Who benefits from a contract wage system and when – brief description, features, salary calculation. Contract form of remuneration Contract system of remuneration is usually used

The word “contract” itself does not have any meaningful meaning, since it is a synonym for the word “agreement”.

Types of contracts concluded with employees:

1. Contracts in the form of employment contracts or employment contracts:

2. Contracts in the form of intra-business agreements;

Based on a contract in the form of an employment contract, labor relations arise between hired workers and the enterprise. It differs from a traditional collective labor agreement in that the parties entering into the contract have more possibilities diversify the terms of the contract (validity period, organization and payment of labor, rights, duties and responsibilities of the parties).

Contracts in the form of intra-company agreements are concluded between the administration of an enterprise and an employee or group of employees or a division of the same enterprise or between divisions of an enterprise to perform any certain works or duties (for example: a contract between the administration of an enterprise and a temporary creative team consisting of employees of the same enterprise to perform some work).

This contract is not a form of employment, since it is concluded with employees who are already associated with the enterprise through labor relations, and therefore is of a secondary nature. It is simply an additional means of resolving issues of payment and labor incentives.

Contracts in the form of civil agreements are concluded both with employees of the enterprise and with other persons.

Contracts can be concluded:

With the head of the enterprise;

With the head of the department or service;

With the department (group of employees) as a whole;

With individual employees (specialists).

Contracts from the enterprise can be concluded (except for managers):

Deputy heads of the enterprise, if such a right is enshrined in the charter or it is transferred to them by the head;

Managers subsidiaries and branches;

Heads of departments and services.

Contracts are usually concluded for a specific period. They may provide two options for conditions specifying the nature of urgency:

Option 1 - it states that the employee has the right to terminate the contract at any time before the expiration of the contract by notifying the hiring party in writing for a specified period of time.

Option 2 - the employee does not have the right to terminate the contract on his own initiative before its expiration. In case of violation of this condition, the employee pays a penalty to the company.

The contract is concluded in writing (in two copies) and signed by both parties. It is a sufficient basis for the emergence of labor relations; this means that an application for employment is not required from the employee.

A contract is a document regulating the hiring, payment and dismissal of an employee. In form, the classic contract of Western countries is a multi-colored card with filled and empty columns where the terms of the contract are written. Such unified form is very convenient for entering into a computer, but it is used mainly for personnel in mass professions. For management employees - managers and specialists - the contract is the most complex and individual and can be 2-3 pages of typewritten text.

It is very difficult and responsible to draw up a contract correctly, since any errors in its conclusion lead to significant material losses for one of the parties.

2. Duration of the contract.

3. Remuneration.

4. Special terms of the contract.

Let's dwell on each point.

1. For each employee hired under a contract, tasks and deadlines for their completion must be clearly formulated in numbers in order to monitor the implementation of the contract and terminate it in case of failure or deviation from the plan.

2. Only one figure is recorded - the duration of the period of work under the contract.

3. Only one figure is entered - the amount of the employee’s monthly (weekly or annual) earnings. It appears as a result of negotiations between the employer and employee on all points of the contract, and its value mediates the purchase and sale transaction labor force, which involves market bargaining between both parties.

4. Any specific features of the employee’s work and rest, his social protection. Typically this clause contains the following information: an obligation to keep the size secret wages(an indispensable attribute of a contract in civilized countries), conditions for early termination of the contract, additional conditions for material incentives and social guarantees. Additional terms material incentives - bonuses or profit sharing. The conditions for compensation for damage may also be specified here. Social guarantees - duration of vacation, medical care at the expense of the company,

provision of housing space.

Thus, the content of the contract can be very diverse.

Keywords

HEALTHCARE/ HEALTHCARE / MEDICINE / SERVICES / SERVICES / REMUNERATION / SALARIES / INDICATIVE INDICATORS/ INDICATIVE / INDICES

Annotation scientific article on economics and business, author of the scientific work - Molotkov Yu.I., Totskaya E.G.

Item. The article is devoted to the study of the process of reforming the sphere health and the introduction of a new contractual remuneration system medical workers, developed project team for medical organizations of the subjects of the Siberian Federal District. The objects of the study were medical organizations of the district subjects. Goals. Development of a project for a new contract wage system that stimulates activity medical personnel and development of medical organizations at the subject level Russian Federation. Methodology. To study the current system and formulate new approaches to remuneration in medical organizations, structural-system analysis, participant observation, SWOT analysis, analysis of statistical data, current regulations, as well as functional modeling methodology were used. Results. A draft of a new contract system for remuneration of medical workers, algorithms, tools, and a target program for its implementation in medical organizations have been developed. Proven using the example of the study medical organization that the introduction of a contractual remuneration system increased the population’s satisfaction with quality and accessibility medical care and basic indicative indicators medical organization. Conclusions. The introduction of a new contractual system of remuneration in the standard medical organization under study allowed us to conclude that program-targeted management of project implementation is a tool for achieving the desired forecast (design) indicators in medical organizations of the constituent entities of the Russian Federation. Implementation results and monitoring indicative indicators confirm the increase in population satisfaction with the quality and availability of medical care. The proposed contractual remuneration system can be used in all medical organizations of the constituent entities of the Russian Federation.

The contract system of remuneration as a tool to manage the development of medical organizations in the constituent entities of the Russian Federation

Importance The article studies the health-sector reform process and the implementation of a new contractual system of medical workers’ compensation, developed by the project team for medical organizations of the subjects of the Siberian Federal District. We studied various medical establishments of the District. Objectives We aim to develop a new draft contract remuneration system, enabling the work of medical personnel and development of medical organizations at the level of the constituent entities of the Russian Federation. Methods For the study of the current system and formation of new approaches to remuneration in medical organizations, we used a structural and system analysis, participant observation, SWOT-analysis, statistics, the existing normative legal acts, and a functional modeling methodology. Results We have developed a draft of a new wage contract system for medical workers, algorithms, tools, and a target program to implement it in health organizations. Using the investigative medical organization case, we proved that the introduction of the contract system provided significant improvements in satisfaction of the population with the quality and availability of medical assistance and the enhancement of key indicative figures of the medical organization. Conclusions and Relevance We conclude that targeted management of the project’s implementation is a tool to achieve the desired forecast (project) indicators in health organizations. The proposed contract system can be used in all medical organizations of the constituent entities of the Russian Federation.

Text of scientific work on the topic “Contractual wage system as a tool for managing the development of medical organizations in the constituent entities of the Russian Federation”

ISSN 2311-8733 (Online) ISSN 2073-1477 (Print)

Socio-economic policy

CONTRACT SYSTEM OF REMUNERATION AS A TOOL FOR MANAGING THE DEVELOPMENT OF MEDICAL ORGANIZATIONS IN THE SUBJECTS OF THE RUSSIAN FEDERATION

Yuri Ivanovich MOLOTKOVA% Elena Gennadievna TOTSKAYA

and the doctor technical sciences, Professor of the Department of Management, Scientific Secretary, Siberian Institute of Management of the Russian Academy national economy And civil service under the President of the Russian Federation, Novosibirsk, Russian Federation [email protected]

b candidate medical sciences, chief physician of the State Budgetary Healthcare Institution of the Novosibirsk Region “City Clinic No. 16”, Novosibirsk,

Russian Federation

[email protected]

Article history:

Accepted 06/03/2015 Approved 06/08/2015

UDC 353.2 (9)

Key words:

healthcare, medicine, services, wages, indicative indicators

Annotation

Item. The article is devoted to the study of the process of reforming the healthcare sector and the introduction of a new contractual system of remuneration for medical workers, developed by the project team for medical organizations of the constituent entities of the Siberian Federal District. The objects of the study were medical organizations of the district subjects.

Goals. Development of a draft of a new contractual remuneration system that stimulates the activities of medical personnel and the development of medical organizations at the level of constituent entities of the Russian Federation.

Methodology. To study the current system and formulate new approaches to remuneration in medical organizations, structural-system analysis, participant observation, SWOT analysis, analysis of statistical data, current regulations, as well as functional modeling methodology were used. Results. A draft of a new contract system for remuneration of medical workers, algorithms, tools, and a target program for its implementation in medical organizations have been developed. It was proven using the example of the medical organization under study that the introduction of a contractual remuneration system increased the population’s satisfaction with the quality and availability of medical care and the main indicative indicators of the medical organization.

Conclusions. The introduction of a new contractual system of remuneration in the standard medical organization under study allowed us to conclude that program-targeted management of project implementation is a tool for achieving the desired forecast (design) indicators in medical organizations of the constituent entities of the Russian Federation. The results of implementation and monitoring of indicative indicators confirm the increase in population satisfaction with the quality and accessibility of medical care. The proposed contractual remuneration system can be used in all medical organizations of the constituent entities of the Russian Federation.

Contractual remuneration system as a tool for managing the development of medical organizations in the constituent entities of the Russian Federation

In accordance with the Concept of Health Care Development in the Russian Federation until 2020 and other program documents, the trend direction in the country is to increase the accessibility and quality of medical care to the population. The healthcare sector requires reforming the mechanism for providing medical services to the population and bringing them closer to international standards. The most important component in the solution

set tasks is the formation of a qualitatively new personnel policy in the medical field, and the tool is changing motivational mechanisms in personnel management.

An analysis of scientific sources and statistical data revealed problems that exist in the provision of personnel to medical institutions, as well as in the current remuneration system in the healthcare sector. One of the main problems is the acute shortage of medical personnel, including paramedical personnel - 270 thousand people, doctors - about 40 thousand people. There is uneven development

healthcare in various regions of the Russian Federation and high interregional differentiation in remuneration of workers social sphere and average wages in the constituent entities of the Federation, which differs by 1.5-2.8 times. In healthcare and provision social services average salary of federal workers government agencies is about 22.5 thousand rubles, state institutions of the constituent entities of the Russian Federation - 18.8 thousand rubles, municipal institutions - 14.7 thousand rubles. .

Application Analysis existing system wages showed that it was not possible to fully solve the problem of stimulating healthcare workers taking into account the results of their work. This determines the insufficient level of quality of government (municipal) services provided (work performed), reduces the efficiency of workers according to given criteria and indicators, and creates dissatisfaction with the increased needs of the population for quality and affordable medical services. The problems existing in the healthcare system of the Russian Federation must be solved by reforming the healthcare sector. The government and relevant ministries have made significant efforts to change the remuneration system, more than 60 regulatory legal acts at various levels have been published, a road map has been approved that determined the sequence of actions, deadlines, necessary organizational and resource provision healthcare. However, implementation new system payment occurs extremely slowly and with great difficulties, and medical organizations are faced with difficulties in achieving their goals due to the lack of uniform recommendations, tools and mechanisms for its implementation and support. Currently Russian healthcare is on the verge of another organizational reform, which provides for the transition of medical

organizations to a new wage system - contract. It differs from the current system by new tools for labor motivation and management human resources potential medical organizations and is aimed at achieving a high level professional activity personnel and increasing the availability and quality of medical services for the population of the constituent entities of the Russian Federation.

Problems of regulating wages in medical organizations

In medical organizations of the Russian Federation, there are similar problems in the field of remuneration and the quality of medical services provided to the population. The project team decomposed the main problems

medical organizations, which included the following:

Uneven development of healthcare in different regions of the Russian Federation and high interregional differentiation in remuneration of medical workers;

Population dissatisfaction with the level of accessibility and quality of medical services;

Insufficient level of wages (basic salary), qualifications and low motivation of medical personnel in conditions of personnel shortage;

Excessive regulation and restrictions in attracting additional sources financing of medical organizations;

Insufficient level of updating of medical equipment and material and technical base of medical organizations.

Analysis of the above list of problems shows that the existing practice of organizing medical services and remuneration does not fully solve the problem of motivating workers to provide quality medical services in medical organizations. Current standards and criteria for assessing the performance of medical workers do not ensure the provision of services at the level of world standards. In a number of medical organizations, incentive payments are used as a guaranteed part of earnings, which is not linked to labor results. The main reason for this is the low tariff part of wages, as well as the lack of competitiveness of medical services in regional markets labor. As a result, bonuses are given to personnel regardless of the results of work, but only in order to retain existing personnel, which is confirmed in some works.

The current stage of development of socio-economic and labor relations in society, in its material and non-material spheres, requires the introduction of new motivational

tools aimed at the final result of work. Such a tool, which is provided for by the concept of reform in the healthcare sector, is the contract labor system.

An effective contract is an employment contract with an employee, which specifies his job responsibilities, conditions of remuneration, indicators and criteria for assessing the effectiveness of activities for the appointment of incentive payments depending on the results of his work and the quality of government services provided

(municipal) services, as well as measures of social support for workers.

The study conducted by the authors presents the experience of developing and implementing a contractual remuneration system, which was carried out by a project group formed from the heads of state medical organizations of the Novosibirsk and Omsk regions, consisting of E.G. Totskoy, V.V. Malgina, A.V. Obukhova, TV. Reut, EE. Dusheba, ON. Sheina, S.V. Voitsitskaya, A.S. Ageeva.

The development of the project and program activities for the implementation of the contract system in the constituent entities of the Siberian Federal District was carried out as part of the training of medical workers at the Siberian Institute of Management of the Russian Academy of National Economy and Public Administration under the President of the Russian Federation under the program “Training of managerial personnel in the field of healthcare.”

This group has done next job:

A project has been prepared on the topic “Development and implementation of a contractual system of remuneration in medical organizations”;

An algorithm and procedures for implementing an effective contract have been formed;

The tools for regulating social and labor relations in medical organizations have been identified;

The advantages and possible problems of introducing a new institutional form in the system of hiring and evaluating medical workers have been identified;

The content and procedure for implementing an effective contract as a tool for managing the human resources potential of medical organizations were detailed;

A system of motivation and stimulation of the work of key personnel is proposed in order to form an internal personnel policy, as well as a system HR audit in medical organizations;

It is planned to measure the results of professional activities of personnel, which will significantly affect the increase in the availability and quality of medical services to the population.

Design and implementation of a contract wage system in medical organizations of the constituent entities of the Russian Federation

The development of a project to introduce a contract wage system was carried out on the basis of medical organizations in the Novosibirsk and Omsk regions. When designing, the object of the study adopted the system of remuneration in healthcare at the level of the constituent entity of the Russian Federation. The GBUZ NSO “City Polyclinic No. 24” was identified as the object for the implementation of the contract wage system. The subjects of the study are the contractual remuneration system and the mechanisms for its implementation in medical organizations in the Novosibirsk and Omsk regions. The main goal of the study was to increase the availability and quality of medical services to the population through the introduction of a contractual remuneration system that stimulates the activities of personnel and the development of medical organizations at the level of constituent entities of the Russian Federation.

At the same time, the main tasks related to the development of the project and methodology for introducing a contractual remuneration system in medical organizations were identified, namely:

Conducting an analysis of the current remuneration system in a medical organization and identifying existing problems in the healthcare sector;

Development of an algorithm for implementing a contract wage system;

Development of a methodology for the implementation of a contractual remuneration system;

Rationale economic efficiency contract wage system;

Formation of a target program “Development and implementation of a contract wage system

in medical organizations for the period 2014-2016.”

During the study of the current remuneration systems and the activities of medical organizations, methods of structural-system analysis, participant observation, SWOT analysis, analysis of statistical data and current regulations, as well as methods of functional modeling, extrapolation and forecasting were used.

Practical implementation project in the medical organization under study allowed:

Eliminate unreasonable differentiation in the level of remuneration of managers and personnel of the organization;

Cancel incentive payments to staff established without taking into account the performance indicators of a medical organization;

Create a transparent mechanism for remuneration of managers of a medical organization;

To differentiate wages for medical workers, taking into account the volume, complexity and quality of work;

Ensure the implementation of an effective contractual remuneration system;

Ensure wider dissemination of the contract system and include staff motivation mechanisms aimed at the development of the medical organization.

Design solutions for the implementation of a contract wage system using the example of the medical organization under study “City Clinic No. 24”

Characteristics of the object of study of the medical organization “City Clinic No. 24”. The clinic is designed to provide multidisciplinary medical and advisory assistance to the adult and child population of the Leninsky district of Novosibirsk. It is designed for 600 visits per shift and serves 29.2 thousand people. The main characteristics of the clinic base under study are given in Table. 1.

The structure of the institution is represented by two therapeutic departments (14 sections), a pediatric department (6 sections), gynecological, dental

physiotherapy departments, radiation diagnostics department, regional functional diagnostics office, clinical and biochemical laboratories, hospital at home. The clinic is equipped with regional nephrology, pulmonology, hematology and gastroenterology rooms. The equipment park contains 153 units. modern medical technology. In 2013, complete computerization of the clinic’s workplaces was completed (128 units).

The material and technical base of the medical organization meets the required standards for the provision of medical services for the assigned population. Its main activities include pre-hospital medical care and outpatient care, including in-patient care at home.

The number of staff at the clinic is 302 people, including 89 doctors. The share of specialists with higher education qualification category is 35%.

Number of key workers per occupied positions is 241 people, of which 240 people work in the compulsory health insurance system.

The number of doctor positions is 112.5 times the rate, occupied - 93.75 times the rate ( individuals -84).

The number of paramedical workers is 174 people, with 157.5 employees employed (93 individuals).

The number of junior staff positions is 56 people, 36 positions are occupied (individuals - 18).

In the organization under study, the formation of the wage fund takes place on the basis of the current payment system in accordance with the regulatory framework, industry agreement and roadmap requirements.

The sources of formation of the wage fund in the clinic are:

Payment for medical services from the Federal Compulsory Health Insurance Fund (state order);

Incentive payments for ensuring accessibility and quality;

Payment for medical examination services for certain groups of the adult population;

Payment for medical examination services for children without parental care;

Payment for birth certificates;

Payment for services for extra-budgetary activities.

The clinic's wage fund in 2013 was 78,531,434 rubles; in 2014 it remained virtually unchanged. Payroll in the clinic occurs in accordance with the Industry Tariff Agreement for state institutions subordinate to the Ministry of Health of the Novosibirsk Region for 2014-2016 ., put into effect on 01/01/2014. In accordance with this document, the employer is recommended to create conditions for remuneration based on an effective contract with employees, depending on the results and quality of work and improving the quality of services provided. For the purpose of specification labor functions For relevant positions, indicators and criteria are established that reflect the conditions and amounts of incentive payments strictly within the limits of the basic wage fund.

Currently, the clinic, based on the recommendations of the Ministry of Health of the Novosibirsk Region, operates a 10-point system for assessing the quality of work of medical workers, taking into account which incentive payments are made.

The share of incentive payments for medical personnel is 38%, for average personnel - 29.7%; the share of payments to doctors for part-time work is 6.9%, to nursing staff - 11.8%. When determining incentive payments

The administration is based on six indicators for assessing the quality of work of specialists, defined in points.

Analysis of the current employee motivation system showed insufficient

the effectiveness of its influence on the quality of medical services. As a result, economic losses, according to medical and economic examination and medical and economic control in 2013, amounted to more than 1% of the funds presented for invoices for medical services provided. In addition, there remains an insufficient level

satisfaction of the attached population with the quality of provision and accessibility of medical services (according to the survey, completely

only 76% of respondents are satisfied). Failure to comply with the medical examination plan was revealed

certain groups of the adult population (in 2013, only 768,255 rubles were spent, or 78% of the planned limits for this type of activity).

Regulatory legal framework and directions for improving remuneration in medical organizations. An important stage in the work of the project team was the analysis of the regulatory framework for remuneration in medical organizations, which helped the authorities state power take a closer look at this problem. During the period from 2005 to 2014, about 65 regulatory legal acts were published regulating wages at the federal and regional levels. More legislative acts currently do not provide the desired motivation for work aimed at achieving the final result, and form a negative attitude towards additionally emerging requirements, even in the context of fairly large financial injections as part of the implementation of the target program “Modernization of Healthcare” and the priority national project “Health”. In general, the current regulatory legal acts establish only a general framework; therefore, these acts require the development of mechanisms and tools for introducing a new system and forms of remuneration in healthcare.

First of all, you should consider:

Article 74 Labor Code Russian Federation;

Order of the Government of the Russian Federation dated November 26, 2012 No. 2190- “On approval of the Program for the gradual improvement of wages in state (municipal) institutions for 2012-2018”;

Decree of the President of the Russian Federation dated 05/07/2012 No. 597 “On measures to implement the state social policy»;

Order of the Ministry of Labor of Russia dated January 18, 2013 No. 21 “On methodological recommendations on the development by executive authorities of the constituent entities of the Russian Federation of action plans (regional “road maps”) “Increasing the efficiency and quality of services in the field of

social services population (2013-2018)"";

Order of the Ministry of Health and Social Development of Russia dated August 28, 2008 No. 463n “On the introduction of a new system of remuneration for employees of federal budgetary scientific institutions that have clinical units subordinate to the Ministry of Health and social development Russian Federation".

An analysis of the current regulatory framework and existing remuneration systems in healthcare, including statistical data on the actual remuneration of medical workers in the Russian Federation and individual regions, indicates the absence of significant differences and the need to improve the remuneration system in all regions of the country.

The main directions for improving the remuneration system in medical organizations include:

Reducing the gap between the average level of wages for employees of institutions and the average level of wages in the constituent entity of the Russian Federation;

Elimination of unjustified differentiation in the level of remuneration of employees of institutions;

Improving the system of criteria and performance indicators for medical workers;

Development of criteria and indicators in medical organizations where they are currently absent;

Cancellation of incentive payments established without taking into account performance indicators of medical workers;

Determining the optimal ratio of the guaranteed part of wages and incentive bonuses.

This requires additional development and implementation of new criteria for assessing the quality of work, as well as the use of new mechanisms for regulating staff motivation.

Features of the formation of a contractual remuneration system in a constituent entity of the Russian Federation and in the medical organization under study. During the work, a program-targeted method was used that allows

implement integrated approach to solve the assigned tasks, program activities were identified that covered all the main sections of the clinic’s activities. Since it is impossible to influence the existing sources of formation of the wage fund of a medical organization, it is advisable to change

redistribution of the structure of these sources. The program activities of the developed project are aimed at this.

Improvement of the remuneration system should be carried out based on the need to establish the dependence of its increase on the achievement of specific indicators of the quality and quantity of services provided. public services based on:

Introduction of a system of industry performance indicators from the federal level to a specific institution and employee;

Establishing incentive payments in accordance with the achieved indicators, criteria and conditions for their appointment (reflected in the approximate provisions on remuneration of employees of institutions, in local regulations and employment agreements (contracts) with employees of institutions);

Cancellation of ineffective incentive payments.

The project group proposed some improvements in the system of incentive payments when establishing the dependence of wage increases on the achievement of specific indicators of the quality and quantity of public services provided, as well as an expanded list of criteria for assessing the performance of medical personnel (for doctors - 17 criteria, for nursing staff - 14 criteria , for junior medical personnel - 6 criteria) and the concept of personal integral performance coefficient (PICR) was introduced.

The technology for assessing an employee’s work includes calculating each criterion that has a natural unit of measurement, converting it into points: the maximum number of points for doctors is 100 (number of criteria - 17), for nursing staff - 70 (number of criteria - 14), for junior staff - 30 (number of criteria - 6).

This approach made it possible to formulate an algorithm and structure of assessment indicators that are mandatory (repeated for all categories of doctors) and

additional ones, taking into account the specifics of their activities.

Evaluation of each criterion and integral value all performance criteria for a specific position are carried out

monthly by intra-institutional expert commissions at the level structural divisions(1st level) by filling out control assessment forms.

Personal integral criterion

performance indicator (PIKR) is issued monthly in accordance with the reporting date adopted by the institution, that is, on the 10th day of each month following the reporting month. This date is determined by decision medical institution and is fixed in

internal regulations on remuneration and incentives for the work of employees of a medical organization (order of the head).

The integral assessment of the criteria for calculating the amount of incentive payments is carried out by establishing a personal integral criterion of effectiveness (efficiency), which is calculated using the following formula:

PIKR = K, + K,... K,

where n is the number of criteria; K - evaluation criterion.

The generalization of the values of the performance criteria for each employee transferred to an effective contract, as well as the subsequent translation of the criteria into indicators for calculating the incentive part of remuneration, is carried out in the institution-wide expert commission (2nd level), which checks the validity of the personal integral performance criterion and their total value for all employees of the medical organization.

To determine the cost of one point, it is necessary to divide the incentive part by the total value of the personal integral performance criterion. Size

The incentive part of each employee is determined by multiplying the personal integral performance criterion by the cost of one point. The criteria are assessed in points. In addition, the personal integral performance coefficient of each employee is displayed, which is taken into account when calculating wages according to

the proposed methodology. Under the new contract wage system, the basic part of the salary will remain unchanged, and incentive payments will depend on the volume and quality of services provided by each employee. If the indicators of high work intensity and combination of professions established by the management of the medical organization are met, the salary increase can be up to 50% or higher.

The project developers completed comparative analysis the existing wage system and those planned for implementation in the Russian Federation and on the territory of the subject. Systematization of the information obtained during the work made it possible to develop a methodology for introducing a new remuneration system in a medical organization, including a conceptual apparatus, an algorithm and stages of implementation, indicative indicators for assessing the performance of personnel and a methodology for calculating wages, samples of local regulatory legal acts, contracts, regulations, etc.

Algorithms and tools for introducing a new wage system at the level of constituent entities of the Russian Federation and municipalities. The main mechanisms and tools for implementing the new system of remuneration for medical workers, prepared by the project team, are:

Algorithms for introducing a new wage system;

Draft resolution of the governor of a constituent entity of the Russian Federation;

Methodology for introducing a new remuneration system in a medical organization;

Target program “Development and implementation of a new contractual system of remuneration in medical organizations for the period 2014-2016.” (hereinafter referred to as the Program).

These documents were developed during the research and design of a new contractual system of remuneration in medical organizations at the level of a constituent entity of the Russian Federation and proposed for implementation in the Omsk and Novosibirsk regions.

Project activities provide for execution at the level of authorities of a constituent entity of the Russian Federation and at the level of a medical organization, therefore two algorithms for the formation of a new contractual agreement were developed

wage systems, which are shown in Fig. 1 and 2.

To implement the project on the territory of the constituent entities of the Russian Federation, it is necessary to carry out a number of activities at the level of executive authorities, the main of which are:

Discussion of the methodology at the board of the Ministry of Health of the constituent entity of the Federation;

Adoption of the governor's resolution on the introduction of a new wage system;

Development of a targeted Program with access to specific program activities and target indicators.

When implementing a project at the level of a medical organization (Fig. 2.), at the initial stage it is envisaged to create a working group, including the head of the medical organization, his deputies and a representative trade union organization. The most important stages of project implementation are testing in a pilot medical organization and evaluation of monitoring results.

If there are expected effects from the implementation of the project (achieving the roadmap indicators), it enters the replication stage. At the same time, the working group adapts the methodology to the conditions of a specific medical organization by developing its own program activities and indicative indicators. Required condition, preceding the introduction of a new wage system, is the adoption of a contract system for general meeting team.

Formation of a target program for the introduction of a contract wage system at the level of constituent entities of the Russian Federation and municipalities. The group that developed the draft of the new remuneration system included the heads of state medical organizations of the Novosibirsk and Omsk regions. They managed to implement a systematic approach to solving existing problems, which will allow optimizing remuneration in the healthcare system. In this regard, the Program and its passport (Form 1) were developed.

In addition, program activities have been formed that cover all areas of the medical organization’s activities, which makes it possible to introduce a new contractual remuneration system.

Monitoring the implementation of program activities of the target program “Development and implementation of a contractual system of remuneration in medical organizations for the period 2014-2016.” The program includes nine sections and provides a monitoring system for program activities given in Table. 2, the implementation of which can significantly change the wage fund. Thus, the introduction of outsourcing mechanisms in ensuring the activities of a medical organization related to the organization of security can increase the fund by 700 thousand rubles. per year. Project implementation timelines include milestones and a schedule for implementing project activities. At control points, experts together with the head of the pilot site and working group to implement the project, assess the status of the project implementation. Evaluation of the implementation of program activities is carried out in accordance with the monitoring given in table. 2.

Based on the monitoring carried out by the expert group, the Program implementation management coefficient is calculated, which makes it possible to determine the level of implementation of the measures taken to implement the new remuneration system and, on this basis, to develop additional organizational and

economic measures that will allow achieving more complete implementation of activities. Indicator optimal control Program

K opt=(VP + UR+NR)/£ M O<1,

where VP - completed activities;

SD - successfully implemented activities;

NR - normally implemented activities (PR - poorly implemented, NV - unfulfilled);

^ M 0 - the total number of Program activities accepted for implementation.

It is difficult to implement the Program 100%, but the estimated level of successful implementation should be in the range from 0.9 to 1. Achieving such a level is only possible with strict control over the implementation of program activities in terms of deadlines and responsible persons.

Monitoring of planned program activities in areas (Table 2) that ensure the implementation of a new wage system allows for the introduction of corrective actions. Based on

value of K opt (the level of management of the implementation of the project for introducing a new remuneration system), it is necessary to develop management decisions aimed at two categories of measures taken: poorly implemented and unfulfilled. By influencing these categories, you can change (increase) the value of the coefficient, and therefore manage the process of implementing the Program aimed at increasing operational efficiency and achieving the roadmap indicators. The list of indicative indicators for assessing the level of effective operation of a medical organization is given in Table. 3.

The customer and coordinator of the Program was the management of polyclinic No. 24, which sends a quarterly report on the progress of the Program to the Ministry of Health of the Novosibirsk Region. Monitoring the implementation of the Program is carried out by an expert commission, which includes the deputy chief physician for economic issues, a specialist in the human resources department, the chairman of the trade union committee, a lawyer, deputy chief physicians, heads of departments, the chief nurse, and the head of the department of automated control systems.

The implementers ensure the implementation of the Program activities. The expert group is entrusted with the following tasks:

Monitoring the implementation of the contract wage system;

Formation of budget requests to finance Program activities;

Justification of financing and selection of priority works;

Justification of methodological and legal regulation carried out by state authorities of a constituent entity of the Russian Federation and local self-government;

Implementation of the plan for professional training and retraining of personnel;

Formation of corporate culture;

Generating Program execution reports.

Motivation of management personnel to introduce a contractual remuneration system in medical organizations. The project team proposed a motivation system

management personnel responsible for the implementation of program activities of the Program, which will contribute to more efficient staff performance. Stimulation of the implementation of Program activities can be achieved by calculating the following coefficients used to evaluate the performance of personnel of a medical organization:

1) the coefficient of implementation of activities kim, enshrined in the Program, which is calculated by the formula:

k ,M=I (x)/£ I (*),

where ^ I(x) is the number of completed activities included in the Program;

^ I(x) - the number of activities assigned to the performer;

2) the coefficient of implementation of activities on time ^.m.s, fixed in the Program and completed on time, which is calculated by the formula:

ki.m.s = E/i.i (x)/E 1 z.i (*) -

where ^ Iii (x) is the number of activities under the Program completed on time by the contractor;

^ Izi - the number of planned activities under the Program assigned to the contractor;

3) the quality coefficient, which is determined by the immediate supervisor, who accepts the employee’s documentation of the implementation of activities under the Program (incentives based on the indicators given earlier will significantly affect the implementation of measures to introduce the new remuneration system, while the quality coefficient must not be lower than 0, 5.);

4) the integral coefficient £ and - which takes into account the degree of influence of the manager on the final result (provides for hard and soft incentives) and is determined by the formula:

and i.m i.m.s >

5) the arithmetic average coefficient for the implementation of activities enshrined in the Program, taking into account the deadline (soft incentives), which is calculated by the formula:

with i.m i.m.s"

Expected results from the implementation of the project

Programs:

Execution government order 100%;

Increasing population satisfaction with the quality and accessibility of medical care (90% according to survey results);

100% achievement of financial limits for clinical examination of adult population groups;

Improvement qualification characteristics key personnel (increasing the proportion of certified medical workers to 97%);

Achieving requirements (increasing staff salaries on average up to 50);

Reduction of financial losses from penalties from medical insurance organizations (up to 0.5% of the amount of invoices for medical services provided);

Achievement economic effect from the introduction of new financial and economic mechanisms (the use of outsourcing in the activities of medical organizations increases the wage fund by 700 thousand rubles per year);

Implementation of the tasks of forming and implementing a new contractual remuneration system aimed at the comprehensive development of all areas of activity and achieving a new level of indicative indicators of medical organizations.

main board roadmap

Main conclusions of the study:

Program-targeted management of the implementation of a new contractual remuneration system is a tool for achieving the desired forecast (design) indicators in medical organizations of the constituent entities of the Russian Federation (Siberian Federal District);

Design and modeling of program-targeted management of the implementation of a new contract system makes it possible to generate financial, economic, organizational, material, labor and time resources that are necessary for the development of the healthcare sector at the level of the constituent entities of the Russian Federation (Siberian Federal District);

The formation of algorithms for the implementation of a new contractual remuneration system makes it possible to systematically design a target program;

The formation of a monitoring and incentive system allows us to ensure the implementation of the Program’s activities and motivate management personnel to achieve final results on the implementation of a new contractual system of remuneration in medical organizations of the constituent entities of the Siberian Federal District.

In general, the financial costs of implementation

project activities The programs amounted to

RUB 29.85 million

Table 1

Characteristics of the medical organization under study GBUZ NSO “City Clinic No. 24”

Research parameter Meaning

Population served, people 29 200

Equipment fleet, units 153

Computer equipment, units. 128

Number of structural divisions, units. 16

Quantity staff positions, units 420.5

Overall staffing, % 71

Economic losses,% 1

Share of completed planned limits for clinical examination, % 78

Satisfaction of the assigned population with the quality and availability of medical services (according to survey data), % 76

1.1 Concept and content of the contract wage system

The contract system is a type of contract tariff system wages, involves the conclusion of an agreement (contract) for a certain period between the employer and the contractor /3/.

An employment agreement (contract) is concluded in writing when hiring an employee, which stipulates working conditions, rights and obligations of the parties, working hours and level of remuneration, as well as the duration of the contract. The agreement also sets out the consequences that may occur for the parties in the event of its early termination by one of the parties. The contract may include both the time the employee spends at the enterprise (time-based payment) and a specific task that the employee must complete within a certain time (piece-rate payment).

By agreement of the parties in employment contract Various additional payments and allowances of an incentive and compensatory nature may be provided /1 /:

· for professional excellence and high qualifications;

· for class;

· for deviations from normal working conditions, etc.

The contract may include issues related to the provision of official transport, additional leave, living space, etc.

Contract - an employment agreement concluded in writing for a period specified in it, containing features in comparison with general standards labor legislation and providing for specific minimum compensation for deterioration in the legal status of the employee (Appendix).

The contract may be:

· when hiring an employee;

· with an employee whose employment contract was concluded for an indefinite period. The conclusion of a contract is carried out in connection with justified production, organizational or economic reasons.

Contracts with pregnant women, women with children under 3 years of age (disabled children under 18 years of age), employment contracts with whom were concluded for an indefinite period, are not concluded unless they consent to the conclusion of such contracts.

The main function of an employment contract is the creation of labor relations. The subject of an employment contract is the labor force of a specific person. Thus, from an economic point of view, an employment contract is a contract for the purchase and sale of labor, and from a legal nature it is a contract for the hiring of labor /5/.

Another function of an employment contract is that it serves legal form organization of labor at enterprises, institutions, farms. Through an employment contract, the distribution of labor force in production is determined and distributed job responsibilities personnel.

Many terms of an employment contract are strictly regulated by law, and the parties cannot change them if the employee’s position worsens as a result, even by mutual agreement.

If the condition of the contract completely coincides with the norms established by law, then it is possible not to duplicate the legislation and not to indicate this condition. But it is necessary to consider all the terms of the employment contract, since the parties may not be aware of the existence of rules.

The employer can change most of the norms established by law to improve the employee’s situation. Of course, in this case, the terms and conditions defined by agreement between the parties must be clearly stated in the employment contract.

Contracts (agreements) refer to documents that are the most important evidence in arbitration court in case of disagreement.

In a market economy leading place occupies a contractual, negotiated system of remuneration.

In all sectors of the national economy, two forms of wages are used /5/:

· payment for the quantity and quality of manufactured products at established prices is called piecework;

· payment for the amount of time worked, taking into account the qualifications of the employee, regardless of output, is called time-based.

The level of remuneration is fixed in an agreement between employees and management, which can be individual or collective.

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The contract system is a type of non-tariff wage system that involves the conclusion of an agreement (contract) for a certain period between the employer and the contractor.

By agreement of the parties, the employment contract may provide for various additional payments and allowances of an incentive and compensatory nature:

1. for professional excellence and high qualifications;

2. for class;

3. for deviations from normal working conditions, etc.

The contract may include issues related to the provision of official transport, additional leave, living space, etc.

The main advantage of the contract system is the clear distribution of rights and responsibilities of both the employee and the management of the enterprise. This system is quite effective in market conditions. Contracts can be concluded with managers, specialists, and also with workers.

With the transition to market relations, quite a lot has happened significant changes in the organization of wages at the enterprise. The rights of enterprises in the distribution of funds earned by them have been expanded. The state reserves only: regulation of the minimum wage, its adjustment according to inflation and the creation of equal opportunities for enterprises to earn money for wages. In addition, the Labor Code regulates minimum compensation payments for work on weekends and holidays, during overtime work, maximum amounts of part-time work, increased wages in hazardous and difficult working conditions, payment during forced downtime and additional payments for teenagers.

24. Labor productivity, its definition and economic significance

Labor productivity characterizes the efficiency of labor in material production. This is not only one of the most important indicators of production efficiency, but also an indicator of great economic and social significance at the macro level. Citizens of the country where the highest labor productivity is achieved should also have the highest standard of living.

Labor productivity- this is the amount of products produced over a certain period per employee or the cost of working time per unit of production.

It is necessary to distinguish between the concepts of productivity and labor intensity. With an increase in labor intensity, the amount of physical and mental effort per unit of time increases, and due to this, the amount of products produced per unit of time increases. Increasing labor intensity requires increasing wages. Labor productivity increases as a result of changes in technology, the use of more advanced equipment, and the use of new work methods and does not always require an increase in wages.

Economic significance The productivity of total (social) labor is determined by the fact that its increase means:

Growth of GDP and national income;

The basis for the socio-economic improvement of the standard of living of the country's citizens and solving social problems;

The basis for the socio-economic development of the country and ensuring the economic security of the state;

Increased accumulation and consumption.

Economic significance ensuring growth in total labor productivity at the enterprise determined by the fact that this growth allows:

Reduce labor costs for production and sales of products;

Increase the competitiveness of the enterprise and product, ensure the financial sustainability of production activities;

Increase (all other things being equal) the volume of production, and most importantly, given its competitiveness, the volume of sales and profit growth;

Carry out a policy to increase the average wages of enterprise employees;

More successfully carry out the reconstruction and technical re-equipment of the enterprise at the expense of the profits received.

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