian Federation, standard labor standards are developed and approved in the manner established by the federal executive body authorized by the Government of the Russian Federation. In the healthcare sector, such a body is the Russian Ministry of Health. Thus, by order of the Ministry of Health of Russia dated June 2, 2015 No. 290n, standard industry standards of time for performing work related to one patient’s visit to a local pediatrician, a local general practitioner, a general practitioner (family doctor), a neurologist, and an otorhinolaryngologist were established , ophthalmologist and obstetrician-gynecologist. These standard standards are the basis for calculating workload standards, headcount standards and other labor standards for doctors medical organizations providing primary medical and primary specialized health care on an outpatient basis.

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

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

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

Currently, when calculating staffing standards, it is first of all necessary to be guided by Decree of the President of the Russian Federation dated May 7, 2012 No. 597 and the order of the Government of the Russian Federation dated November 26, 2012
No. 2190-r, which approved the Program for the gradual improvement of the remuneration system in state (municipal) institutions for 2012-2018.

According to the specified Program for the gradual improvement of the remuneration system, the formation of the staffing level of institutions should be carried out using labor standardization systems, taking into account the need for high-quality provision of state (municipal) services, fulfillment of the volumes of medical care established by the Program of State Guarantees of Free Medical Care to Citizens and the corresponding territorial program.

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

It should be noted that in accordance with sub. "g" clause 39 section. X Unified recommendations, approved. By decision of the Russian Tripartite Commission dated December 24, 2014 (Minutes No. 11), the formation of staffing schedules for healthcare institutions must be carried out taking into account the Nomenclature of Positions of Medical Workers and Pharmaceutical Workers, approved. by order of the Ministry of Health of Russia dated December 20, 2012 No. 1183n.

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

1. Order of the USSR Ministry of Health dated 06/06/1979 No. 600 (with amendments and additions).
2. Order of the USSR Ministry of Health dated September 26, 1978 No. 900 (with amendments and additions).
3. Order of the USSR Ministry of Health dated May 31, 1979 No. 560.

These documents have not been officially canceled by the Russian Ministry of Health and, in accordance with the order of the USSR Ministry of Health dated August 31, 1989 No. 504, are advisory in nature. In this connection, they can be used as a basis for the development of labor standards systems installed in medical organizations. When applying these documents, it should be taken into account that the names of positions of medical and other personnel of healthcare institutions must comply with the Nomenclature of Positions of Medical Workers and Pharmaceutical Workers (approved by Order of the Ministry of Health of Russia dated December 20, 2012 No. 1183n).

In relation to determining the standard of staffing units for employees and workers of state and municipal healthcare institutions, one can be guided by the order of the Ministry of Health of Russia dated 06/09/2003 No. 230, which establishes the dependence of the number of staffing units of blue-collar professions on the volume of work according to technically sound standards, and in their absence - according to standards developed by the institution experimentally and statistically.

Thus, the staffing schedule of a medical organization is established by the medical organization itself on the basis of reasonable labor standards and approved by its head (subparagraph “d”, paragraph 33 of section VIII of the Unified Recommendations, approved by the decision of the Russian Tripartite Commission dated December 25, 2013, protocol No. 11) .

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

The staffing table is used to formalize the structure, staffing and staffing levels of an organization in accordance with its charter (regulations). The staffing table contains a list of structural units, names of positions, specialties, professions indicating qualifications, information on the number of staff units (Instructions for the use and completion of forms of primary accounting documentation, approved by Resolution of the State Statistics Committee of Russia dated January 5, 2004 No. 1).

According to sub. “c” clause 35 of the Unified Recommendations, approved. By decision of the Russian Tripartite Commission dated December 24, 2014 (Minutes No. 11), the formation of a unified staffing table in an institution is carried out regardless of what types of economic activities the structural divisions of the institution belong to.

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

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

Speaking about the form of staffing, it is worth saying that there are no direct explanations from the federal authorities on this issue. However, since a departmental regulatory act (Order of the Ministry of Health and Medical Industry of Russia dated January 18, 1996 No. 16) approved its own form of staffing for healthcare institutions, in my opinion, this is what should be used.

For example, the relevant departmental regulations have approved schedule forms for subordinate institutions: staffing table, approved. by order of the Federal Agency for Special Construction dated December 3, 2010 No. 540, staffing table, approved. by order of the Federal Agency for State Reserves dated 09.09.2010 No. 180, staffing table, approved. by order of the Federal Customs Service dated October 18, 2005 No. 970, staffing table, approved. Methodological recommendations for working with documents in educational institutions (letter of the Ministry of Education of Russia dated December 20, 2000 No. 03–51/64), and others.

From January 1, 2013 in connection with the entry into force of the provisions of the Federal Law of December 6, 2011
No. 402-FZ “On Accounting”, unified forms for accounting for labor and its payment, approved by Resolution of the State Statistics Committee of Russia dated January 5, 2004 No. 1 “On approval of unified forms of primary accounting documentation for accounting for labor and its payment,” are not mandatory for use. At the same time, in the information of the Ministry of Finance of Russia dated December 4, 2012 No. PZ-10/2012, it is explained that forms of documents used as primary accounting documents established by authorized bodies in accordance with and on the basis of other federal laws continue to be mandatory for use (for example, cash documents ).

Who should approve the staffing schedule of a medical organization?

A similar responsibility is legally assigned to the head of a medical organization.

Thus, the right of the head of a medical organization to approve the staffing table is secured by the following regulatory legal acts:

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

In addition, according to sub. "e" clause 8 standard form employment contract with the head of a state (municipal) institution, approved. By Decree of the Government of the Russian Federation dated April 12, 2013 No. 329, the head has the right to approve in the prescribed manner the structure and staffing of the institution. It is worth noting that, by virtue of Part 3 of Art. 275 of the Labor Code of the Russian Federation, an employment contract with the head of a state (municipal) institution is concluded on the basis of a standard form of an employment contract, approved by the Government of the Russian Federation, taking into account the opinion of the Russian Tripartite Commission for the Regulation of Social and Labor Relations.

It should also be said that by virtue of the direct instructions of the law, namely Part 2 of Art. 13 of Federal Law No. 174-FZ of November 3, 2006, the head of an autonomous institution independently approves the staffing table.

Should the head of a medical organization coordinate the staffing schedule with higher authorities?

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

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

According to clause 11 of Regulation No. 583, the wage fund for employees of a federal budgetary institution is formed based on the volume of subsidies received in the prescribed manner by the federal budgetary institution from the federal budget, and funds received from income-generating activities.

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

Thus, if the obligation to coordinate the staffing table is not established in the legal act of the founder or in other agreements regulating the issues of remuneration of employees, then the budgetary institution develops and approves the staffing table independently. No additional approval is required in this case.

It is especially worth noting that in practice there are also quite often demands from territorial compulsory health insurance funds to coordinate staffing directly with them. It should be said that federal legislation also does not provide for a similar obligation for the heads of a medical organization. In turn, the FFOMS letter dated 04/06/2015 No. 1726/30–4 “On the procedure for creating staffing schedules” directly explains that the structure and staffing levels are established by the head of the medical organization based on the volume of diagnostic and treatment work carried out and the number of the population served, taking into account recommended staffing standards provided for in the procedures for providing medical care. Thus, coordination of the staffing table, approved by the head of the medical organization, with the Federal Compulsory Compulsory Medical Insurance Fund is not required.

What should the head of a medical organization be guided by when calculating staffing standards? Is it possible to apply orders, for example, order of the Russian Ministry of Health dated 06/09/2003 No. 230?

The staffing standards established by order of the Ministry of Health of Russia dated June 9, 2003 No. 230 are recommended; they must be followed when drawing up the staffing table along with the procedures for providing medical care, but the medical organization is not obliged to strictly comply with them.

In accordance with the letter of the Ministry of Health of Russia dated 01/08/2004 No. 14–04/9846, the order of the Ministry of Health of Russia dated 06/09/2003 No. 230 was recognized by the Ministry of Justice of Russia (letter dated 06/26/2003 No. 07/6476-YUD) as not requiring state registration, since it bears an organizational character and does not contain legal norms. Accordingly, as follows from the above letters, the order of the Ministry of Health of Russia dated 06/09/2003 No. 230 is advisory in nature, since it does not contain binding legal norms.

In addition, in accordance with clause I of the current order of the USSR Ministry of Health dated February 10, 1988 No. 90, heads of healthcare institutions, based on production needs, are allowed to strengthen individual structural units or introduce positions not provided for by the current staffing standards, at the expense of positions in other structural units divisions within the limits of the number of positions and payroll established by the institution. In this case, replacement of positions in any order is allowed. Changes made are made to staffing schedules without approval from a higher health authority.

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

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

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

In addition, in accordance with sub. 7 paragraph 2 art. 7 of Federal Law No. 174 of November 3, 2006, the charter of an autonomous institution must necessarily reflect the structure and competence of the bodies of the autonomous institution. Thus, if the authority to approve the staffing number of employees of a given institution is not within the competence of the founder or supervisory board, then they relate to the powers of the head of the autonomous institution along with the approval of the staffing table (clause 2 of article 13 of the Federal Law of November 3, 2006 No. 174).

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

It is especially worth noting that currently the procedures for the provision of medical care, which, according to the current legislation, are mandatory, contain recommended staffing standards for the number of medical personnel. The very fact that these staffing standards are recommended does not oblige the head of a medical organization to strictly adhere to them when drawing up the staffing schedule. It should also be noted that if in the Unified Recommendations for the establishment at the federal, regional and local levels of remuneration systems for employees of state and municipal institutions for 2014, there was an indication of the formation of a staffing table in accordance with the procedures for providing medical care, then similar recommendations for 2015 there is no such indication. Thus, the legislation has not established a strict obligation to use the recommended staffing standards established by the procedures for providing medical care when drawing up the staffing table.

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

Yes, the manager has the right to do this. In addition, in a letter from the Russian Ministry of Health dated October 25, 2012
No. 16–5/10/2–3238 “On the direction of methodological recommendations “Determination of the optimal ratio of medical / paramedical / other personnel in state and municipal health care institutions of the general medical network and specialized services” contains clarifications that when determining the optimal ratio of medical / paramedical / other personnel in state and municipal health care institutions of the general medical network and specialized service institutions, it is advisable to take into account such factors as the availability of staff and occupied positions maintained through income-generating activities (paid services). This activity is self-sustaining, and there is no need to monitor the availability and ratio of positions financed through paid medical services and other areas of income-generating activities. For example, additional positions of other personnel help improve the quality of patient care when providing paid medical services.

Should a medical organization introduce separate staffing schedules based on the source of funding (for example, compulsory medical insurance and income-generating activities)?

No, drawing up separate staffing tables is not required in this case. The FFOMS directly points to this in letter No. 1726/30–4 dated 04/06/2015, explaining that a separate establishment of staffing within the framework of activities in the field of compulsory health insurance is not provided for and is not required.

Introduction

The current stage of healthcare development poses new questions about the quality of medical care provided to the population. The proper level of medical care can only be achieved with appropriate staffing of healthcare institutions. Formation of the number of medical personnel, establishment of labor standards, rational placement and use of personnel are the most significant components of the labor standardization system in healthcare, which are based on industry regulatory documents on labor. Currently, the regulatory framework developed by the USSR Ministry of Health in the late 80s is used. Labor regulations are not focused on the organizational and technical conditions of the activities of medical and preventive health care institutions, as well as the morbidity of the population and the demographic situation that currently exists in Russia. The need to update the existing regulatory framework and the development of modern labor regulations is completely obvious. Firstly, the crisis in the economy and the deterioration of the environmental situation in recent years have significantly changed the nature of the pathology and the severity of the diseases of the population served, as well as the frequency of referrals, duration and intensity of treatment. In this regard, the need arose to develop new modern labor standards and standards and improve existing ones. Secondly, the staffing standards of most main types of institutions (regional, city hospitals, adult and children's city clinics, etc.), developed 25-30 years ago and corresponding to the technology of the diagnostic and treatment process adopted at that time, do not meet modern ones requirements and need revision. Thirdly, the rapid development of medical science, the introduction of new technologies and modern equipment into the diagnostic and treatment process, and the improvement of instrumental research methods have significantly changed the nature and content of a doctor’s work and also require a serious revision and updating of the regulatory framework in healthcare.

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

The work uses various sources, publications, educational literature.

The work consists of several sections. The first section characterizes the concepts of labor standards, its types, defines the functions, tasks and principles of labor standards, as well as the procedure for introducing, replacing and revising labor standards. The second section discusses types of labor regulation and methods for studying working time costs. The third section provides calculations of labor standards for nursing and junior medical personnel in various departments of a medical institution.

In conclusion, conclusions about the work done and a list of references are provided.

Theoretical aspects of labor regulation in healthcare

The essence of labor standards and its types

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

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

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

Time standard is the amount of working time (in hours, minutes) for the production of a unit of product or work operation; it is used to calculate, determine production standards and other labor standards.

Maintenance standards are the amount of maintenance established per employee for production mechanisms, machines, and areas. Their variety is the controllability norm - the number of workers in a given production who must be managed by one manager (foreman, site manager, foreman, etc.). This is also a calculated norm for determining the staff of managers who manage labor.

The norm for the number of workers is the established number of working personnel of a certain profession, qualifications to perform work in a given area of ​​​​production, for example, repair workers for servicing machines or all employees of a workshop, department, enterprise, institution, organization.

The headcount rate and the service rate are interrelated, since the service rate is used to determine the headcount rate, and vice versa.

Integrated and complex standards applied during the collective work of a production team on a single basis are calculated for the entire team, i.e., this is the amount of work that the team must complete per day, week, month.

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

A standardized task is the total amount of work per working day (shift) for an employee or team, established under a time-based wage system based on time standards and production standards, and is used to increase the labor efficiency of time-paid workers. Depending on the time for which the task is set, the daily (shift) and monthly standardized tasks differ. Essentially, this is a special production rate applied to time workers.

Functions, tasks, meaning and principles of labor regulation

The main functions of labor standardization are distribution by work, scientific organization of labor and production, production planning, assessment of the work activities of individual workers and teams, which serves as the basis for moral and material encouragement and dissemination of best practices.

Labor rationing includes:

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

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

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

¾ establishment and implementation of labor standards;

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

The main objectives of labor standardization are to:

¾ justify the necessary and sufficient amount of working time spent per unit of production in specific conditions;

¾ design rational labor methods;

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

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

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

Solving these problems will make it easier for workers, increase labor productivity and increase production volume.

Labor regulation is the basis of the scientific organization of labor. Using the methods used in labor standardization, losses and unproductive costs of working time are identified. By studying labor movements, the most economical, productive and least tiring methods of work are developed. This contributes to increased labor productivity. Further improvement of labor organization is impossible without improving its standardization.

Also, labor regulation is the basis for organizing wages. The establishment of labor standards aims to guarantee society a certain labor productivity and the employee a certain level of wages. Based on the fulfillment of labor standards, the work activity of each employee is assessed and his work is paid. Without rationing of labor, the implementation of the economic law of distribution according to labor is impossible.

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

Scientifically based labor standards make it possible to evaluate the results of the labor activity of each employee, each team and compare their results. It is only through comparison that the leaders and the laggards are identified.

Scientifically based labor standards, correctly reflecting specific conditions, ensure increased labor productivity. If labor standards are too low, they can give rise to complacency or pessimism, which negatively affects productivity results; if labor standards are too high, they are unfulfillable. In both cases, labor productivity growth will be slowed down. Thus, all changes in the organization of labor and production, technology and work technology are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor at the enterprise.

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

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

Labor standards should be based on the following principles:

¾ scientific validity of labor standards;

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

¾ preservation of the main productive force of society - workers;

¾ participation of workers in establishing labor standards.

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

The procedure for introducing, replacing and revising labor standards

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

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

The most rational and preferred method for designing regulatory materials is the analytical-calculation method, since it is the most advanced and cost-effective.

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

1. Preparatory, organizational and methodological work.

In the course of work, the goals and objectives of the development of normative materials for labor regulation are determined, the types of norms are clarified, and technical specifications are drawn up.

The terms of reference are developed by the organization performing the regulatory research work and approved by the customer organization.

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

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

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

¾ use of existing regulatory materials for labor standardization, including microelement standards;

¾ identification of factors that influence the time spent when performing individual works and ensure the greatest accuracy of standards and norms with the least complexity and labor intensity of their development;

¾ instructing workers who monitor and analyze working hours and design norms and standards, use instruments, video equipment, computer equipment, statistical, operational and other reporting data for this work;

¾ verification of the draft regulatory materials in production conditions;

¾ design of the collection of regulatory materials as a whole.

2. Study of working time costs at workplaces.

The specified works include:

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

¾ carrying out direct measurements of working time (timing, photographs of working time, video recording of work processes, etc.) or momentary observations; at the same time, materials related to the establishment of labor cost standards at selected enterprises are used to the maximum;

¾ carrying out technical calculations, experimental and other research work, processing of collected materials.

3. Processing of collected materials.

These works include:

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

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

¾ preparation of a draft regulatory document in the first edition, as well as instructions on the procedure for checking it directly at the enterprise;

¾ identification of specific enterprises (institutions, organizations), their structural divisions for checking regulatory materials;

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

4. Checking regulatory materials in production conditions.

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

5. Preparation of the final version of regulatory materials.

The analysis and study of the results of checking the draft regulatory document in production conditions is carried out, the feedback, comments and suggestions received are summarized.

Established labor standards in accordance with Art. 160 of the Labor Code of the Russian Federation may be revised as new equipment, technology, and organizational or other measures are improved or introduced to ensure an increase in labor productivity, as well as in the case of the use of physically and morally outdated equipment.

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

Replacement and revision of uniform and standard norms is carried out by the bodies that approved them. The revised standards are formalized by the organization’s local regulations and communicated to employees no later than two months before implementation.

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

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

Outdated and erroneously established standards are considered uncertified and are subject to revision. In particular, the standards in force for work whose labor intensity has decreased as a result of a general improvement in the organization of production and labor, the growth of professional skills and the improvement of production skills of workers and employees should be considered obsolete. Standards may be considered erroneous if, when establishing them, organizational and technical conditions were incorrectly taken into account or if there were inaccuracies in the application of normative materials or in carrying out calculations.

When checking labor cost standards, the administration is obliged to ensure a thorough check of the implementation of the technology provided for by the standards in all operations labor process, compliance of the actual volume of work performed with the volumes included in the calculation of standards. At the same time, the administration, based on specific production conditions, is obliged to rationalize the technological processes of those operations, the conditions for which, provided for by the standards, do not correspond to the achieved level of organization of production and labor, and best practices.

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

The basis for applying correction factors to norms and standards can be the development of production capacity, new equipment, technology, new types of products or non-compliance of the actual organizational and technical conditions of production with those provided for in the newly introduced norms and standards.

Labor standardization methods

Types of labor standardization methods

Improving medical care to the population requires not only increasing the material and personnel base of healthcare, but also further improving the style and methods of work, organizational activities at all levels, taking into account the economic efficiency of the activities carried out. One of the important tasks of further improving healthcare is the rational use of all resources. Determining the volume of activity of a particular group of medical personnel, establishing a direct connection between indicators and remuneration, calculating the cost of providing medical care to the population as a whole and its individual types is especially important during the implementation period economic methods management in healthcare and transition to insurance medicine.

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

The labor standardization method is a set of techniques for studying and analyzing labor processes, determining the cost of working time, identifying and taking into account standard-forming factors, designing rational organization labor and development of standards.

Labor standardization for medical workers is the most complex issue, reflecting the specifics of the industry and requiring a careful approach and scientific justification when solving it. In healthcare, as in other sectors of the national economy, there are two types of labor standardization methods: analytical and summary (Fig. 1).

Figure 1 - Labor standardization methods

The analytical method involves dividing the labor process into individual components. Depending on the methods of developing labor standards, this method is divided into analytical-research and analytical-calculation.

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

The analytical-calculation method involves calculating time costs according to pre-established time standards, equipment operating modes, as well as formulas for the dependence of time on factors influencing the duration of the operation. This method establishes the normalized number of support workers, managers, specialists and technical performers.

The summary method of labor standardization establishes the cost of working time as a whole per unit of production of a specific work process without analyzing the latter. The way the work is performed is determined by the employee. Varieties of the summary method are experimental, statistical and comparative methods.

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

Statistical method. Labor standards are established primarily on the basis of statistical reporting data on the volume of work. This method can be used only if you are confident that the doctor, on the one hand, is not underworked, and on the other hand, the technology of the diagnostic and treatment process is followed, and the patient is provided with proper medical care in full.

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

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

Thus, at present, for the centralized development of labor standards, it is advisable to use mainly the analytical and research method. In health care institutions, to determine the number of personnel required for a given amount of work and to establish a number of standard indicators, the calculation and analytical method should be widely used. In cases where there are no developed standards for personnel workloads, for example, when introducing new types of instrumental research, when organizing a new service, summary standardization methods can be used to establish temporary standards so that in the next 2–3 years, based on existing work experience, their scientific basis.

Methods for studying working time costs

There are 4 methods for studying working time costs (Fig. 2).

Figure 2 - Methods for studying working time costs

Let's look at each of them.

Timing, methodology.

Timing is a method of studying labor time expenditure by measuring repetitive elements of an operation.

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

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

At the second stage, observation and recording of time is carried out. Time measurements are made by collective and cumulative methods using a two-hand stopwatch. The observer must note the time at the fixing points and enter the stopwatch readings into the observation sheet of the timing card, and monitor the order in which the operation is performed.

At the third stage, data is processed and the duration of the operation element is determined. The obtained values ​​of the duration of the operation element are recorded in the timing variation series, where the top line of the option is measurements in ascending (descending) order of measurement duration (t), and the bottom line of frequencies (p) shows how often this option occurs in the timing series. The total sum of frequencies must be equal to the number of measurements. Inaccurate (defective) measurements are first excluded and then the quality of the timing series is assessed.

Photograph of working hours, types and methods of carrying out

Time photography is the observation, measurement and consistent recording of each and every time spent during a work shift or other period.

If the observation period coincides with the length of the working day, this will be a photograph of the working day.

Working time photography is used to identify lost working time and the reasons that cause it, as well as to establish the relationship between certain types time expenditure. The obtained data are used as initial data for normalization.

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

Working time photography is carried out in three stages.

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

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

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

Photochronometry

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

In labor practice, individual and group phototiming is used. Thus, group photographic timing is recommended to be carried out when establishing the composition of a team and distributing functions between its members, the individual elements of which do not have cyclic repeatability.

Observations and measurements are carried out using accepted methods for processing observation results, analysis of the data obtained and the design of rational labor processes during photographic timing are carried out separately according to the data of timing observations and photographs in the prescribed manner.

Momentary Observation Method

The method of momentary observations makes it possible to register and take into account during the observation period the same working time expenditures of a group of performers or the working time and breaks in the operation of a different number of equipment and, on this basis, determine the specific weights and absolute values ​​of time expenditures. The method is characterized by insignificant labor intensity and simplicity of carrying out observations and processing the results obtained, efficiency of the study, wide coverage of observations various objects, as well as involving personnel in research while simultaneously performing their main work, etc. The disadvantages of the method include: obtaining only average values ​​of working time and equipment use time; lack of data on the sequence of execution of the processes being studied, as well as possible changes, etc.

When conducting research, it is recommended to use pointer clock instruments (watches, one- and two-hand stopwatches), special equipment that allows you to automatically record both time and the content, structure and method of performing standardized processes (oscillography, photo-video and film equipment).

Filming ensures objectivity and high accuracy of recording all elements of the labor process in time and space, as well as the conditions that determine it, the completeness of the characteristics of the process being studied (trajectories and speeds of movements, distances of movement of objects of labor, the sequence and degree of combination of techniques, actions and movements, etc. .)

Labor standards for nursing and junior medical personnel

Labor standards for paramedical and junior medical personnel in outpatient clinics

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

The need to allocate medical positions for outpatient visits is due to the fact that, depending on their number, according to staffing standards, the number of positions for doctors and nursing staff in auxiliary and some other diagnostic and treatment units is determined:

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

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

· change of work of a department or institution (to calculate the number of nurses in the treatment room, vaccination room, registry);

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

· mixed procedure for establishing positions: to calculate the number of paramedics or filter nurses in a children's city clinic (job change and number of children).

Most of the currently valid staff standards for outpatient clinics were approved more than 25 years ago: staff standards for city and children's city clinics located in cities with a population of over 25 thousand people were determined by order of the USSR Ministry of Health dated October 11, 1982 No. 999, in cities and urban-type settlements with a population of up to 25 thousand people. by order of the USSR Ministry of Health dated September 26, 1978 No. 900. In 2001, an order was approved on staffing standards for children's clinics that are part of city and children's city hospitals, medical units with hospitals (order of the Russian Ministry of Health dated October 16, 2001 No. 371), however, the lack of justification for the main provisions of this order makes it unacceptable for healthcare practice.

According to the nature and scope of activities of paramedical personnel established for outpatient doctors in various specialties, these positions can be divided into the following groups:

· nurses, together with the doctor, carry out outpatient visits to patients;

· along with outpatient appointments, together with a doctor, nurses from local general practitioners, pediatricians, general practitioners (family medicine) also carry out doctor’s orders to provide appropriate diagnostic, treatment and preventive care at home to the population of the site.

Nurses of surgeons, traumatologists and orthopedists perform dressings, apply and remove plaster, etc.

The first group includes the majority of positions of outpatient nurses. The standard ratio of nursing and medical personnel in this group is, as a rule, 1: 1, i.e., one nurse position is planned for one doctor position. At the same time, in such specialties of doctors as neurology, endocrinology and dentistry, this ratio is violated and, in accordance with the current staffing standards, 0.5 positions of a nurse are established for one position of a doctor in these specialties. It is difficult to find a logical explanation for such standards, and in the absence of appropriate recommendations at the industry level, it is advisable for the heads of health care institutions, based on the rights granted to them to form the number of staff at health care facilities, to establish the number of nursing staff positions in these specialties corresponding to the medical level. By Order of the Ministry of Health and Social Development of Russia dated April 14, 2006 No. 289, this situation in the children's dental clinic was corrected, and the positions of nurses in medical offices are established at the rate of 1 position for each position of a pediatric dentist, dental surgeon and orthodontist. This standard is fully consistent with modern technologies of the diagnostic and treatment process in dentistry when using modern composite materials, working “with four hands” and ethical and legal standards for receiving a patient in a separate office.

In recent years, in connection with the introduction of compulsory health insurance in territories where payment is made for individual medical services, classifiers of medical services are developed and approved, which establish appropriate time standards for doctors and nurses. The expediency of such separate establishment of time standards for those specialties where the standards determine an equal number of doctors and paramedical personnel raises serious doubts. For example, in one of the classifiers for otolaryngology, where, according to staff standards, one nurse position is established for one doctor position, the time spent on anterior nasal tamponade (including after bleeding) is determined in the amount of 2.0 UET for a doctor and 1.5 UET for a nurse, i.e. 20 and 15 minutes, respectively. It is unlikely that a nurse, having completed the procedure earlier than the doctor, will provide assistance to another patient without an appropriate medical examination and prescriptions. The situation becomes more complicated when the specified working hours of a doctor are less than those of a nurse. For example, to replace cystostomy drainage, the urologist is set to 3.0 CHET, i.e. 30 minutes, and the nurse – 4.0 CHET, i.e. 40 minutes. Having completed this operation, the doctor will accept the next patient without a nurse, which may lead to a violation of the technology of the diagnostic and treatment process, which involves the joint work of the doctor and the nurse, or wait for the nurse to complete this work operation within 10 minutes.

Thus, the establishment of different time standards for individual labor operations for a doctor and a nurse conflicts with industry labor standards that determine the ratio between the number of positions of nurses and outpatient doctors in a particular specialty.

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

The standard number of junior medical staff positions is also differentiated according to the specialties of outpatient doctors. Thus, in city clinics located in cities with a population of over 25 thousand people, the positions of nurses are established at the rate of 1 position for each position of a surgeon, orthopedic traumatologist, infectious disease specialist; for every 2 positions of physical therapy doctors, allergists-immunologists; for every 3 positions of other doctors conducting outpatient visits.

Labor standards for nursing and junior medical personnel in hospital institutions

Labor standards for nursing and junior medical personnel in hospital institutions have certain features, which are listed below:

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

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

· establishing workload (service) standards for the patient’s day in the hospital or shift.

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

Stage I. Standard working hours for medical personnel in hospital institutions are determined per 1 patient per day or per day. To calculate standard indicators for labor, a patient’s stay in a hospital is differentiated as follows:

· day of admission;

· day of treatment;

· day of discharge.

Time costs are established, as a rule, on the basis of timing.

Calculation of the weighted average indicator of the working time of a nurse or orderly working daily on the day of a patient’s stay in the hospital (Tday) is carried out using the formula:

Tday = (tп + tл x 0.825(m - 2) + tв) / (m x 0.825), (1)

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

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

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

m – average duration of inpatient treatment (in days).

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

Under the specified regime, i.e., nurses working daily provide individual care for seriously ill patients, dressing rooms, treatment rooms, barmaids, and orderlies.

Calculation example

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

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

In the department, approximately 10% are seriously ill, therefore, this figure per hospitalized person is 8.4 minutes (83.5: 10).

Most paramedical and junior medical staff in hospital institutions work around the clock. In this case, a 2 or 3 power system of service is introduced.

The use of a 2-degree system involves the care of patients by a doctor and a nurse. At the same time, the ward nurse fully and directly serves the patient, and the cleaning lady performs only sanitary and hygienic functions in the wards and utility rooms. The forced performance by ward nurses of the functions of junior medical personnel, for example, cleaning premises in the absence of the required number of nurses, certainly worsens the quality of medical care and is contrary to sanitary and hygienic requirements.

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

Calculation of the weighted average cost of working time of a nurse or orderly per day of a patient’s hospital stay (Tsut) is calculated using a formula similar to formula 1, but without taking into account the coefficient 0.825:

Тsut = (tп + tл x (m - 2) + tв) / m, (2)

All designations correspond to formula 1 with calculations not per day, but per day of the patient’s stay in the hospital.

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

Calculation example.

Cost of a nurse's working time per patient per day for periods of hospital stay, admitted for emergency reasons and on a planned basis.

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

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

The working time spent on patients admitted as an emergency, with an average length of hospital stay of 8 days, will be 107.4 minutes: (396.6 + 60.8(8 2) + 97.8) / 8 ≈ 107, 4.

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

The average time spent for a 30% emergency hospitalization will be 61.8 minutes: (107.4 × 30 + 40.8 × 70) / 100 ≈ 61.8.

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

Stage II. Estimated workload (service) norms for medical personnel of hospital institutions are expressed in the number of patients served per day or per day using the formula:

Nb = (V x k) / T, (3)

where Nb – norms of workload for hospital medical staff;

B – daily work time medical personnel (six-day working week) or daily working hours;

k is the coefficient of use of working time of nursing staff for primary and auxiliary activities;

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

The main activities of medical personnel include, as a rule, work carried out directly with the patient, i.e. the time of direct contact of personnel with the patient, namely the performance of various types of procedures and manipulations. However, some categories of medical personnel do not have any contact with patients at all, for example, a nurse-cleaner in a two-level service system, so the main activity for them is to perform the immediate production task.

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

During the working day, personnel need short rest, meals, and sanitary and hygienic measures. These costs relate to the personal time required.

Interdisciplinary methodological materials recommend devoting approximately 10% of your working time to necessary personal time. The experience of labor standardization in healthcare shows that the coefficient of working time for main and auxiliary activities for most positions of medical personnel (except for auxiliary medical and diagnostic services) is 0.923, i.e., out of a 6.5-hour working day, about 30 minutes are allocated to other types of work : (6.5 - 0.5) / 6.5 = 0.923.

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

Calculation example.

The calculated workload norms for a nurse for organizing individual care for seriously ill patients with the cost of working time per hospitalized patient is 8.4 minutes. The workload (service) norms calculated using formula 3 are 42 hospitalized patients:

(6.5 × 60 × 0.9) / 8.4 ≈ 42.

Calculation example.

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

and at a cost of 61.8 minutes, 21 patients: (24 × 60 × 0.9) / 61.8 ≈ 21.

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

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

where Nk is the number of beds per position;

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

R is the planned number of days the bed is open per year.

The value of the R indicator in formula 4 is:

· for city and regional hospitals – 330–340 days;

· for hospitals located in rural areas – 320 days;

· for infectious diseases hospitals – 310 days;

· for maternity hospitals – 300 days.

Calculation example.

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

Calculation example.

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

The number of positions to ensure the operation of a 24-hour post is calculated using the formula:

Dpost = (24 × 60 × 365) / B, (5)

where Dpost is the number of positions to ensure the operation of a 24-hour post;

B – annual working time budget for the position.

The annual working time budget (B in formula 5) is calculated using the formula presented in the Methodological Recommendations “Development of technology for standardizing labor in healthcare”:

B = m × d - n - z,

where B is the annual working time budget;

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

d – the number of working days per year for a five-day working week;

n – number of hours of reduction in working hours or shifts on pre-holiday days (during the year);

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

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

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

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

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

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

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

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

Calculation example.

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

Calculation example.

The number of nursing positions to ensure the operation of a 24-hour post with an annual working time budget of 1787 hours, calculated using formula 5, is 4,916 positions ((24 x 366) / 1787)

The number of positions in a particular department is calculated using the formula:

Dotd = (Dp × K) / P, (6)

where Dotd is the number of positions in the department;

Дп – number of positions per 1 post;

K – number of beds in the department;

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

Calculation example.

In a department with 30 beds, with a standard indicator of 20 beds per post, and the number of nurse positions (ward) to ensure the work of one round-the-clock post equal to 4,916 positions (with a 39-hour work week and 28-day vacation), 7,374 are required ward nurse positions: (4.916 × 30) / 20 = 7.374.

The calculation was carried out according to formula 6.

Peculiarities of labor standardization for nursing and junior medical personnel in day hospitals

In recent years, inpatient replacement types of care have received significant development. The staffing standards for medical personnel in day hospitals establish the position of a senior nurse (regardless of the total number of beds). The positions of nurses are introduced at the rate of 1 position for 15 beds, the positions of ward nurses or junior nurses for patient care are established according to the positions of nurses (Order of the Ministry of Health of Russia dated December 9, 1999 No. 438).

The volume of work of paramedical and junior medical personnel is associated with the need to organize care and carry out medical prescriptions during the day, and in different institutions, the opening hours of the day hospital are determined depending on specific local conditions and range from 5 to 9 hours daily. In some cases, two-shift operation of a day hospital is practiced. When making calculations, it is necessary to take into account the number of days the day hospital operates per year: a five-day or six-day work week, excluding weekends and holidays, etc.

Calculation of the number of paramedical and junior medical personnel in day hospitals can be performed on the basis of photographic observation data. However, taking into account the laboriousness of conducting photographic observations to determine time standards in healthcare institutions, it can be recommended to use the existing regulatory framework for labor for these groups of personnel in hospital institutions, but taking into account the working hours of the day hospital.

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

However, the differences in the composition of patients in a day hospital compared to a regular hospital department, the mobility of patients and the ability to self-care allow us to take the general value of the number of beds per post as a basis for planning the number of nursing and junior medical personnel in a day hospital.

The number of positions of ward nurses and ward nurses in a day hospital is calculated using the formula:

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

where Ddayn is the number of positions of ward nurses and orderlies in a day hospital;

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

T – number of hours of operation of the day hospital during the year;

W – number of hours of operation of a 24-hour post per year;

K – number of beds in a day hospital;

N is the standard number of beds in a hospital with round-the-clock stay per post.

Calculation example.

The therapeutic day hospital with 25 beds operates from 10 a.m. to 6 p.m., i.e., 8 hours daily for 303 days (a six-day work week).

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

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

Conclusion

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

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

As can be seen from the work done, scientifically based labor standards, correctly reflecting specific conditions, ensure an increase in labor productivity. If labor standards are too low, they can give rise to pessimism, which has a negative impact on productivity results; if labor standards are too high, they are impossible to achieve. In both cases, labor productivity growth will be slowed down. Thus, all changes in the organization of labor and production, technology and work technology are reflected primarily in labor standards. And the level of labor standards is an indicator of the level of organization of production and labor at the enterprise. Labor rationing is the basis of labor planning.

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

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2. Kadyrov F.N. Incentive remuneration systems in healthcare. M.: Grant, 2000.

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

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

5 . Adamchuk V.V., Romanov O.V., Sorokina M.E. Economics and sociology of labor: Textbook for universities. - M.: UNITY, 1999.

6. Economics Course: Textbook / Ed. B.A. Reisberg. - INFRA-M, 1997.

7. Methodological recommendations “Development of technology for labor standardization in healthcare”, approved by the Ministry of Health and Social Development of Russia on December 20, 2007 No. 250-PD/704. Authors and developers are employees of the National Research Institute of Public Health of the Russian Academy of Medical Sciences: O.P. Shchepin, A.L. Lindenbraten, V.M. Shipova, V.V. Kovaleva, N.K. Grishina, V.I. Filippova, S.M. Golovina, O.A. Kozachenko, N.B. Solovyova.

8. Shipova V.M. Planning the number of medical personnel in hospital institutions. M.: Grant. 1999.

9.Margulis A.L., Shilova V.M., Gavrilov V.A. Number of positions in medical institutions // Methodological and normative materials on calculating the number of positions and compiling staffing schedules of medical institutions. – M.: Agar, 1997.

Organizational science (scientific management) in different periods solved the problems of rationalization and optimization of work activity to increase productivity, reduce physical and material costs, combating unemployment, etc. Now these problems are becoming increasingly relevant. Consequently, more attention should be paid to the problems of labor regulation, which will rationalize and optimize various areas of work activity.

The processes occurring in the modern economy, characterized by different dynamics of market relations, represent new stage in the history of the formation of social and labor relations. However, social and labor relations, as the experience of developed countries shows, can be effective only when the guarantor is a strong and stable state, the main parameters of which are: a constant growth rate of the gross national product, state control is unconditional, and the effectiveness of the economic course being pursued is confirmed by visible citizens results. For a federal state, the most significant indicator is the socio-economic development of its constituent entities and municipalities, which determines the quality of life of the country's population.

And one of the main areas influencing the quality of life of the population is healthcare, the level of development of which is largely determined by the efficiency indicators of the use of the country’s labor resources.

In healthcare, technologies for the provision of medical services are constantly developing, the structures of the pathology of diseases are changing, which requires constant improvement of methodologies in the field of labor regulation of personnel of medical healthcare institutions.

Quite a lot of attention was paid to the study of labor regulation problems, in particular, intersectoral, sectoral and local regulatory materials were developed on time standards for work performed, workload standards and headcount standards, and research was also carried out to establish and consolidate the composition of work in the form of qualification reference books.

Improving the organization of work in healthcare institutions requires further development of a methodology for determining time standards for medical services, methods for calculating workload standards for medical personnel, and approaches to determining and planning the number of medical personnel.

To achieve the above goal, it is necessary to solve the following tasks:

• the formation of a new system for regulating the work of medical personnel using world standards for technologies for the provision of medical services;
• development of modern methods for developing time standards (labor intensity of work) for the provision of simple and complex medical services;
• developing a methodology for calculating workload standards for medical personnel in healthcare institutions in three areas (outpatient clinics, diagnostic services, hospitals) taking into account the priorities for the development of healthcare in the Russian Federation;
• development of new approaches to determining and planning the number of medical personnel in healthcare institutions.

It should be noted that the basis for the functioning of medical institutions is labor resources, therefore a special role should be given to the organization of labor, which should be based on the management of personnel of medical institutions on the basis of scientific and rational (regulatory) activities. Currently, high organization of work gives better results, which certainly leads to higher dedication of the employee, increased productivity of his work, self-realization under organized leadership, designed by management means to motivate and stimulate the employee and, most importantly, provides required quality provided medical services.

It is obvious that only management organized on scientific basis, will allow you to find optimal solutions for many social problems, relating to the standard of living not only of medical personnel of healthcare institutions, but also of potential employees.

The relationship between labor rationing and the general standard of living

In recent years, research has been carried out by the Federal State Unitary Enterprise "Research Institute TSS" of the Ministry of Health and Social Development of the Russian Federation, intended for healthcare institutions of the Russian Federation.

Based on a comprehensive analysis of the functioning of medical institutions, collected materials and expected prospects, it was revealed: with the help of labor standardization, it is possible to solve many problems relating to the standard of living of medical workers at both the micro and macro levels.

A healthcare institution, using a scientifically based organization of work, manages to increase the effectiveness of all its activities, increase the productivity of its employees, and achieve an increase in the efficiency of medical personnel in performing their duties. In turn, this leads to increased reward for work done in the form of wages and thereby increased purchasing power. And effective activities organized throughout the health care institution as a whole and the high-quality functioning of this institution as a whole lead to the improvement of its activities at the state level. This ensures the possibility of comprehensive influence on the standard of living of the country's population.

Rationing and efficiency

Labor standards must be applied when determining and planning the number of medical personnel. It has a direct impact on the remuneration of primary and auxiliary medical personnel in healthcare institutions.

This direction now plays a key role in shaping the development strategy of healthcare institutions. The effectiveness of the entire healthcare institution as a whole depends on how optimally the composition of medical personnel is formed. Unfortunately, the modern period of development is characterized by an acute problem of both the quality and composition of medical personnel in healthcare institutions.

One of the most current problems for public health care institutions is the lack of materials approved at the industry level on labor standards for emergency departments, covering the full scope of medical functions performed. In this regard, the following uncertainties arise in the process of establishing wages and the number of personnel in reception departments:

• lack of labor standards for personnel in emergency departments of public health institutions;
• lack of labor standards for support staff (nurses, orderlies) in emergency departments of public health institutions;
• the need to determine the work intensity of the staff of emergency departments of public health institutions;
• Standard criteria for the operation of emergency departments by type of health care institution have not been developed.

Currently, there are no regulatory documents on the workload of doctors, nursing staff and junior medical staff in emergency departments (with the exception of Order of the USSR Ministry of Health No. 560 of May 31, 1979, which is currently advisory in nature, is significantly outdated, and therefore is not applicable in practice).

All of the above problems make it difficult to develop an adequate remuneration system that takes into account the work intensity of the main and auxiliary staff of the reception departments of public health institutions. As a result, all this affects the quality of medical services provided to the population.

Methodology for calculating labor standards

Almost every medical institution faces the difficulties described above. Individual rates already exist simply because they have always existed, even if the load on them falls. There are no rates for other work and workloads, since the management of the institution, although they are clearly in demand, does not always know how to justify and calculate their need.

For a detailed analysis of the described problems and as a solution, we provide an example of calculating the required rates based on the work actually performed and the time spent by a doctor in the admission department of a public health institution.

The current stage of development of labor regulation in healthcare is characterized by two opposing trends:

1. at the intersectoral level, a number of decisions are being made aimed at creating a labor standardization system, including in healthcare institutions; in one of the research institutes of the Russian Ministry of Health, a unit has been opened to regulate the work of medical workers;
2. The Russian Ministry of Health approves legal documents on labor that contain a lot of erroneous provisions, both editorial and semantic in nature, and not corresponding to the theory and practice of labor regulation.

1. Organizational technologies for labor regulation

As positive measures to create a labor standardization system, one should recognize the approval of the Orders of the Ministry of Labor of Russia: dated May 31, 2013 No. 235 “On approval of methodological recommendations for federal executive authorities on the development of standard industry labor standards” and dated September 30, 2013 No. 504 “On approval of methodological recommendations for the development of labor standardization systems in state (municipal) institutions.”

Order No. 235 contains:

• conditions and timing for the revision of standard industry labor standards;
• norm-forming factors;
• labor standardization methods;
• labor intensity;
• stages of regulatory research work.

The appendix to the order provides statistical tools on the development of standard industry labor standards.

The main provisions of the order coincide with methodological materials on labor standards in the healthcare sector [ Shipova V.M. Basics of labor regulation in healthcare ( tutorial) Edited by Academician of the Russian Academy of Medical Sciences O P. Shchepin: -M.: GRANT Publishing House, 1998. - 320 pp.; Labor rationing in healthcare, lectures No. 1-No. 10 M.: RIO FSBI "TsNIIOIZ", 2013-2017. ]. However, when applying Order No. 235, the specifics of the work of medical workers should be taken into account. Recently, there has been an increased interest among managers of medical organizations in the development of local labor standards, including timekeeping. In the process of timing, an examination of the volume and quality of work is carried out, an assessment of the compliance of treatment and diagnostic measures with the diagnosis and health status of the patient, and medical prescriptions. This work can only be carried out by an appropriate specialist who is well aware of the technology of the diagnostic and treatment process. It is a mistake to involve economists, personnel department workers, and commissions in timing the activities of medical workers, since, firstly, these workers not only cannot conduct an expert assessment, but even accurately determine the name of the labor operation, and, secondly, the presence of persons who do not have medical education, is unacceptable during contact between a medical worker and a patient.

Order No. 504 defines the types of labor standards and establishes the connection between them. These provisions are very important for health care managers and for all health workers. The fact is that issues of labor regulation are still not included in the diploma and postgraduate training programs for doctors and paramedical workers; these issues are not discussed in textbooks on public health.

Order No. 504 contains certain innovations in organizational technologies for rationing labor. The document provides recommendations for state (municipal) institutions on the development of Regulations on the labor standardization system, which is either approved by the local regulatory act of the institution, taking into account the opinion of the representative body of workers, or is included as a separate section in the collective agreement.

• labor standards applied in the institution;
• the procedure for introducing labor standards;
• the procedure for organizing the replacement and revision of labor standards;
• measures aimed at compliance with established labor standards.

The most important for medical organizations, taking into account the existing regulatory framework for labor in the healthcare sector, is the first section, the appendices to which indicate the following data:

• links to standard labor standards used in determining labor standards;
• applied methods for determining the number norm based on the standard time norm, the number norm based on the standard service norm and the service norm based on the standard time norm (if calculations were carried out);
• calculation of the correction of standard labor standards, taking into account the organizational and technical conditions for the implementation of technological (labor) processes in the institution (if correction was carried out);
• methods and means of establishing labor standards for individual positions (professions of workers), types of work (functions) for which there are no standard labor standards.

Order No. 504 also defines the circle of persons who should be involved in the development of a labor standardization system in the institution.

Taking into account the number of employees and the specifics of the institution’s activities, in order to perform work related to labor standardization, it is recommended to create a specialized structural unit (service) for labor standardization in the institution. In its absence, the performance of work related to labor standardization may be entrusted to the structural unit (employee), which is responsible for the issues of staffing the activities of the institution, labor organization and wages.

The implementation of these recommendations in medical organizations should be decided, in our opinion, as follows. Taking into account the fact that medical workers do not, as indicated, have the necessary knowledge and skills in labor standardization, the deputy chief physician for economic issues should be responsible for organizing labor standardization in medical organizations. In the absence of this position, the organization of labor standardization can be entrusted to the personnel department, accounting staff, and it should be emphasized that organization labor rationing.

The direct development and establishment of labor standards based on standard standards approved at the federal level, or in the absence of such, is carried out by the heads of structural medical and diagnostic units, chief and senior nurses, taking into account the specifics of specific labor organization conditions.

2. Analysis of the modern regulatory framework for labor in the healthcare sector

Labor standards for medical workers have been set out in recent years in the following departmental regulatory documents:

• orders of the Russian Ministry of Health on procedures for providing medical care;
• letters from the Russian Ministry of Health on the formation and economic justification territorial program of state guarantees of free medical care to citizens for the corresponding financial year and planning period (hereinafter referred to as the territorial program);
• letters from the Ministry of Health of Russia, FFOMS “On methodological recommendations on methods of paying for medical care at the expense of compulsory health insurance” (labor standards for dentistry).

Mass approval of orders of the Russian Ministry of Health on the procedures for providing medical care, integral part which are the recommended staffing standards, began in 2009 and, after a short break in 2014, continues to this day. There are currently 67 orders in effect. Unfortunately, the erroneous provisions of labor standards given in these documents are, as a rule, not corrected during revision, and in some cases new errors are added to them.

The systemic erroneous provisions of modern labor regulations boil down to the following.

2.1. Erroneous application of different types of labor standards

The following types of labor standards are used in healthcare: standards of time, workload (service), and number. The values ​​of these indicators are presented in methodological materials on labor standardization in healthcare and, as indicated, in Order of the Ministry of Labor No. 504.

Time standards in healthcare are expressed in minutes, conventional units, conventional units of labor intensity (CUT), workload (service) norms - in the number of visits per hour, year, patients per day, number of studies, procedures per day, year or for any other period of time .

The size standards are presented in the size of the population or its contingents, the number of beds or round-the-clock posts per 1 medical position, the volume of a particular work.

Orders on procedures approved before 2012 provided time standards for visits to individual specialties, erroneously called workload standards or workload. When revising such orders, this data is not indicated. However, the current order for coloproctology (dated 04/02/2010 No. 206n) provides time standards for a diagnostic and treatment appointment, called the load rate.

In territorial programs, starting from 2008 and up to the present time, a table is provided, the title of which indicates “the load indicator for 1 position of a doctor (paramedical worker)”, and the table contents indicate the number of beds per 1 medical position and the number of beds per 1 post of nurses, i.e. headcount standards.

2.2. Unreasonable change in the format of presenting labor standards

The standards for the number of personnel in healthcare institutions are determined by the staffing standards used for medical workers, and the standard staffing levels used to standardize the work of employees and workers of a medical organization. The difference between these documents is that staffing standards are established based on some indicator, for example, based on 1 position of a general practitioner per 25 beds. Typical states in the overwhelming majority do not require such a calculation, and a particular position is established based on the presence or certain capacity of an institution or unit, for example, the position of deputy chief physician for economic issues is established in a health care facility with 100 or more beds and which includes outpatient clinics divisions.

The recommended staffing standards given in the orders are modeled on standard staffing standards that do not provide for calculation and are used for non-medical personnel. With the transition to this new form of population norms, i.e. the use of model states instead of staffing standards - the words so necessary for staffing standards have also disappeared: “the position is established on the basis of...”, which can lead to different workloads for medical workers with the same amount of work. For example, if a doctor’s position is set as “1 for 20 beds,” this leads to the fact that only one position can be installed for 20 beds, and for 30, and for 35 beds, which obviously leads to a different doctor’s workload. If a position were established “based on 20 beds,” as is customary in staffing standards, then 1.5 positions could be installed for 30 beds (30: 20 = 1.5), and for 35 beds - 1.75 positions ( 35:20=1.75).

Only in two orders (dated November 15, 2012 No. 923n “Procedure for the provision of medical care in the field of “neurosurgery”” and dated November 15, 2012 No. 918n “Procedure for the provision of medical care to patients with cardiovascular diseases”) and only in hospital departments, the positions of medical workers are installed “based on 30 beds.”

2.3. Violations of nomenclatures of medical organizations, specialties and positions of medical workers, bed capacity

Currently, the following regulatory documents on nomenclatures are in force:

• Order of the Ministry of Health of Russia dated August 6, 2013 No. 529n “Nomenclature of medical organizations”;
• Order of the Ministry of Health of Russia dated October 7, 2015 No. 700n “Nomenclature of specialties of specialists with higher medical and pharmaceutical education” with additions made by order of the Ministry of Health of Russia dated October 11, 2016 No. 771n;
• Order of the Ministry of Health and Social Development of the Russian Federation dated April 16, 2008 No. 176n with subsequent additions “Nomenclature of specialties of specialists with secondary medical and pharmaceutical education in the field of healthcare of the Russian Federation”;
• Order of the Ministry of Health of Russia dated December 20, 2012 No. 1183n “Nomenclature of positions for medical and pharmaceutical workers”;
• Order of the Ministry of Health of Russia dated October 8, 2015 No. 707n “Qualification requirements for medical and pharmaceutical workers with higher education in the direction of training “Healthcare and Medical Sciences”;
• Order of the Russian Ministry of Health dated 10.02. 2016 No. 83n “Qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education”;
• Order of the Ministry of Health and Social Development of the Russian Federation dated May 17, 2012 No. 555n “Nomenclature of beds according to medical care profiles.”

Compliance with these nomenclatures is mandatory for medical organizations. Incorrect names of positions and specialties in the staffing schedules of medical organizations lead to complications when pension provision workers, establishing work and rest schedules, remuneration, and so on. Moreover, such violations are unacceptable in regulatory documents. However, almost every order on procedures contains names of positions and specialties that do not correspond to the current nomenclatures. So, for example, in the orders on the procedures, the positions of a gynecologist are given instead of the position of an obstetrician-gynecologist, a dermatologist instead of a dermatovenereologist, a traumatologist instead of an orthopedic traumatologist, a neurologist instead of a neurologist, a laboratory assistant instead of a clinical laboratory diagnostics doctor, a ward nurse instead of a ward nurse (guard), bacteriologist instead of a bacteriologist, massage therapist instead of a massage nurse, etc., as well as positions not included in the nomenclature, for example, microbiologist, senior laboratory assistant, senior x-ray technician, etc.

When applying orders on nomenclature, one should keep in mind a number of contradictions between the nomenclature of positions, the nomenclature of specialties and qualification requirements. A number of medical positions indicated in the nomenclature of positions are not included in the nomenclature of specialties. These positions include: diabetes doctor, medical prevention doctor, clinical mycologist, laboratory mycologist, palliative care doctor, medical rehabilitation doctor. These positions are also absent from Order No. 707n on qualification requirements, although for most of these positions there are labor standards defined in the relevant orders on procedures.

Contributed to the incomparability of orders on the range of specialties, positions and qualification requirements introduced the order of the Ministry of Health of Russia dated October 11, 2016 No. 771n, which included a number of specialties as an addition to the list of specialties of specialists with higher medical and pharmaceutical education.

These changes in the nomenclature of specialties are not accompanied by changes either in the nomenclature of positions or in the document on qualification requirements.

2.4. Incorrect data on the number of positions to ensure 24/7 operations

The organization of the activities of medical organizations involves different modes of operation of departments and corresponding positions for their functioning. For example, an emergency medical service station (department) operates around the clock; in the hospital, to ensure round-the-clock provision of therapeutic and diagnostic medical care, round-the-clock posts of junior and junior medical workers and a number of doctor positions are established. Orders on procedures indicate a specific number of positions to ensure round-the-clock work: from 1 to 5.7 positions.

The number of positions to ensure 24/7 operation depends on two main groups of data:

• the number of working days and pre-holiday days per year on which working hours are reduced;
• work and rest schedule of the position.

The number of working days and pre-holiday days in which working hours are reduced changes annually.

The work and rest regime differs not only according to job titles, but even for the same position, but working in medical organizations in different regions of the country, for example, in an institution in the Central region of Russia and in the regions of the Far North due to different durations of vacation.

Consequently, what is erroneous is not the different number of positions to ensure round-the-clock work, defined in the orders on procedures, but the very indication in the regulatory entry for this number of positions. The regulatory record regarding the standard provision of round-the-clock work should contain only the number of beds for organizing this mode of operation, or a certain amount of work, for example, the number of emergency medical calls and, therefore, the number of teams. The specific number of positions must be calculated in a medical organization annually depending on the work and rest schedule of the position and the number of working days and pre-holiday days per year on which working hours are reduced.

2.5. Unreasonable introduction of new indicators for labor standardization

When choosing an indicator for labor standardization, the following requirements must be observed:

• taking into account the current level of development and organization of medical care, labor organization, equipment, compliance with appropriate technologies of the diagnostic and treatment process;
• compliance of the degree of aggregation of the indicator with the conditions and nature of the work of a particular type of institution, ensuring the necessary accuracy when establishing staffing standards; the influence of the main standard-forming factors and the need to take them into account in the standard indicator;
• coverage of the most common options for performing work, convenience for calculating staffing standards;
• the specific content of standard indicators, the possibility of establishing their quantitative value.

The following indicators meet these requirements:

• the size of the population or its individual contingents to establish the positions of outpatient doctors;
• the number of beds to establish the positions of medical workers in hospital institutions;
• the number of outpatient doctors and the number of beds or the amount of work to establish the positions of medical personnel of the auxiliary treatment and diagnostic service, most positions of middle and junior medical workers.

An unjustified change in these indicators for rationing the pile in the absence of their value fixed by statistics makes these data very manageable and leads to the possibility of an unjustified increase or decrease in the number of employees. An example of the erroneous introduction of a new labor indicator is the establishment in work orders of the position of an anesthesiologist-resuscitator for the number of operating table workstations.

It is quite obvious that the number of workplaces and operating tables does not indicate the amount of work of the staff; in this case, it is necessary to determine at least the number of surgical interventions on one operating table, or the operating hours of the operating table, and so on. According to previously existing orders of the USSR Ministry of Health, the standard number of these doctors was set to the number of surgical beds, and, in our opinion, there are no grounds for changing this indicator.

Another example of changing an indicator for labor standardization is to establish a standard number of orderly positions per office. In fact, the number of offices, as premises for a doctor’s work, is not included in the statistics, and the indicator for the standard number of positions for a nurse should be the number of doctor positions in a particular specialty.

Another “novelty” of the orders on procedures is the change in the standard indicator for the position of chief physician, head of the department. Thus, the number of these positions in a children's clinic, according to the relevant order (dated April 16, 2012 No. 363n), is set per 10 thousand of the assigned population. If you follow the “letter” of this order, then in a children’s clinic serving 20 thousand children, you can establish 2 chief physician positions, and 30 thousand - 3 chief physician positions, which is contrary to healthcare practice.

2.6. Lack of regulatory provisions for a number of departments of health care facilities and individual positions

In a number of modern regulatory documents, positions or entire departments are “missed.” Thus, the order on the procedure in the inpatient department of traumatology and orthopedics (dated March 31, 2010 No. 201n) did not provide for the positions of a dressing room and operating room nurse. When this document was revised (No. 901n dated November 12, 2012), the position of a dressing room nurse was introduced into the structure of this unit, but the position of an operating room nurse is still missing. The staffing standards of the dermatovenerological dispensary do not include sufficient staffing for medical workers in the admissions department; the staffing standards of the children's clinic do not include sufficient staffing for the reception desk, etc.

2.7. Incorrect formulation of the standard for the position of head of a department

In the staffing table of a medical organization, the position of a manager can be established only as one position, although the procedure for establishing this position may be different: instead of a whole or part of a doctor’s position or in addition to medical positions. In this case, the position of the head in outpatient departments is set to the number of positions of outpatient doctors of the corresponding specialty, in hospital departments - to the number of beds. In orders on procedures, in some cases it is recommended to establish a fractional number of positions: 0.25; 0.5 or 0.75 positions.

The position of the head of a hospital department in a number of cases is established, as stated, “based on 30 beds.” This entry is quite acceptable for most positions, but these positions include the head of the department. At the same time, the question remains open about the number of manager positions in a department of a different capacity, for example, in a department with 45 or 50 beds. Following the specified standard, in a department with 45 beds you can install 1.5 manager positions (45:30 = 1.5), and in a department with 50 beds - 1.75 (50:30 = 1.667, rounded 1.75). Thus, the presented establishment of positions for heads of departments contradicts healthcare practice.

2.8. Inconsistency of labor standards in different simultaneously valid documents

Simultaneously valid orders on procedures indicate different standards for the same position. For example, the position of a surgeon, according to one of the orders, is set as 1 position per 10.0 thousand adult population, according to another - 0.65 positions. It is very characteristic that both of these orders were approved in 2012 and came into force almost simultaneously - in November-December 2012. The standard for the position of a pediatric urologist-andrologist has a two-fold difference: according to one of the orders on procedures, this position is established for 10.0 thousand of the assigned child population, according to another - for 20.0 thousand.

In addition to orders on procedures, labor standards are also indicated in territorial programs, while in a number of profiles there is a discrepancy between these values ​​and orders on procedures. Thus, in otorhinolaryngology, according to the territorial program for 2016, a standard is established equal to 12 beds for 1 doctor position, and according to the order on the procedure - for 20 beds, for nephrology - for 12 and 15 beds, respectively, and so on.

There are no coincidences specified in the territorial program and in the orders of the Ministry of Health regarding the standard labor costs for a visit: according to the order approved in mid-2015, the following standard time standards for a visit were established: for a local therapist - 15 minutes, for a general practitioner (family doctor) - 18 min. The territorial program for 2016 states the following: “The recommended time standard for 1 visit to a local therapist, general practitioner, local pediatrician is on average 20 minutes.”

Such contradictory data on the value of standard labor indicators specified in simultaneously valid regulatory documents approved by the same department require urgent measures to be taken at the federal level of health care management.

2.9. Recommendations for the use of one of several indicators given in the standard

In staffing standards, the establishment of a particular position is possible based on several indicators. In these cases, the number of positions is calculated for each indicator, and then the estimated number of positions is summed up. In the orders on procedures approved in 2016 (dated 03/01/2016 No. 134n, dated 03/24/2016 No. 179n), the union “or” is included in the normative entry. This conjunction is used in Russian to connect two or more sentences, as well as homogeneous members of a sentence that exclude each other. Thus, the normative entry with the conjunction “or” suggests that you need to select only one of the given indicators. However, the logic and practice of applying labor standards suggests that if a position in one of the medical organizations is set to one of the specified indicators, for example, in one of the medical and physical education dispensaries for the number of people involved in sports, and in another - for another indicator, for example, for the urban population living in the territory where the dispensary operates, this will lead to different standard numbers of positions that do not reflect the full amount of work and burden of serving all the populations and athletes specified in the document.

2.10. Economic unjustification of new labor standards

All the shortcomings of regulatory documents indicated in the previous paragraphs can be considered as editorial, although unacceptable in documents of this kind. If desired, erroneous provisions can be corrected: you can introduce a calculation method for the formation of labor standards, bring the names of positions and specialties into line with the nomenclatures, change the regulatory entries for establishing the positions of heads of departments, establish the necessary indicator for round-the-clock work, eliminate contradictions in simultaneously existing regulatory legal documents and so on.

A medical and economic assessment of modern labor standards was carried out using the methodology of labor standardization in healthcare. Within the framework of this publication, it is not possible to describe all the methodological approaches used; they are presented in sufficient detail in the relevant literature and are used in medical organizations in the economic analysis of the activities of medical workers and departments.

Carrying out calculations of the standard number of medical positions only according to orders approved over the last two years (except for order No. 134n), showed that for their implementation an additional over 30 thousand positions are needed, including the need to increase the positions of narcologist doctors by more than 3 times compared to their actual number, geriatricians - 10 times and so on. Moreover, calculations were carried out only for those indicators that have statistical support.

A striking example of the economic unjustification of labor standards is Order No. 134n “On approval of the procedure for organizing the provision of medical care to persons involved in physical education and sports (including during the preparation and conduct of physical education events and sports events), including the procedure for medical examination of persons wishing to undergo sports training , engage in physical education and sports in organizations and (or) fulfill the test standards of the All-Russian Physical Culture and Sports Complex “Ready for Labor and Defense.”

If, when calculating the standard number of medical positions, we use only one indicator: the number of people involved in physical education and health clubs, organizations and groups, which currently amounts to 39,071.4 thousand people [ Healthcare in Russia, 2015: Statistical collection/Rosstat. - M., 2015. - 174 p.], i.e., contrary to common sense, to use the word “or” specified in the normative entry, it turns out that to implement only this provision of the order, the number of medical positions required is greater than the actual number of all doctors in the country. For comparison, we note that the previously effective order (dated 08/09/2010 No. 613n) established the standard number of doctors in sports medicine and physical therapy equal to more than 25 thousand positions, and the actual number of these doctors is 3.9 thousand positions. Moreover, these positions include not only doctors working in medical and physical education clinics, but also in hospitals, sanatoriums, and clinics. In these conditions, with such inadequacy of the staffing standards of the current order, the decision to revise the regulatory document itself is erroneous.

With regard to the standard number of paramedical and junior medical workers, a different trend is revealed: a decrease in the number of paramedical personnel and the disappearance of the standard number of junior medical workers. The standard for the positions of paramedical workers in sanatorium-resort organizations, in accordance with the new order (dated 05/05/2016 No. 279n), has been reduced tens of times compared to what was previously in force, and the standard for the position of a ward nurse (according to the nomenclature in force during the period of approval of this standard) or the standard for junior there is no nurse at all to care for patients (according to the currently valid nomenclature).

The implementation of Order No. 279n of the Russian Ministry of Health into healthcare practice does not allow organizing the work of a sanatorium for children with a number of beds of less than 250 and a sanatorium for adults with a number of beds of less than 500, primarily due to such a reduction in the standard number of middle and junior medical workers and the impossibility of their round-the-clock work. In sanatoriums of greater capacity, the reduction in the number of round-the-clock posts of ward (guard) nurses and the complete lack of regulatory provision of junior medical workers will lead to significant difficulties in organizing the provision of medical care.

There are no standards for the positions of orderlies in the recommended staffing standards of the department (office) of medical prevention for adults (dated 09/30/2015 No. 683n), the audiology office (dated 04/09/2015 No. 178n), the geriatric department and geriatric office (order dated 01/29/2016 No. 38 ) and so on.

The reduction in the actual number of junior medical personnel in medical organizations is due to an attempt to implement the May 2012 decrees of the President of Russia. In medical organizations, the positions of nurses are being transferred to the positions of cleaners, i.e., these positions are being excluded from the number of medical workers, and in several months of 2016, according to Rosstat, about 50 thousand nurses quit [ Chief Nurse, 2016. - No. 10. - P.8.]. It should be noted that such a transfer is not always justified, since in some cases the nurse performs not only the functions of a cleaner, but also takes part, to a certain extent, in the provision of medical care to the patient, i.e., she performs the functions of a junior nurse in caring for the sick, especially when providing hospital and sanatorium care. But in this case we are talking about the standard supply of junior medical personnel, and in order to transfer the positions of nurses to the positions of cleaners, it is necessary to have a standard for the position of a nurse. In this regard, we consider it erroneous to exclude positions of junior medical personnel from staffing standards.

Conclusion

The current stage of development of labor standardization can be considered as transitional to the creation of a labor standardization system. The measures taken to create this system are apparently not enough, since regulatory documents containing such obvious errors are still being approved.

A critical mass of erroneous provisions of orders on procedures regarding labor standards, the main one of which is economic unjustification, determines the need to revise these regulatory documents. IN modern conditions organization of labor standardization and the functioning of a labor standardization unit in one of the research institutes of the Ministry of Health of Russia, all documents of this kind should be developed jointly with specialists in labor standardization, or at least undergo an appropriate expert assessment before their approval. Such work is partially being carried out, but it should, in our opinion, extend to all draft regulatory documents on labor standards.

In order to improve the development of labor standards, it is necessary to include labor standardization issues in the training program for doctors and nursing staff and postgraduate training in the specialty “Healthcare Organization and Public Health”, “Nursing Organization”, holding seminars, lectures on this topic, and, firstly, turn, for developers of labor standards and specialists who approve these standards.

For chief doctors, heads of departments of medical organizations, representatives of ministries and departments in the field of healthcare: we invite you to familiarize yourself with the program of the symposium, which will be held on August 21 - 25, 2017, “Management of a medical institution in modern conditions.”

We invite you to take part in International conference for private clinics , where you will receive tools to create a positive image of your clinic, which will increase demand for medical services and increase profits. Take the first step towards developing your clinic.

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Sklyarova M. E., HR Specialist
GBUK VO "Voronezh Regional Center of Folk Art and Cinema"

The transition of budgetary institutions to an effective contract system assumes that the salaries of public sector employees will depend on performance indicators and the quality of public services provided. In this regard, labor standardization systems are being developed and implemented in institutions.

The main goals of the labor standardization system in institutions are:

Creation of conditions necessary for the introduction of rational organizational, technological and labor processes, improvement of labor organization;

Ensuring a normal level of labor intensity (intensity) when performing work and public services;

Increasing the efficiency of servicing consumers of public services.

The program for the gradual improvement of the remuneration system in state (municipal) institutions for 2012-2018, approved by Order of the Government of the Russian Federation of November 26, 2012 No. 2190-r, provides for the change and development of standard labor standards by federal executive authorities in the period from 2013 to 2018.

Article 159 of the Labor Code of the Russian Federation guarantees the use of labor standards systems determined by the employer, taking into account the opinion of the representative body of employees, or established by a collective agreement. According to Article 129 of the Labor Code of the Russian Federation, an employee is defined as remuneration for work depending on the employee’s qualifications, complexity, quantity, quality and conditions of the work performed, and also includes compensation and incentive payments.

Labor standards - production standards, time standards, number standards and other standards - are established in accordance with the achieved level of technology, technology, organization of production and labor. For homogeneous work, standard (intersectoral, sectoral, professional, etc.) labor standards can be developed and established in accordance with the Rules approved by Decree of the Government of the Russian Federation of November 11, 2002 No. 804.

In addition to labor standards, there are also labor standards. If labor standards are calculated in relation to specific conditions for performing a regulated process, then labor standards are established for various variants of standardized or average organizational and technical conditions, they are repeatedly used to calculate labor standards.

Currently, the process of developing and implementing labor standardization systems in institutions is actively underway. The Russian Ministry of Labor has approved methodological recommendations for the development of labor standards systems in state (municipal) institutions, as well as methodological recommendations for federal executive authorities on the development of standard industry labor standards.

In accordance with the methodological recommendations for state (municipal) institutions on the development of labor standardization systems, approved by order of the Ministry of Labor of Russia dated September 30, 2013 No. 504, in state and municipal institutions, labor standardization systems should be established taking into account the standard standards established by federal line ministries. If there are no standard labor standards for any type of work, the institution needs to establish its own time or number standards using working hours and other methods in accordance with methodological recommendations. In the absence of standard labor standards for individual positions (professions of workers), types of work (functions), the corresponding labor standards are developed in the institution, taking into account the recommendations of a higher organization, or with the involvement of external specialists in the prescribed manner.

Standard industry labor standards are focused on a set of organizational and technical conditions that ensure the possibility of normal work in accordance with current sanitary and hygienic standards, namely:

a) the activities of employees are regulated by job descriptions, internal labor regulations, labor protection rules and fire safety and other local regulations adopted by specific institutions;

b) when distributing work among employees, their qualifications, specialization and business qualities should be taken into account, which should contribute to the quality and fast execution assignments;

c) the area of ​​the premises must comply with standards that take into account the requirements for rational placement of the necessary equipment. In this case, rectangular rooms are recommended. The level of illumination of the workplace, the frequency of air exchange and the temperature in the working premises must be within the limits provided for by the relevant sanitary standards;

d) when arranging furniture in the workroom, one should take into account the convenience of approach to each workplace and ensuring rational flow patterns for documents, taking into account the specialization of performers;

e) the work and rest schedule of workers is established in accordance with the internal labor regulations, taking into account the regulation of all mandatory work and the performance of the most difficult of them in the first half of the day, when workers have a high stable ability to work.

The labor standardization system in a state (municipal) institution is understood as a set of decisions formalized in a local regulatory act of the institution or a collective agreement, defining:

Labor standards applied in the institution for positions of employees (professions of workers) of various categories and groups when performing certain types of work (functions) (general industry positions, main personnel, support personnel), as well as methods and methods for their establishment;

The procedure for introducing labor standards in relation to specific production conditions and the workplace;

Organizing the replacement and revision of labor standards based on assessing the level of their intensity, progressiveness and other quality indicators;

Measures aimed at compliance with established labor standards (instruction of workers, master classes, etc.).

In accordance with Article 159 of the Labor Code of the Russian Federation (hereinafter referred to as the Labor Code of the Russian Federation), labor standardization systems are determined by the employer taking into account the opinion of the representative body of workers or are established by a collective agreement.

The labor standards established in this case must correspond to the achieved level of technology, technology, organization of production and labor.

In accordance with the methodological recommendations, the labor standardization system in the institution is recommended to be established in the Regulations on the institution’s labor standardization system (hereinafter referred to as the Regulations), which is approved by the local regulatory act of the institution, taking into account the opinion of the representative body of workers, or is included as a separate section in the collective agreement.

Thus, the manager, after preparing the Regulations, must send it (in an official letter) for consideration to the representative body of the institution’s employees. Within 30 calendar days, the employee representative body must send an official response (letter) with an opinion.

The official response of the representative body of the employees of the institution, regardless of positive or negative content, must mandatory adhere to the Regulations.

In case of a positive response from the representative body of employees of the institution, the employer has the right to introduce labor standards and a labor standardization system in the institution, while the representative body of employees loses the right to protest the introduced labor standards for 5 years.

In the event of a negative response from the representative body of employees of the institution, the employer has the right to introduce labor standards and a system of labor standardization in the institution, while the representative body of employees has the right to protest the introduced labor standards in court for 5 years.

The regulations must be agreed upon with all structural divisions of the institution.

The regulation should include the following sections:

1 area of ​​use.

2.Terms and definitions.

3. The main goals and objectives of labor regulation in a state (municipal) institution.

4. Regulatory materials and labor standards applied in a state (municipal) institution.

5. Organization of the development and revision of regulatory materials on labor standards.

6. The procedure for coordination and approval of regulatory materials on labor standards.

7. The procedure for checking regulatory materials for standardizing labor for compliance with the achieved level of technology, technology, and labor organization.

8. The procedure for introducing normative materials on labor standards in a state (municipal) institution.

Labor standards must be recorded in annex(s) to the Regulations. (that is, as collections of standard labor standards are published, it is necessary to make changes to the Regulations).

In a state (municipal) institution, it is necessary to introduce exactly those rules that relate to a specific institution. Local labor standards are developed by state (municipal) institutions taking into account standard, sectoral, and intersectoral labor standards. Local labor standards are established below, or in accordance with standard ones. All intersectoral and sectoral labor standards can only be recommendations and serve as guidelines in the development of local standards.

The Order for approval and enforcement of the Regulations must include (an example of the contents of the Order is attached):

1. List of persons or units with whom the order was agreed upon.

2. Date of approval and the date by which interested employees must be familiarized with the introduced rules and regulations.

3. The fact that the opinion of the representative body of workers was taken into account (number and date of the letter from the representative body of workers).

4. The date of entry into force of the norms (standards) (must be at least 60 calendar days from the date of familiarization).

5. Validity period of the introduced regulatory materials (no more than 5 years or 60 months).

6. Responsible for the supervision of regulatory materials during the period of their validity and for the organization of inspection, monitoring, revision of labor standards (it is recommended to appoint the head of the personnel department, or personnel management specialists, in the absence of compensation specialists, etc.).

Information about approved labor standards must be monitored on the websites of the Ministry of Education and Science of the Russian Federation, the Ministry of Health of the Russian Federation, the Ministry of Culture of the Russian Federation, the Ministry of Labor and Social Development of the Russian Federation, and the Labor Research Institute.

Factors such as the introduction of new standards for the provision of services, new equipment, technology, and types of products (services) may serve as grounds for revising an institution’s labor standards at an earlier date. The revision of erroneous norms is carried out as they are identified, taking into account the opinion of the representative body of workers. Achieving a high level of production (provision of services) by individual workers through the use of new work methods and improvement of workplaces on their initiative is not a basis for revising previously established labor standards.

To comply with established labor standards in a state (municipal) institution, it is recommended to take the following measures:

Conduct internal control for compliance with established labor standards (at least once a year);

Analyze results independent assessment quality of services provided by the institution;

Provide high level staffing of the institution (at least 90%).

In accordance with Article 162 of the Labor Code of the Russian Federation, employees of a state (municipal) institution must be notified of the introduction of new labor standards no later than two months in advance. The form of notification of the introduction of new labor standards is determined by the institution independently. It is recommended to indicate previously existing labor standards, new labor standards, and the factors that served as the basis for the introduction of new labor standards.

When concluding an employment contract, the employee must be informed about labor standards. If the institution establishes staffing standards, the employee’s employment contract specifies the standard working hours. The employee must be informed about the time standards for performing work (providing services) or service standards if they are established for him, indicating that they are performed within the working hours established for him.

It is recommended, before introducing new labor standards, to instruct and train workers in the most effective techniques and methods of performing work, and both individual and group forms of their implementation can be used.

Responsibility for the state of labor standards in a state (municipal) institution, the timely implementation of organizational and technical measures, the introduction of rational organizational, technological and labor processes, improvement of labor organization, rests with the head of the institution or, on his behalf, with one of the deputy heads in charge of organizational issues and labor rationing.

The development of a labor standardization system in an institution must be carried out by specialists who have the necessary knowledge and skills in the field of organization and labor standardization. It is advisable that work related to labor standardization be carried out by a specialized unit (service) of a labor standardization institution. It is created taking into account the number of employees and the specifics of the institution’s activities. If there is no such unit, the work can be entrusted to a structural unit or employee who is responsible for the issues of staffing the institution’s activities, labor organization and wages. The development of a labor standardization system in an institution must be carried out by specialists who have the necessary knowledge and skills in the field of organization and labor standardization.

According to Article 5.27. The Code of the Russian Federation on Administrative Offenses for violation of labor legislation (including the absence of local acts) provides for administrative fines in the amount of:

For officials- from one thousand to five thousand rubles;

For legal entities- from thirty thousand to fifty thousand rubles or administrative suspension of activities for a period of up to ninety days.

The population norm based on standard time norms is determined by the following formula:

Nch = (To / Fp) x Kn,

where Nch is the norm for the number of workers of a certain qualification required to perform work for which time standards are determined;

That is the total time spent per year on the volume of work performed by employees (hours);

Fp is the planned standard working time fund for one employee per year. It is determined by production calendar for the current year. At the same time, the working time fund according to the production calendar is reduced taking into account the established duration of the employee’s paid vacations (both main and additional) and the reduced working time for certain employee positions (worker professions), as well as depending on working conditions;

Kn is a coefficient that takes into account the planned absences of employees during unpaid leave, illness, etc.

In turn, the Kn coefficient is determined by the formula:

Kn = 1 + Vr / (Fsum x Chsr),

where Вр is the total time not worked due to absenteeism of the institution’s employees for the estimated period of time;

Fsum - the standard working time fund of one employee for the billing period;

Czech Republic - average number all employees of the institution (including employees holding office positions, for whom headcount standards are updated during this calculation) for the billing period (the recommended billing period is at least two years preceding the month of the calculation).

The total time spent per year on the volume of work performed by employees (hours) (To) is determined by the formula:

To = ∑Tp x Kp,

where Tr is the time spent on the corresponding type of work, for which time standards are determined (the values ​​for all types of work performed are summed up);

Kr is a coefficient that takes into account labor costs for work that is one-time in nature, for which time standards have not been determined:

Kr = 1+% of irregular work / 100.

The time spent on the corresponding type of regulated work (Tr) is calculated using the formula:

Tp = ∑Hв x Oi,

where Нв is the standard time norm for work of the i-th type (hours);

Оi is the amount of work of the i-th type performed during the year.

Sample documents:

«________________________________________________________»

ORDER

G. ______________

On the development of a standardization system in an institution

P r i kaz y v a y:

To develop a labor standardization system in the institution by May 1, 2016.

Appoint a human resources specialist responsible for the development of labor standards in the institution. Last name I.O.

Prepare the Regulations on the labor standardization system in the State Budgetary Institution _________________ by 02/20/2016 to the HR specialist Last name I.O.

Create a working group to prepare labor standards in the institution with the following composition:

Last name I.O. - Deputy Director;

Last name I.O. - HR Specialist;

Last name I.O. - chief accountant's assistant;

Last name I.O. - Chairman of the trade union committee of the institution.

5. The working group should check the organizational and technical readiness of workplaces for work according to the new standards (the extent to which the organizational and technical conditions for performing work correspond to the conditions provided for by regulatory materials). If deficiencies are identified, propose organizational and technical measures to eliminate them. Based on the results of the inspection, draw up an examination protocol by March 20, 2016.

6. Head of department Last name I.O. provide, by March 20, 2016, summary information on department positions indicating the list of types of activities of department positions (employees) and the frequency of work, including taking into account work that is one-time in nature, for which time standards have not been determined (Appendix 1).

7. Before May 1, 2016, the HR specialist (Last name) will prepare Appendix No. 1 to the Regulations on the labor standardization system in the institution “Labor standards for _______________________________ in the institution.”

8. The HR specialist (Last name) and the deputy chief accountant (Last name) should calculate the headcount rate based on time standards until 05/01/2016.

9. Entrust control over the execution of this order to Surname I.O.

Appendix 1 to the order

No. ______ dated “___”________ 2015

Summary information by type of activity

position___________ department___________

State budgetary institution

«_______________________________________________________»

ORDER

G. _______________

On approval of the Regulations on the system

standardization of labor in the institution

Pr and kaz y v a y:

1. Approve the Regulations on the labor standardization system in the State Budgetary Institution “______________”.

2. The HR specialist (Last name) familiarizes all employees with the Regulations and conducts explanatory work among employees.

3. The HR specialist (Last name) should send the Regulations on the labor standardization system in the institution to the chairman of the trade union committee. Last name I.O. to take into account the opinion of the trade union committee.

4. Entrust control over the execution of this order to Surname I.O.

State budgetary institution

«_____________________________________________»

ORDER

G. _________________

On approval of labor standards for ________________ in the institution

Pr and kaz y v a y:

1. Approve Appendix No. 1 to the Regulations on the labor standardization system in the institution “Labor standards for _________________________ in the institution.”

2. Recognize the organizational and technical conditions for performing the work as corresponding to the conditions provided for by the regulatory materials.

3. Introduce labor standards for __________________________ in the institution from July 4, 2016.

4. The HR specialist (Last name) prepare notifications to employees about the introduction of labor standards for ___________________ in the institution by May 4, 2016.

5. The HR specialist (Last name) should send Appendix No. 1 to the Regulations on the labor standardization system in the institution “Labor standards for ______________________________ in the institution” to the chairman of the trade union committee Last name I.O. to take into account the opinion of the trade union committee.

6. Entrust control over the execution of this order to Surname I.O.

Model regulations on the labor standardization system of an institution

Preface

DEVELOPED (name of division

or developer organization)

APPROVED…………………………….. …. (executive body of the establishment

Deniya) Order No. _____ dated "__"

20 ____g.

CONSIDERATION OF OPINIONS……………………...…………..name of representative-

of the workers' body whose opinion was taken into account)

EXECUTORS (full names of persons responsible for

development in the institution)

INSTEAD (Order No. dated “__”______

20___ on the approval of the old provision, if absent, it is indicated that it is being introduced for the first time).

Introduction

This Regulation has been developed in accordance with and on the basis of the following regulations:

Labor Code of the Russian Federation;

Decree of the Government of the Russian Federation of November 11, 2002 No. 804 “On the rules for the development and approval of standard labor standards”;

Resolution of the State Committee for Labor and the Presidium of the All-Union Central Council of Trade Unions of June 19, 1986 No. 226/P-6 “Regulations on the organization of labor standardization in the national economy” (insofar as it does not contradict current legislation); Order of the Government of the Russian Federation of November 26, 2012 No. 2190-r; Order of the Ministry of Labor and Social Protection of the Russian Federation dated May 31, 2013 No. 235 “On approval of methodological recommendations for federal executive authorities on the development of standard industry labor standards”;

Order of the Ministry of Labor and Social Protection of the Russian Federation dated September 30, 2013 No. 504 “On approval of methodological recommendations for state (municipal) institutions on the development of labor standardization systems.”

1. Scope of application…………………………………………………………….4

2. Terms and definitions…………………………………...…………4

3. The main goals and objectives of labor standardization in a state (municipal) institution……………………………………………..... 5

4. Regulatory materials and labor standards applied in state (municipal) institutions………………….……….6

5. Organization of the development and revision of normative materials on labor standards…………………………………………………………7

6. The procedure for coordination and approval of normative materials on labor standards…………………………………………………………………………………9

7. The procedure for checking normative materials for standardizing labor for compliance with the achieved level of technology, technology, labor organization ……………………………………………………….………………………….9

8. The procedure for introducing normative materials on labor standards in an institution……………………………………………………………..……………………….9

1 area of ​​use

This provision establishes a system of standards and norms on the basis of which the function of labor standardization is implemented, contains the main provisions regulating the organization of labor standardization, and also establishes the procedure for conducting regulatory and research work on labor in a state (municipal) institution………………… …....

(name of institution)

This Regulation is put into effect for use in all divisions of a state (municipal) institution……………

……………………………………………………………………………….

(name of institution)

2. Terms and definitions

The following terms and definitions apply throughout this document:

approbation: The process of introducing, for a limited (test) period, the results of work performed (regulatory materials, labor standards) in order to analyze and study their impact on the labor process (activities) in conditions close to real (actual) and the effectiveness of the institution.

certified standards: Technically sound standards corresponding to the achieved level of technology and technology, organization of production and labor.

temporary standards: Standards for repetitive operations established for the period of mastering certain types of work in the absence of regulatory materials for labor standardization. Temporary norms are established for a period of up to three months and after this period they are replaced by permanent norms.

replacement and revision of labor standards: A necessary and natural process that requires appropriate organization of control at the level of the institution and its divisions. This is explained by the employer’s desire to increase the efficiency of using the labor potential of employees, to find reserves, and to take into account any opportunities to increase efficiency.

intensity of labor standards: A relative value that determines the required time to perform a specific job in specific organizational and technical conditions; intensity indicator - the ratio of the required time to the established norm or actual time spent.

standard service time: The amount of working time required to complete a unit of work or provide services under certain organizational and technical conditions.

labor cost rate: The amount of labor that must be spent on high-quality provision of services in certain organizational and technical conditions.

service standard: The number of objects that an employee or group of appropriately qualified employees service during a unit of working time under certain organizational and technical conditions. A variation of the service standard is the controllability standard, which determines the number of employees who must be managed by one manager. The standard service rate is established based on the average for homogeneous workplaces.

population norm: The established number of employees of a certain professional and qualification composition, necessary to perform specific functions, provide services, perform a certain amount of work in certain organizational and technical conditions.

normalized given ie: The volume of work/services established on the basis of the above types of labor cost standards that an employee or group of employees must perform/provide per work shift (working day), month or other unit of working time. Standardized tasks are developed on the basis of current labor cost standards and may contain individual and collective labor costs, established taking into account tasks to increase labor productivity and save material resources. These tasks are set based on the capabilities available at each workplace. Therefore, standardized tasks, in contrast to norms for labor costs, can be established only for a specific workplace and taking into account only its inherent characteristics and opportunities for mobilizing reserves for increasing labor efficiency.

industry standards: Normative materials on labor, intended to standardize labor for work performed in institutions of one sector of the economy (health care, education, etc.).

erroneously established standards(erroneous): Labor standards, in the establishment of which organizational, technical and other conditions were incorrectly taken into account or inaccuracies were made in the application of labor standards and calculations.

one-time rates: Labor standards are established for individual work that is of a one-time nature (unscheduled, emergency, accidental and other work not provided for by technology), and are valid while these works are being performed, unless temporary or permanent standards are introduced for them.

technically justified labor standard: A standard established by the analytical method of standardization and providing for the most complete and effective use of working time.

outdated standards: Labor standards for work, the labor intensity of which has decreased as a result of a general improvement in the organization of production and labor, an increase in the volume of work, an increase in professional skill and improvement in the skills of workers.

intersectoral labor standards: Normative materials on labor, which are used to standardize the labor of workers engaged in performing work using the same technology in similar organizational and technical conditions in various sectors of the economy.

local labor standards: Regulatory materials on labor developed and approved by the institution.

Note: Other concepts and terms used in these Regulations are applied in accordance with the current legislation of the Russian Federation.

3. The main goals and objectives of labor standardization in a state (municipal) institution.

3.1. Labor standardization is a priority and initial link in the economic mechanism, as well as an integral part of the organization of personnel management, ensuring the establishment of scientifically based labor standards in certain organizational and technical conditions to increase labor efficiency. The main task of labor standardization in an institution is to establish reasonable, progressive indicators of labor cost standards in order to increase total productivity and increase the efficiency of use of labor resources.

3.2. The purpose of labor standardization in an institution is to create a labor standardization system that allows:

improve the organization of production and labor from the perspective of minimizing labor costs;

systematically reduce the labor intensity of work and services;

calculate and plan the number of employees by workplace and department based on planned indicators;

calculate and regulate the size of the fixed and variable part of workers’ wages, improve the forms and systems of remuneration and bonuses.

3.3. The main tasks of labor standardization in an institution are:

development of a labor standardization system;

development of measures to systematically improve labor standards;

analysis and determination of optimal labor costs for all work and services;

development of norms and standards for labor standardization for new and not covered by standardization equipment, technologies, works and services;

development of enlarged and comprehensive standards for labor costs for the completed volume of work and services;

improving the quality of developed regulatory materials and the level of their justification;

organizing systematic work on the timely implementation of developed labor standards and regulations and ensuring control over their correct application;

ensuring the determination and planning of the number of employees by quantity, level of their qualifications based on labor standards;

justification and organization of rational employment of workers at individual and collective workplaces, analysis of the ratio of the duration of work of varying complexity;

identifying and reducing waste of working time, eliminating lost working time and downtime at workplaces;

determining the optimal ratio of workers of the same profession (specialty) of different qualifications in the departments of the institution;

calculation of the standard number of employees required to perform the planned volume of work and services;

justification of forms and types of bonuses for employees for quantitative and qualitative labor results.

3.4. The development of labor standardization should contribute to the improvement of labor organization, planning and analysis of the use of labor resources, the development of forms of use of labor resources, reducing the labor intensity of work performed, and increasing labor productivity

3.5. In order to rationally and effectively achieve the tasks of labor standardization, it is necessary to widely use modern economic and mathematical methods for processing source data and electronic computer technology, microelement standardization systems, video equipment and other technical means of measuring working time costs and studying labor techniques and methods.

4. Regulatory materials and labor standards applied in state (municipal) institutions

4.1. The institution applies the following basic regulatory materials on labor standards:

regulations on the organization of labor standards at shipbuilding industry enterprises;

labor standards (norms, time standards, numbers, production standards, service standards).

4.2. At the institution level, intersectoral and sectoral labor standards are used as basic indicators when developing local labor standards, calculating derivative indicators, and for the purposes of organizing and managing personnel. In the absence of intersectoral and sectoral labor standards, enterprises develop local labor standards.

4.3. Regulatory materials for labor standards must meet the following basic requirements:

comply with the modern level of technology and technology, labor organization;

take into account to the maximum extent the influence of technical, technological, organizational, economic and psychophysiological factors;

provide high quality established labor standards, the optimal level of intensity (intensity) of labor;

meet the required level of accuracy;

be convenient for calculating labor costs in an institution and determining the labor intensity of work;

provide the possibility of using them in automated systems and personal electronic computers for collecting and processing information.

4.4. According to the scope of application, regulatory materials are divided into intersectoral, sectoral and local.

4.5. Establishing the amount of labor required to perform the work is organically connected with the establishment of qualification requirements for the performers of these works.

4.6. The degree of differentiation or consolidation of standards is determined by the specific conditions of labor organization.

4.7. Along with the standards established for work that is stable in terms of organizational and technical conditions, temporary and one-time standards are applied.

4.8. Temporary standards are established for the period of mastering certain works in the absence of approved labor standards for a period of no more than 1 (one) year, which can be established by summary expert methods of labor standardization.

4.9. Permanent standards are developed and approved for a period of no more than 5 (five) years and have technical validity.

4.10. Technically sound labor standards are those established on the basis of analytical methods of labor standardization, indicating qualification requirements for the performance of work and focused on the fullest use of all working time reserves in terms of duration and level of labor intensity, and the pace of work. Tariffing of work and determination of qualification requirements for employees are carried out in accordance with the norms of the legislation of the Russian Federation.

4.11. Along with the standards established by the current regulatory documents For work that is stable in terms of organizational and technical conditions, temporary and one-time standards will be applied.

4.12. One-time standards are established for individual work that is of an isolated nature (unscheduled, emergency, etc.). They can be calculated and experimentally statistical.

4.13. Temporary experimental and statistical standards for time, number, production or service are established in the absence of technically sound regulatory materials on labor for performing these types of work in the institution. Experimental statistical standards are established on the basis of an expert assessment of a labor standardization specialist, which is based on systematized data on the actual time spent on similar work for the previous period of time. The validity period of temporary standards should not exceed three months (for frequently repeated work), and in case of a long process - for the period of performance of the necessary work. Persons responsible for standardization bear personal responsibility for the correct (reasonable) establishment of temporary labor standards.

4.14 Work collectives must be notified of the introduction of temporary or one-time labor standards before the start of work.

5. Organization of the development and revision of regulatory materials on labor standards

The development of regulatory materials on labor standards in an institution is based on the initiative of the employer or a representative body of workers.

The main type of regulatory materials on labor standardization in an institution are technically sound labor standards.

The standards established by the analytical method, taking into account factors influencing the standard value of labor costs, are justified.

Factors influencing the standard value of labor costs, depending on the nature and direction of the impact, are divided into technical, organizational, psychophysiological, social and economic.

Technical factors are determined by the characteristics of the material elements of labor:

objects of labor;

means of labor.

Organizational factors are determined by the forms of division and cooperation of labor, the organization of the workplace and its maintenance, methods and techniques for performing work, work and rest regimes.

Technical and organizational factors predetermine the organizational and technical conditions for performing work.

Economic factors determine the impact of the developed standards on labor productivity and the quality of services provided.

Psychophysiological factors are determined by the characteristics of the work performer: gender, age, some anthropometric data (height, leg length, strength, agility, endurance, etc.), as well as some production characteristics (parameters of the viewing area and reach area, working posture, visual load , pace of work, etc.). Taking into account psychophysiological factors is necessary for choosing optimal option the labor process taking place in favorable conditions with normal labor intensity and a rational regime of work and rest in order to preserve the health of workers, their high performance and vital activity.

Social factors, like psychophysiological factors, are determined by the characteristics of the work performer, his cultural and technical level, experience, length of service, etc. Social factors also include some characteristics of the organization of production and labor - the content and attractiveness of work, etc.

Identification and consideration of all factors influencing the amount of labor costs is carried out in the process of developing standards and regulatory materials for labor standardization.

Factors are taken into account in the following sequence:

factors influencing the standard value of labor costs determined by a specific type of economic activity are identified;

the possible values ​​of factors when performing this work are determined;

restrictions are determined that impose certain requirements on the labor process, as a result of which its acceptable options are established;

combinations of factors are selected that achieve effective work results in the most favorable conditions for their performers (designing a rational labor process).

These procedures are carried out at the stage of preliminary study of organizational, technical and other conditions for performing work. Some of the factors that depend on the performers of the work are taken into account at the stage of selecting personnel for observation during the analytical and research method of establishing norms and standards.

The quality of labor cost standards and their validity depend on the methods on the basis of which they are established. Labor cost standards can be established by two methods: on the basis of a detailed analysis carried out in the institution and the design of an optimal labor process (analytical method); or on the basis of statistical reports on production, time spent on work for the previous period, or expert assessments(summary method).

The analytical method makes it possible to determine reasonable standards, the implementation of which helps to increase labor productivity and, in general, the efficiency of using labor resources.

The summary method only records actual costs labor. This method is used in exceptional cases when rationing emergency or experimental work.

Standards developed on the basis analytical method, are justified, and the norms established by the summary method are experimental and statistical.

The development of justified regulatory materials is carried out using one of the methods of the analytical method: analytical-research or analytical-computational.

With the analytical and research method of standardization necessary costs working time for each element of a regulated operation is determined on the basis of an analysis of data obtained as a result of direct observation of the implementation of this operation at a workplace in which the organization of labor complies with accepted conditions.

With the analytical-calculation method, labor costs for standardized work are determined according to labor standards for individual elements, previously developed on the basis of research, or by calculation based on the accepted modes of optimal operation of technological equipment.

The analytical-calculation method is the most rational and preferred way of designing regulatory materials, since it is the most advanced and cost-effective method of standardization.

The improvement of the analytical and calculation method is carried out by developing systems of microelement standards, including carrying out simulation modeling.

The advantages of the analytical and calculation method of labor standardization do not exclude the use of the analytical and research method.

When developing regulatory materials on labor standards at enterprises, it is necessary to adhere to the following requirements:

regulatory materials on labor standards should be developed on the basis of methodological recommendations approved for the type of economic activity;

regulatory materials on labor standards must be justified based on their period of development;

testing of regulatory materials for at least 14 calendar days;

When forming results on labor standardization, the opinion of the representative body of workers must be taken into account.

Labor standards developed taking into account these requirements at the institutional level are local and approved by the executive body of the institution.

In order to ensure organizational and methodological unity in organizing the development, revision and improvement of regulatory materials for labor standardization, increasing their validity and quality, the following order of work is recommended.

The revision of standard labor standards in cases provided for by the legislation of the Russian Federation is carried out in the manner established for their development and approval.

In cases where the organizational and technical conditions of an institution allow the establishment of standards that are more progressive than the corresponding intersectoral or sectoral ones, or in their absence, local labor standards are developed.

The establishment, replacement and revision of labor standards are carried out on the basis of an order (instruction) of the employer, taking into account the opinion of the representative body of workers.

Employees must be notified of the establishment, replacement and revision of labor standards no later than two months in advance. Employees must be notified of the establishment of temporary and one-time standards before the start of work.

The procedure for notifying employees is established by the employer independently.

At least once every two years structural unit(service) in the organization entrusted with the functions of organizing and regulating labor, or the employee (employees) entrusted with these functions, checks and analyzes the current labor standards for their compliance with the level of technology, technology, and labor organization in the institution. Outdated and erroneously established standards are subject to revision. The revision of outdated standards is carried out within the time frame established by the management of the institution.

The revision of labor standards in cases provided for by the legislation of the Russian Federation is carried out in the manner established for their development and approval. Review is carried out every 5 years from the date of approval.

6. The procedure for coordination and approval of normative materials on labor standards

6.1 The standards are unified in nature and reflect the generalized organizational and technical conditions of the institution and the most rational techniques and methods for performing work.

6.2 Intersectoral regulatory materials are approved by the Ministry of Labor and Social Protection of Russia.

6.3 Industry-specific regulatory materials are approved by the Federal executive body of the relevant industry or sub-industry in coordination with the Ministry of Labor and Social Protection of the Russian Federation.

6.4 The procedure for coordination and approval of local regulatory materials at the institutional level:

at the institutional level, regulatory materials are developed by the employer. The employer sends the developed regulatory materials to the representative body of employees to take into account their opinions;

If the representative body of employees disagrees with the position of the employer, it must submit a written protest justifying its position, while the employer has the right to approve regulatory materials without a positive assessment of the representative body of employees;

in the event of a negative assessment of the regulatory materials on labor standards, which are approved by the employer, the representative body of employees has grounds to file a complaint and consider it in court.

6.5 The employer and the employee representative body must:

explain to employees the reasons for replacing or revising labor standards and the conditions under which they should be applied;

constantly support and develop the initiative of employees to review existing and introduce new, more progressive labor standards.

7. The procedure for checking regulatory materials for standardizing labor for compliance with the achieved level of technology, technology, and labor organization

7.1. An assessment of the level of current labor standards is carried out by analyzing the standards calculated according to these standards, conducting sample studies and studying the dynamics of performance indicators of production standards.

7.2. When checking regulatory materials on labor standards in an institution, it is necessary to perform the following work:

conduct an analysis of the fulfillment of labor standards (production) established in the institution (carried out annually); if labor standards are exceeded or not fulfilled by 15% or more, it is necessary to organize a check of indicators of labor standards and norms;

issue a regulation (order, instruction) on conducting an inspection of regulatory materials indicating the period;

establish a responsible unit for the process of checking regulatory materials on labor standards at the enterprise level;

organization working group with the involvement of a representative body of workers;

conducting sample studies, processing results;

calculating norms and standards for sample studies;

making changes and adjustments based on the calculation results;

approval of regulatory materials with changes and notification of employees in accordance with the legislation of the Russian Federation.

7.3. The detailed procedure for checking normative materials on labor standards is set out in the relevant methodological recommendations.

8. The procedure for introducing normative materials on labor standards in an institution

8.1. Regulatory materials for labor standardization, approved in the established manner, are introduced into the institution’s workplaces in accordance with their scope and scope on the basis of an order from the manager, taking into account the opinion of the representative body of workers.

8.2. To ensure the effective implementation and development of regulatory materials, the following activities should be carried out in the institution:

Check the organizational and technical readiness of workplaces to work according to the new standards (to what extent the organizational and technical conditions for performing work correspond to the conditions provided for by the new regulatory materials);

Develop and implement organizational and technical measures to eliminate identified deficiencies in the organization of work, as well as to improve working conditions;

Introduce new time standards to all employees who will work according to them, within the time limits in accordance with the legislation of the Russian Federation.

8.3. Familiarization with the new standards should be accompanied by mass explanatory work, instructing workers, and, if necessary, training them to work in new organizational and technical conditions.

8.4. If, during the specified preparatory work, it turns out that the existing organizational and technical conditions in the institution are more advanced than the conditions provided for in the new norms or regulations, and the current local norms for the relevant work are more progressive than the new norms, then the new norms or regulations are not implemented .

8.5. In those institutions where the actual organizational and technical conditions coincide with the conditions provided for in the collection, new norms or standards are introduced without any changes.

8.6. For work not covered by the new regulatory materials, local reasonable time standards are established, calculated by labor standardization methods.