1.    Health care management system of the Russian Federation.

2.    Ways of reforming the healthcare system in Russia (decentralization, demonopolization, democratization).

3.    Factors affecting the management of nursing personnel in medical institutions at the present stage

4.    Features of health care facilities that affect personnel management.

Healthcare management system

The goal of the health care system is to prevent and eliminate diseases, reduce mortality and disability, improve physical development, increase working capacity and increase the life expectancy of people.

Healthcare management is a complex multi-level and multi-component system of activities.

The system ensures the rational functioning of the industry and its resources (personnel, healthcare organizations, material and technical base, financing).

The functioning of the industry is carried out through legal regulation, medical technology, knowledge and skills of medical workers.

The healthcare management process includes:

  • sources and channels of information on health resources;
  • regulatory and technical base of health care, database of medical, including managerial, technologies;
  • a structure for analyzing the information received and developing optimal management    decisions.

Ways of reforming the healthcare system

Socio-economic and political changes in the country have affected the health care system.

The introduction of market relations in health care required changes in the industry management system.

The economic model (in terms of funding sources) of health care has changed from “budgetary” to “budgetary and insurance”.

According to the form of ownership, health care institutions were divided into state, municipal, and private.

Reforming the healthcare system followed the path:

·         Decentralization;

·         Demonopolization;

·         Democratization.


Decentralization is one of the elements of system reform

health care in many European countries.

A centralized health care system and strict methods of managing it were necessary and effective in the past, especially in the pre-war and wartime conditions, the need to solve very difficult health problems with the most severe shortage of resources and personnel.

The principle of decentralization is based on the idea that small organizations with effective structure and management have more organizational flexibility and accountability than large organizations.

In Russia, health care reform has also followed the path of decentralizing management.

The administrative vertical of health care management was destroyed, the health care system split into federal, regional (oblast) and municipal systems.

On the one hand, two ministries merged into the Ministry of Health and Social Development of the Russian Federation, on the other hand, the Ministry of Health and Social Support appeared in the constituent entities of the Federation as in the Saratov region. the division of ministries took place again.

Decentralization has led to a redistribution of the functions of economic and social responsibility, both between different levels of government and between individual links in the provision of health care. This division made it possible to form a regional approach in the development of national programs, to create conditions for the formation of intersectoral approaches in the management of public health protection.

The state level of government was left with such important functions as:

·         Monitoring of the main indicators of public health;

·         Legislative policy;

·         Definition of medical and medico-economic standards;

·         Determination of uniform requirements for the training of specialists;

·         Approval of sanitary and hygienic norms, standards and rules;

·         Development of standards of professional activity and medical ethics;

·         Coordination of scientific activities;

·         Scientific and methodological support for the implementation of national policy and strategic planning;

·         Development of a system for financing health care institutions;

·         Optimization of the health care structure.

The competence of the state also includes non-medical measures, including improving the state of the environment, the material well-being of people, the quality of food, water, a comfortable psychological environment, safety, etc.

Decentralization has brought both positive and negative consequences.

The positive side is that decentralization allows the constituent entities of the Russian Federation to take into account regional characteristics and thereby in the most effective way to improve medical care and optimally allocate resources.   Management becomes more flexible and faster can be responding to changing circumstances.

The negative sides that make effective management difficult are:

firstly, the functions of health care management were not supported by appropriate information support. In particular, this concerns the issues of rational use of resources of territorial health care systems;

 secondly, organizational decentralization, due to the lack of a unified methodological approach, narrows the capabilities of the health authorities of the constituent entities of the Russian Federation to pursue a targeted policy in the field of health protection.

For example, due to the independence of budgets of different levels, it is very difficult to calculate a single per capita funding standard for individual territories. Hence the unevenness and duplication of functions in the network of health care facilities (municipal, departmental, specialized, etc.) in certain cities and regions;

third, the separation of functions   leads to a weakening of the central apparatus and the public sector.

An extreme form of decentralization is the privatization of health care institutions.

fourthly, decentralization is one of the reasons for the duplication of activities of various structures of the system.

The second reason for duplication is the development of departmental health care systems, each of which uses its own hospitals and clinics.

The development of the private health sector also creates duplication.

Patients, at present, themselves have the opportunity to choose between different systems (state, departmental, private) and thereby stimulate the activities of certain medical institutions.

Duplication is overcome through the formation of regional markets for medical services and through regional planning.

In the UK, private healthcare organizations participate in the State Guarantee Program and are funded by the state for an agreed amount of state guarantees, in Russia private healthcare provides exclusively paid medical services.


Demonopolization is the second direction in the reform of the health care system.

The division of health care institutions according to the form of ownership into state, municipal and private, creates conditions for competition, which stimulates the search for more effective forms of work.

Demonopolization of the healthcare network will make it possible to abandon outdated types of institutions, instructions and dogmas, which have accumulated a lot. This also made it possible to accelerate the reconstruction and strengthening of the material and technical base of health care.

Demonopolization solves the problem of the patient’s right to choose the attending physician and medical institution in which he would like to receive qualified diagnostic, medical and rehabilitation assistance at any time.

However, demonopolization should not turn medical institutions into sources of profit, at the expense of the population that has been put in a hopeless position.


The main idea of ​​building health care was the democratization of management and financing of the system

The democratization of the healthcare management system is aimed at weakening administrative methods and strengthening the economic independence of medical organizations:

Ø  finding sources of financing not prohibited by law (sponsors, introduction of a volume of paid services at the discretion of the head of a health care facility, but not more than those established by the regulation, renting out premises, bank loans, securities);

Ø a  new incentive system of remuneration for medical workers, taking into account the coefficient of participation in the labor process of an employee;

Ø  independence of health care facilities in choosing an insurance organization (or refusing to choose) when fulfilling a state order under the compulsory medical insurance or contracts for the provision of medical care in excess of the state order.

Ø  Involvement in extra-departmental control:

·         Consumer advocacy organizations;

·         Associations of citizens created in order to protect and implement the rights of certain categories of citizens to quality medical care and a healthy lifestyle;

·         Board of Trustees (from citizens representing the local government).

Factors affecting the management of nursing staff in medical institutions at the present stage

The management activities in medical institutions are influenced by many factors, the number of which has significantly increased in connection with the reform of the health care system and which complicate the management process, including for nursing personnel.

Problems in the management of a medical and prophylactic institution arise as a result of factors:

1.    complication of the structure of the health care system;

2.deficiency    of a scientific management approach to solving

problems in medicine;

3.the    emergence of market relations between business entities

military activity in the health care system;

4. the    emergence of a market for paid medical services;

5.the    emergence of competition between treatment-and-prophylactic

institutions of various forms of ownership (municipal, state, private);

6.    soaring quality requirements of medical

services from consumers, MHIF and insurance companies;

7.increasing    the requirements and forms of reporting by the authorities

health management and other regulatory organizations;

8.    personnel imbalance   (lack of junior medical

staff, nursing staff shortage);

9.the    growth of self-awareness and the need for nursing staff for

increasing the level of knowledge;

10.the          emergence of the state reform program

nursing and the need for their implementation;

11.          development and implementation of innovative nursing technologies;

12. The          trend towards the differentiation of professional sestrin-

business and its separation into an independent sphere of medical activity;

13.          implementation of the national project “Health” and other federal and regional target programs;

14.          introduction of a new system of remuneration.

All of these changes increase the burden on healthcare workers, increase the stressful situation, provoke resistance among a number of employees and make it difficult to manage personnel.

The complexity of the management of   medical personnel is also associated with the peculiarity of the medical and preventive institution as a specific organization.

Features of health care facilities affecting personnel management

1.     The complexity of the social structure of medical institutions .

No other company has such a diversity in its employees as a healthcare facility, in terms of professionalism.

This is the difference in education, work experience, experience, qualifications, responsibility for their actions, professional independence, a variety of characters.

2.     High level of conflict.

High conflicts are associated with:

Ø  with a complex social structure of personnel;

Ø  with high intensity of medical work;

Ø  interdependence of labor and other organizational reasons.

3.    The consequences of erroneous decisions are difficult or even impossible to correct.

The activity of a medical worker, constantly related to the health and life of the patient, does not give the right to make a mistake that can lead to deterioration of health or loss of life.

In a   market economy, due to changes in   the health care system, the role of the leader in this reformed system is significantly changing.

On the one hand, he is given independence in dealing with the functioning and distribution of financial resources, on the other hand, the responsibility of the management for achieving the set goals increases.

In modern conditions, managers are required to:

1.    knowledge of the laws of economics, marketing,   psychology and sociology, conflict management;

2.    knowledge of the theory of health care management;

3. the    ability to react intelligently to a rapid change in the situation;

4.    special responsibility for decision-making;

5.    entrepreneurial spirit, etc.