Any enterprise needs a leader, and medicine is no exception. Each hospital is managed chief physician. What is hidden in this position?

What does the chief physician do?

Chief Physician of the Modern medical institution- this is specialist with the highest level of qualification. But this does not mean that he is obliged to explain to the surgeon the correct sequence of the operation or to discuss with the obstetrician-gynecologist the procedure for conducting labor. Maintaining the proper level of knowledge is necessary for professional communication with colleagues, including in providing assistance, if required, and making decisions on complex medical situations.

The next thing, without which it is impossible to manage an institution, regardless of its scale, is ability to quickly accept right decisions . At the same time, medical experience alone will not save, because a hospital cannot exist without accounting, economic and legal structures.

AT recent times Violent debate often unfolds around the question of who should run a medical institution: chief medical officer or qualified manager?

So, a global study of the activities of 400 hospitals located in the United States showed that the efficiency rate is 30-40% higher in those hospitals that are run by doctors, not managers.

General provisions of the instruction

Appoint a chief physician to a position or release him from his post, may either the founder or head of the health department(if we are talking about budgetary medicine).

The leader must monitor compliance with the order in all areas of the hospital: hygiene, epidemiology, sports rehabilitation, medical work, culture, etc.

A person who has a higher medical education, a certificate of internship (residency), a certificate confirming the fact of obtaining knowledge in the field of organization and management of healthcare, as well as At least 5 years experience in management.

The chief doctor manages the entire hospital, respectively, he is subordinate to: heads of structural units, chief nurse, head of household, planning and economic service, etc.

If the manager needs to leave for some time workplace(undergo training, go on vacation, etc.), then he must appoint a person to act in his capacity, which can be only one of the managers.

The standard job description states that the chief medical officer must be proficient in:

• necessary knowledge in the field of organization and management of the hospital;
• information contained in resolutions, orders, normative documents concerning the work of the institution;
• information on promising technical, social and economic directions of development of the institution;
• effective ways of enterprise management;
• the procedure to be followed when concluding and executing contracts for economic and other purposes;
• rights governing the service life of equipment and the period of its repair;
• staffing;
• the procedure for carrying out sanitary and hygienic measures;
• official duties of subordinate employees;
• the basic principles of medical care;
• a regulatory framework describing the procedure for issuing medical documents;
• etc.

Responsibilities and tasks

The head doctor can manage a budget hospital, a paid clinic, a private medical center or a dispensary. Regardless of the place of work, he is obliged to adhere to the general provisions:

• effectively organize the work of subordinates who strive to provide patients with quality medical care qualitatively and in a timely manner;
• when managing a hospital, comply with the current legal framework;
• be a representative of the institution in any state, insurance, judicial, etc. structure;
• provide medical, financial and administrative activities hospitals;
• control the implementation of internal labor regulations, compliance fire safety in the workplace, etc.;
• evaluate the performance of the institution and constantly strive to improve performance.

Requirements for a specialist

To become the chief physician of any medical structure must have the following mandatory components:

• diploma of higher medical education;
• a certificate confirming the fact of obtaining a certain specialty;
• certificate of completion of a course considering organizational issues in the health sector;
• At least 5 years of experience in a managerial position.

Responsibility and rights

Any worker in the medical field is endowed with duties to provide care to patients, but within the limits of their profile and skill level. In general, the chief physician can also be viewed through the prism general principles, because he, like an ordinary full-time doctor, is trying to provide citizens with proper treatment. True, he uses slightly different tools (follows effective work hospitals, directs medical practice, worries that the institution has the necessary medicines, consumables, etc.), and the attending physician receives patients and prescribes treatment (has direct contact with the patient).

The very position of a doctor suggests that the complex of his rights and obligations can be considered from 3 sides:

• common, which means that he, like any other citizen of a civilized society, has the right to live, study, freely express personal opinion etc.;
• special, involving additional features for example, providing medical care to patients in accordance with a higher education diploma, license, skill level, etc.;
• individual related to specific person and a certain situation.

The status of the chief physician includes the rights and obligations established by the current legislative framework. So far, no single order has been created, regulating the behavior of the leader medical organization .

Often, the job description of the chief representative of the hospital enshrines the following rights:

• hiring, terminating an existing labor relationship, making a decision to reward an employee or to impose a penalty;
• publication of orders, orders and other internal local acts;
• instructing the deputy head of the structural unit, in accordance with his official position, to perform duties that are not reflected in the job description, but corresponding to the qualification level;
• implementation of replacements dictated by production necessity;
• attraction public attention to measures aimed at improving the activities of the institution and material issues;
• creation new service(office) on the basis of an analysis of the needs of citizens in specialized medical care;
• control over subordinates in terms of conscientious following official duties fixed in the internal local act and compliance with the regulations in force on the territory of the medical institution;
• raising the level of qualifications through the passage of an appropriate training course.

To assess the effectiveness of the leader, the higher-level health service considers and evaluates the following factors:

• qualitative and quantitative indicators of the functioning of the hospital;
• the degree of compliance with the rules and requirements reflected in the regulatory documents by the chief physician;
• public efficiency, etc.

The head of a medical institution is responsible both for his own poor performance of duties and for his subordinates. Responsibility may be different character: from administrative to criminal. The controlling structure, after identifying any violations, may decide to impose a fine.

If it's about individual, then the amount will be several times less than when punishing legal entity(of the hospital as a whole, which is represented by the chief physician).

How to become the chief physician of a dental clinic or medical center?

Decree of the Government of the Russian Federation No. 291 dated April 16, 2012, states the procedure for obtaining a license. One of the conditions requires that the head of the hospital, heads of structural divisions and other persons responsible for providing medical support to patients, have documents confirming the receipt of higher education, postgraduate training and additional professional knowledge.

Order of the Ministry of Health of the Russian Federation No. 1183 n, issued at the end of 2012, provides that a person holding one of the following positions may be at the helm of a medical institution:

• chief physician (a citizen with a higher medical education and sufficient experience in a leadership position);
• director (top manager);
• Deputy chief physician (during the absence of the head).

That is, he can manage a medical institution as a citizen with a higher medical education (if the job description provides for the provision of specialized assistance patients, the requirement for education is mandatory), and the manager (economist, lawyer), who has a higher education, special training in health and experience in fulfilling the job description of the management team. But, this does not mean that one excludes the other. Appointment to a managerial position is possible only if staffing includes both positions: both the chief physician and the director (without medical education).

The same conditions apply to all dental clinics and private medical centers. The activity of any of the above institutions is not possible without a license, and in order to obtain it, you must comply with the requirements Government Decree No. 291 of April 16, 2012.

How to fire a manager?

The main difficulty in terminating an employment relationship with the head of a medical institution lies in the duties he performs. In accordance with regulations Ministry of Health, the chief physician of the hospital is required to perform both medical and administrative functions, for example, signing financial statements.

Dismiss the head doctor of a budgetary medical institution only the head of the health department of the relevant locality . Modern Private medical Center usually has not only a leader with a medical education, but also a general director. At the same time, the following functions are assigned to the latter:

• monitors the quality of medical services;
• supervises medical activity;
• conducts recruitment;
• develops work standards, orders and other internal documentation.

AT this case termination of employment relationship with the head physician is possible by decision (signing an order) CEO . Competently compiled labor contract always allows you to find a reason for dismissal, even if we are talking about the head.

A good career as a chief physician can only be made by a person who works by vocation - then he will not have to be fired. A doctor is a profession where love for people, attention and desire to help are very important. pure heart. Watch this video about people whose calling is to help people.

Serov’s paramedic bought a diploma with the money of patients, fled to Kurgan and became the head physician there
He faces up to six years in prison
Using a fake diploma, Vladislav Fedin got a job at a regional hospital and treated patients
AT Kurgan region Vladislav Fedin, former paramedic of the Serovskaya district hospital, will be tried. A year ago, the prosecutor's office found out that he got a job as the head physician at the district hospital of the Kurgan region with a fake diploma, the 45.ru portal wrote about this. His former village patients from Sverdlovsk region told E1.RU how they gave him a loan at interest and were sure that they were helping in personal trouble.

How I praised him: both good, and smart, and attentive, wonderful person, - recalls kind word her former village paramedic, pensioner Galina Kazantseva. - You should, I say, be a doctor. Here she praised, jinxed, and he became a doctor.

Vladislav Fedin worked in the village of Morozkovo. They went to him with the first complaints, in mild cases he was for the therapist, he could provide first aid: pressure, injections. In case of serious complaints, he wrote out a referral to Serov. As a specialist, he seemed to suit everyone. And then suddenly he began to borrow money from village patients. Pensioners, accustomed to trusting the doctor, were willing to lend. Moreover, the doctor promised to pay interest. The sums for pensioners were rather big. So Galina Kazantseva borrowed 20 thousand for the paramedic. And her neighbor Alla ten thousand, he borrowed another 20 from another. Some grandmothers turned out to be literate - they gave money on receipt.

Two years ago, Vladislav Evgenievich went on vacation and suddenly disappeared, - recalls Galina Konstantinovna. - I called him, at first he told me: “I’m at the resort for now,” then he told me that he couldn’t go to work, his wife was sick, allegedly takes her to the doctors. And then I couldn't get through to him. Even then, there was talk that the wife was not sick, she just had to repay the debt, she helped her daughter buy an apartment, she lives in the city. Our paramedic never showed up at work. From the neighboring village of Sotryna, a man with an ax came to him, looking for him. He owed him too.

Fedin did not come for the work book. He was fired for absenteeism. Some of the patients sued, presenting all IOUs. After the decision of the court, bailiffs began to look for him.

But they found the runaway paramedic a year later former colleagues from the Serov hospital by chance on the Internet: on the website of the district hospital in the village of Polovinskoye, Kurgan region, I came across a photograph where their dismissed paramedic is sitting surrounded by subordinates as the head doctor. It turns out that in a year the paramedic has fantastically climbed career ladder and became the head physician of the district hospital in the Kurgan region.

At the same time, only a year ago he had only a document on secondary education, with which he was not entitled to be appointed chief physician. And finish in a year medical school Vladislav Evgenievich could not. Serov's doctors called Kurgan. They began to understand, the prosecutor's office intervened.

It turned out that the diploma, like the entry in the new work book, fake. According to the diploma and labor, Fedin graduated from Ivanovo medical institute worked as a therapist. At first, he was hired as a therapist, and then he became the head physician. A criminal case was initiated on the forgery of a diploma. Recently, Fedin was charged.

The charge was brought under the third part of Article 327 - this is the use of a forged document, under the third part of Article 159 for fraud using official position. This applies to two cases of treating "dead souls" - that is, fictitious assistance to patients who were not there, and he received money from insurance companies, - Maria Melnikova, senior assistant prosecutor for media relations, told E1.RU. - In the near future, after the approval of the indictment, the case will be submitted to the court.

According to the first article, the most serious punishment is two years in prison. But most often the maximum is softer: a fine, restriction of freedom, forced labor. But for fraud using one's official position, one faces a penalty of up to six years in prison. Now former paramedic is under bail. He never returned the money to the village patients, the bailiffs have not yet collected debts from him.

It is interesting to observe how the basic dialectical laws work in practice. It is enough to be able to draw a number of necessary parallels. Come on and something to keep in own memory: Google and Wikipedia are, of course, cool and large-scale, but you need to know what to ask them about.

Eighty-two and a half years ago, the graduates of military academies heard the phrase "Cadres decide everything." And not so much as a slogan, but in the context of a change in priorities: they say, if before that technology solved everything, now it is, so the question arose of who will manage it all, operate it.

Something similar is happening now in medicine - in any case, in medicine in the capital. I have already written, and more than once, about what, in bureaucratic terms, the material and technical base has been created here. Starting from hospital buildings and ending with new medical equipment, ambulance cars and helicopters for disaster medicine. Now the second question arises: who should steer all this magnificence? And most importantly - how?

I remember that during one of my trips to Switzerland with Oksana, we talked with the head physician of the Genolier clinic in Zurich. By the way, he does not have a medical education - he is just a manager with rich experience. And he expressed himself very interestingly about himself and about the team of doctors and nurses in this very clinic: they say, can you imagine the impresario of a prima ballerina? His worries, his headache? Well, I've got two hundred prima ballerinas here.

I agree with him: it is rather difficult to manage a medical team. The effect is that each of them is a personality that not everyone seeks to dissolve in the team. And the fact that their work, if we are talking about really good doctors, is not so much a craft as an art. And the guild is on the verge of caste. And almost total Jacobinism and rejection of anyone's authorities. In this case, the hospital or clinic should work. In quite conflicting conditions. And the head doctor, like that same UN peacekeeper: he receives his blue helmet from the team, from patients, and from higher authorities. Well, except that the salary somehow compensates for these difficult working conditions.

I think that Sobyanin was a fairly correct step to create a personnel reserve of medical managers in the past year. Kind of like a job fair. Sooner or later, this decision had to be made: protectionism and clannishness are not particularly beneficial to the cause. Therefore, in August 2017, the Leader.Med program was launched. Its main goal is to select talented employees who in the future will be able to occupy the positions of heads of medical institutions.

The people - and this is in total 6033 people - wrote tests, essays on the topic “Why do I feel a pathological tendency to leadership”, made videos about himself, participated in brainstorming on management topics, was selected and screened for big list parameters - and as a result, 300 people were still selected for the personnel reserve of the Department of Health. No, they will not be made head physicians and heads of departments right away. But they will have in mind - for the not so distant future. Again, now there is an incentive for the current head physicians: they say, if anything ...

The personnel reserve for the capital's health care was created in 5 areas. Thus, in the category "Chief Physician / Director of a Medical Organization" 98 people were included in the list of reservists, in the category "Deputy Chief Physician / Director of a Medical Organization" - 116 people, in the category "Chief Nurse" - 14 people, in the category "Head of the Department / structural unit"- 51 people, in the category" Head of department / deputy head / head of the organization (with non-medical education) "- 21 people.

How viable and successful such a personnel reserve will be - time will tell. But, in my opinion, the very fact of its creation is not bad news. Less random people in key positions, less personal in the process of being appointed to a leadership position - you see, something will begin to change for the better.

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