An effective contract for a physician: instructions for use. Effective contract Effective contract in healthcare

December 16 at the Palace of Trade Unions on the square. Labor, 4, a seminar on effective contracts in healthcare was held, organized by Terkom.

Read by F.N. Kadyrov (Deputy Director for Economic Affairs of the Federal State Budgetary Institution "Central Research Institute of Organization and Informatization of Health Care" of the Ministry of Health of the Russian Federation, Doctor of Economic Sciences, Professor, Honored Economist of the Russian Federation) sets out in an extremely clear and detailed manner the regulations and facts that are associated with the transition to an "effective contract" ", its true purpose, nuances for managers when formalizing this transition, forecasts for the period until 2018 regarding the implementation of Presidential Decree 597.
After listening to the lecture, I had a strong feeling that it was being read not for employees, but for managers, since all the stages of transferring subordinates to a new format of work, methods of “painless” transfer using skillful manipulation of employees and reticence, forms of notifications were listed and presented “on a silver platter.” and tactics of the HR department.
On the other hand, you need to know the enemy by sight. And there are a number of ways for the employee and the team to not prevent the transition - it will happen sooner or later, but to delay it, gain time, in response to new demands from the employer, extract new rights, write down the subtleties in the collective agreement, monitor the development additional agreements to employment contracts.
So, a report on the lecture (with the listener’s conclusions).

What is an “effective contract”?

The concept of “effective contract” (EC) implies:
- in the narrow sense - an employment contract.
- in a broad sense - a set of measures aimed at improving the quality and accessibility of medical care.

An effective contract is primarily aimed at SOLVING THE PERSONNEL ISSUE. The promised increase in wages is only a method of solving it.

At the same time, it was during this period (2013-14) that the trade union committee and workers have the opportunity to demand payments, since the situation in the legislative sphere at the level of institutions is quite blurred. In almost any situation where an employee is deprived of benefits, if an audit is initiated, the issue will be resolved in favor of the employee. In addition, the employer is required to meet the wage ratio indicator in his institution according to the “road map”.

* What to do if an employee is deprived of incentive payments?

Contact the trade union!

A representative of the trade union organization, both in the conditions of an “effective contract” and in conditions when the transition to it has not yet taken place, must take part in the work of the commission for calculating incentive payments - it exists in every institution.
It also includes: chief accountant, head of the economic department, chief of medicine. The commission's decision is made signed by the chief physician.
In the event that this commission decides for some reason to deprive an employee of an incentive payment, the consent of a representative of the trade union organization is asked.
In such a situation, he must express disagreement with depriving the employee of an incentive payment. And if he fails to convince the employer, then the mechanism is as follows:
The chairman of the trade union organization writes a complaint against the employer (chief physician) regarding the deprivation of benefits to the employee to the following authorities: the President of the Russian Federation, the plenipotentiary representative of the President of the Russian Federation in the region/city, the Ministry of Health of the Russian Federation, the Ministry of Labor, the State Labor Inspectorate, the prosecutor's office, the governor/mayor, the Health Committee, Terkom , Rayzdrav.
The complaint indicates to which authorities copies of the complaint were sent
The expected result is:
payment of funds in full, since the manager will be summoned to higher authorities (Gorzdrav, Raizdrav), and in order to prevent further proceedings from above, he will be ordered to resolve the issue in a manner favorable to the employee.

What criteria for assessing labor efficiency can be applied to employees?

The criteria, indicators and frequency of evaluating the performance of employees are established ONLY by the institution on the basis of methodological recommendations and orders. In other words, the employer can introduce any criteria for assessing labor efficiency for the employee - against the background of this, the responsibility of the trade union collective and employees who are not members of the trade union should increase. It must be emphasized - COLLECTIVE - since the chairman of a trade union organization is unlikely to cope with such a volume of work. Any employee, even those who are not members of a trade union, has the right to support and protection of their rights by a trade union organization.

Can an employee be fined under an effective contract?

According to the Labor Code, the use of disciplinary measures is strictly prohibited, except for the penalties provided for by the Code itself, federal laws, charters and discipline regulations. An employee cannot be forced to work seven days a week or be deprived of vacation. You cannot fine an employee.
When an employee commits a disciplinary offense, the employer (Article 192 of the Labor Code of the Russian Federation) has the right: to make an oral or written reprimand to the employee, to reprimand, to dismiss the employee. In addition, the procedure for applying disciplinary sanctions is clearly stated in Art. 193 Labor Code of the Russian Federation algorithm.
In the context of incentive payments, it may not be the imposition of a fine, but the non-awarding of a bonus, i.e. If employees fail to meet a number of criteria, the bonus will not be partially or fully calculated.
The additional agreement must clearly state all incentive payments due to the employee, the conditions for their non-accrual and the criteria by which they are accrued, as well as the amounts. The employer in the “amount” column may not give specific numbers or points and refer to the collective agreement and regulations on wages, regulations on the calculation of incentive payments.
If you have been charged a certain amount (say, 1000 rubles for non-compliance with the dress code), you have the right to go to court, where the employer will have to explain on what basis this particular amount was withdrawn. Therefore, if such subtleties are not spelled out in local regulations, the court will rule in your favor.

An effective contract as an employment contract.

The concept of an effective contract does not yet exist in the Labor Code; the concept of “employment contract” is used.
In order to improve the quality of medical care, and, accordingly, tighten the demand from medical workers, the government recommends CONCRETE the employment contract in the form of an effective contract.
That. An effective contract is an employment contract that specifies job responsibilities, terms of remuneration, performance assessment criteria for assigning incentive payments, as well as measures of social support for employees.
If previously it was enough for an employee to carry out his job duties without focusing on specific indicators, then when switching to EC, work will be characterized not only by the performance of the function, but also by a number of specific indicators.
As for existing employment contracts, your management does not have the right to terminate them and enter into new ones.
In addition, according to the correct algorithm for the transition to EC, the conclusion of additional agreements to employment contracts is one of the final stages.

IMPORTANT! Stages of transfer to an “effective contract” or what an ordinary employee and members of a trade union organization need to know.

1. We do not sign any contracts or additional agreements right away!
By law, you must be given written notice of a change in the terms of the employment contract determined by the parties (transfer to a new wage system and the need to conclude additional agreements to the EXISTING EMPLOYMENT CONTRACT) no later than 2 months before the transfer.
Amendments to the employment contract in this situation are carried out on the basis of Article 74 of the Labor Code of the Russian Federation (for reasons of organizational or technological changes in working conditions).
In no case is it permissible to re-sign an employment contract (terminate the existing one and conclude a new contract) - since this means dismissal with subsequent hiring. Perhaps this is a tactical move to eliminate an unwanted employee - you simply may not be hired again.
2. So, a general meeting has been held, at which you are informed about the need to switch to a new remuneration system - an effective contract with the need to conclude additional agreements.
3. Next, one by one, workers are called to the HR department, where they are verbally notified of the need to sign an additional agreement to the employment contract. Arguments for haste can be different - “it’s beneficial for you, everything is clearly spelled out there,” “otherwise you won’t receive bonuses,” “everyone will have to sign anyway,” etc.
Don’t worry - bonuses will be paid to you, because it is not profitable for the employer to reduce the average level of wages - his bonus also depends on this. And if they don’t risk not paying, read the paragraph * What to do if an employee is deprived of incentive payments?
And there is only one reason - managers are entitled to a bonus for early or timely transfers.
There are also those who will sign immediately. To the joy and relief of personnel officers and management.
4. Is the employee required to sign an additional agreement immediately?
No. Firstly, you must be given TWO MONTHS WRITTEN NOTICE about changes to the terms of the employment contract determined by the parties.
According to the article of the Labor Code of the Russian Federation, you have 2 months to think about it. If you do not express your disagreement in any way, after 2 months you will still be transferred to EC.
If you write “I do not agree” on the notice or in an application addressed to the employer, 2 months after signing the notice you must be provided with a vacant position that matches your qualifications or is less paid*
*it is important that working conditions should not worsen the employee’s position in comparison with the conditions prescribed in the collective agreement, and the vacancy should be provided in the same area, for example, an employee of a district hospital in a city should not move to a branch in a village, unless this is provided for by the collective agreement.
If there is none or if there is a refusal in accordance with Article 77, Part 1 of the Labor Code of the Russian Federation, you may be dismissed.

Why then wait 2 months?

In a situation where the employer first of all requires the employee to sign an additional agreement, without providing for changes in the collective agreement or the provision on incentive payments, we can talk about a violation of the transfer algorithm to EC.
The first stage of the transition is the development of a collective agreement with the trade union committee, regulations on incentives (since incentive payments will be specified in the additional agreement, most likely with reference to the collective agreement and internal regulations on incentives).
Only after this can changes be made to the employment contract with the employee.
Speaking of the collective agreement, its standard form is laid out in our documents, but in each institution the trade union committee can defend private details, since we are talking about an agreement, a contract - and this implies negotiations, concessions and agreements on BOTH PARTIES. The employer will not miss the opportunity to expand and deepen the range of your job responsibilities - so do not miss the opportunity to receive new rights and additional payments.
In addition, as long as you work under a valid employment contract and regulations on the accrual of incentives, bonuses should be paid to you on the same basis as other employees. In response to threats from the personnel officer (“since you have not signed the additional agreement, you are not entitled to a bonus”), immediately ask for a written justification for such a statement.

Are workers who do not provide medical services included in the list of workers covered by the Decree of the President of the Russian Federation? Should their salaries be increased?

According to regulatory documents, a statistician, an accountant, and a human resources officer at a healthcare facility are not included in the list of groups of workers whose wages should be increased, however, this is not prohibited - in the case when the categories of workers specified in the roadmap have achieved the target level. This issue is resolved by the employer.
The same applies to employees of children's institutions - increasing their salaries is the right of the institution.
It is also advisable to reflect these points in the collective agreement.

At what rate will wages increase?
According to the roadmap, the maximum increase in wages is planned for 2017.
However, until 2015, the pace will be low. First of all, this is due to the calculation of tariffs in accordance with Federal Law 354 of November 30, 2011 “On the amount and procedure for calculating the insurance premium tariff.”

Why hasn't my wages increased?

The employee talks like this:
- if, according to Presidential Decree No. 597 and the “road map”, a doctor’s salary in 2013 should be 129.7% of the regional average (for doctors in St. Petersburg the average salary should be about 47 thousand), then working at one and a half thousand two bets I will earn one and a half to two times more - 60-90 thousand.
However, this does not happen. Why?

The salary level is currently assessed per individual.

How is the average salary calculated?
Based on Rosstat Order No. 574 dated October 30, 2012, the average wages of employees are calculated by dividing the wage fund by the number of INDIVIDUALS for these categories of employees (for example, managers, doctors, nurses, and orderlies are considered separately). Thus, taking into account the high percentage of internal combinations in medical institutions, according to the monitoring carried out in accordance with Order 574, the average salary turns out to be higher than the average salary at the rate.
And, accordingly, basically, the target indicators are considered achieved - there is no need to pay employees extra! And the indicators are met, and the stakes are covered, and the chief physician receives incentive payments for achieving the set indicators. Only the employee is at a loss.
Not all employees will be able to receive the amounts indicated in the roadmap. Salary will depend on qualifications, quantitative and qualitative performance indicators. PART OF THE WORKERS WILL NOT RECEIVE SALARY IN THE AMOUNT SPECIFIED IN THE DECREE OF THE PRESIDENT. Thus, STIMULATION is achieved.

What to do in such a situation?
It is clear that from 2013-2014, especially in connection with the transition to an effective contract, the employer’s incentive payments will depend on his achievement of target average wages for the institution.
In such a situation, he will be forced to “tighten” the wages of his employees.
Now let's think about what is more profitable - to work like a normal person, at a rate, go home on time or for an external part-time job and receive a base salary of 17 thousand plus incentives up to 47 thousand, or work at two rates in one institution, earn a salary of 34 thousand and receive incentives in the amount of 13 thousand?
Therefore, many workers see a solution in “Italian strikes” - work strictly according to the labor code, with the fulfillment of job duties, hiring standards no more than at the rate, in compliance with the hiring regulations.

Hello, friends! In this article I would like to talk about how, from a legal point of view, the relationship between a medical professional and an employer is built today. If in not so distant Soviet times the concept of an employment contract existed more in theory than in practice, today not a single enterprise or institution operates without it.

Why do you need an employment contract?

Your social security depends on how the employment contract is drawn up and what rights and responsibilities are included in it. The law strictly regulates such concepts as working hours, rest, minimum wage, working conditions, which is reflected in the contract. It is important for both parties.

However, today, in a number of industries, conventional employment contracts are undergoing changes. This primarily applies to social workers, including medical workers. In recent years, such a form of contract as an effective contract in healthcare has become widespread.

Approximate examples of such a contract can be easily found and downloaded on the Internet. However, it must be understood that these are just exemplary samples, since an effective contract in force in one institution may differ significantly from that adopted in another. Therefore, you need to figure out what kind of document this is, how it differs from a regular employment contract, and whether it is really effective.

Similarities and differences

First, let's note who and when it was regulated. In November 2012, the Russian government issued a decree, the purpose of which was to regulate the issues of remuneration for employees of social institutions, including healthcare institutions. It is this document that contains the requirement to transition to concluding an effective contract in the industry by 2018.

Can we say that an effective contract and an employment contract are exactly opposite concepts? No, this statement is incorrect. Both comply with Labor Laws. Essentially, a contract is the same agreement, but more detailed. It describes what specific job duties the employee must perform. This is an important point, since previously the agreement was based not on them, but on the position.

Effective work needs to be stimulated

In addition to describing responsibilities, an effective contract will detail the terms of remuneration. Not the minimum wage, but everything together - salary, incentive payments, compensation for work in hazardous working conditions, in special weather conditions, etc. The bonus, if any, is also indicated.

The contract also includes an indicator such as efficiency. To evaluate it, criteria for assessing the work of medical workers are being developed. This is a rather difficult point, causing different reviews when switching to a new system. It was assumed that work would be assessed using a point system. However, as it turned out, special staff is needed to calculate points, which is not always possible.

Nevertheless, each health care institution itself accepts the conditions under which incentive payments are established. Their adoption must be documented and reflected, for example, in documents such as the Regulations on remuneration or incentive payments.

These payments necessarily take into account the quality of work of the doctor, nurse and other medical workers. For example, if an emergency occurred due to the fault of an employee, a medical error was made, and patients reasonably complain about the quality of treatment, then incentive payments can hardly be discussed.

On the contrary, if the work is intensive, generates good reviews, leads to results, the employee improves his qualifications, and has extensive work experience, then he has the right to count on incentive payments. This approach is important not in itself, but for improving the quality of services, which also occurs due to material interest.

If the employee refuses

How does the transition to a new type of contract take place? Firstly, it is not at all necessary to enter into a new employment contract with employees who already work in the institution. It is enough to draw up an additional agreement and reflect in it all the changes that an effective contract entails. If the employee does not agree, he is offered another position. In case of refusal, the employment relationship is terminated.

Employees must be notified two months before switching to the new uniform. It is being developed by responsible employees of the labor department, taking as a basis the appendix to the government order mentioned above. Before the transition to new conditions, documents must be developed to determine effectiveness.

Pitfalls of innovation

The introduction of an effective contract was aimed at motivating healthcare workers to improve the quality of service delivery. At the same time, the government is taking steps to significantly increase their wages. It is assumed that this form will increase wages so that they will be 200% of the average in the region.

Unfortunately, in practice it does not always work out as intended. Reviews from health workers indicate that the new form also has disadvantages. One of them is insufficient funding for the industry, as a result of which there is a contract, incentive payments are prescribed, people work well, but there are no funds to implement what was promised.

Not everything is simple with the definition of work efficiency - it still raises many questions and dissatisfaction on the part of doctors and nurses. Although in general the idea of ​​an effective contract is a positive moment in the development of healthcare and in the activities of every medical worker.

If you have already switched to a new form of contract or are just about to do so, we will be glad to hear your opinion on the topic, as well as your response to our article. Leave comments on our website, we are interested in everyone's opinion.

"Health care institutions: accounting and taxation", 2014, N 11

Back in 2012, the question arose about the need to link the salaries of medical workers with the quality of the services they provide. One of the tools to do this is an effective contract. However, in order for healthcare institutions to reasonably and intelligibly switch to effective contracts, it is necessary to implement a whole range of measures, for example, to develop performance indicators for medical workers, a labor standardization system, etc. Today we will tell you what an effective contract is, how to develop performance indicators for medical workers, whether it is necessary to terminate existing employment contracts and enter into an effective contract, and we will also consider the procedure for switching to an effective contract.

What payments should be taken into account when establishing remuneration systems, what should you pay attention to?

In accordance with the Unified Recommendations<1>remuneration systems should include fixed tariff rates, salaries (official salaries) for the performance of labor duties for a calendar month, as well as the amount of additional payments and allowances of a compensatory and incentive nature.

<1>Unified recommendations for the establishment at the federal, regional and local levels of remuneration systems for employees of state and municipal institutions for 2014, approved. By the decision of the Russian Tripartite Commission for the Regulation of Social and Labor Relations dated December 25, 2013, protocol 11.

Thus, when determining the base rate or salary, it is necessary to take into account labor standards. For this, in accordance with the Order of the Government of the Russian Federation dated November 26, 2012 N 2190-r “On approval of the Program for the gradual improvement of the wage system in state (municipal) institutions for 2012 - 2018”, the Order of the Ministry of Labor of Russia dated September 30, 2013 N 504 approved Methodological recommendations for the development of systems labor standards in state (municipal) institutions.

Therefore, at the level of the institution, local regulations should be approved, taking into account the opinion of the representative body of workers:

• labor standardization system in the institution;
• changes that are made to the regulations on remuneration of employees in terms of establishing specific salary amounts (rates), indicators, criteria, conditions and amounts of incentive payments to employees.

According to Letter of the Ministry of Health of Russia dated September 4, 2014 N 16-3/10/2-6752 “On improving regional and municipal remuneration systems for medical workers,” incentive payments include:

1. payments for intensity and high performance results:

• bonus for labor intensity;
• bonus for high performance results;
• bonus for performing particularly important and responsible work;

1. payments for the quality of work performed:

• bonus for having a qualification category;
• award for exemplary performance of state (municipal) assignments;

1. payments for length of service, length of service:

• long service bonus;
• bonus for continuous work experience;
• bonus for length of service;

1. bonus payments based on performance results:

• bonus based on the results of work for the month;
• bonus based on performance results for the quarter;
• bonus based on work results for the year.

Compensatory payments include, in particular:

• payments for work in harmful, dangerous or other special working conditions;
• payments for work in areas with special climatic conditions (regional coefficient, bonus for work experience in the Far North and equivalent areas, coefficients for work in desert and waterless areas or high mountain areas);
• payments for work in conditions deviating from normal (additional payment for combining professions (positions), expanding service areas, increasing the volume of work, performing the duties of a temporarily absent employee without exemption from work specified in the employment contract, performing work of various qualifications at night).

Please note that in the employment contract or an additional agreement to it, it is recommended to specify the conditions for making these payments in relation to a given employee of the institution.

What could be the indicators of employee performance?

First of all, it is worth saying that it is impossible to switch to an effective contract without developing and approving employee performance criteria used in establishing the criteria and conditions for assigning incentive payments. Of course, when developing such criteria and indicators, the head of an institution may have difficulties. It would be good if the higher-level organization provided at least an approximate list of such indicators and criteria, but this may not be the case.

Currently, by Order of the Ministry of Health of Russia dated July 11, 2013 N 451, target performance indicators for the activities of federal budgetary and government institutions under the jurisdiction of the Ministry of Health have been developed, as well as criteria for assessing the efficiency and effectiveness of the work of managers.

The list of performance indicators for medical workers should allow for a comprehensive and objective assessment of the results of work to satisfy citizens with the quality and quantity of services provided, as well as to stimulate the improvement of the professional level of employees of the institution.

For example, according to Order of the Ministry of Labor of Russia dated 01.07.2013 N 287 “On methodological recommendations for the development by public authorities of the constituent entities of the Russian Federation and local governments of performance indicators for the activities of subordinate state (municipal) institutions of social services for the population, their managers and employees by type of institution and main categories workers" when determining the performance indicators of employees of institutions from among the main personnel should take into account:

• compliance with labor discipline and proper performance of their labor duties;
• participation in the methodological work and innovative activities of the institution (participation in the development of educational, methodological, scientific and methodological publications, manuals, recommendations, as well as in the preparation of speeches at conferences and seminars);
• participation in professional skills competitions, creative laboratories, experimental groups;
• mastering advanced training or professional training programs;
• use of new effective technologies;
• satisfaction of citizens with the quality and quantity of services provided to them (absence of justified complaints about the quality of their provision).

So, what performance criteria can be enshrined in local regulations? Let us repeat that all criteria are developed by a specific institution based on methodological recommendations, orders and other acts of the Ministry of Health. For example, for doctors it may be<2>:

• absence of emergencies during treatment at the institution;
• no cases of mortality or medical error;
• absence of justified complaints about the quality, volume of medical care, compliance with deontological aspects of activities according to the conclusion of the medical commission of the institution;
• compliance of the quality of medical care with established standards (compliance with the timing of patient examination, scope and timeliness of treatment measures, compliance of prescribed biological therapy with the nosological diagnosis, use of psychosocial rehabilitation, etc.);
• absence of violations in the preparation of medical documentation;
• absence of violations of the executive discipline of document flow, reporting, and administration orders;
• compliance with the deadlines for patient referral and complete preparation for conducting a medical and social examination (initial and repeated);
• lack of comments on the implementation of job descriptions.

<2>The draft order of the Ministry of Health of Russia "On the establishment of a system of remuneration for employees of federal government institutions subordinate to the Ministry of Health of the Russian Federation", posted on the Unified portal for posting information on the development by federal executive authorities of draft regulatory legal acts and the results of public discussion (http://regulation. gov.ru/).

For nursing staff, such indicators may be, in particular:

• no violations of the rules for obtaining, recording, storing and distributing medicines;
• absence of emergency incidents in the department;
• lack of comments when carrying out medical prescriptions, caring for patients, preparing patients for studies (in violation of established standards);
• absence of violations in ensuring intensive, continuous and high-quality monitoring of patients.

In addition, criteria such as coverage of medical examinations, vaccinations, patient satisfaction surveys, and, for pediatricians, the level of breastfeeding, can be effective.

Let us recall that all these indicators and criteria must be enshrined in a local regulatory act regulating the procedure for remuneration in a particular institution.

Effective contract = employment contract?

You should not think that when introducing an effective contract, you need to renegotiate employment contracts with medical employees. An effective contract is the same employment contract, but with some expanded mandatory conditions. Let us remind you that the list of mandatory conditions to be included in the employment contract is given in Art. 57 Labor Code of the Russian Federation. Let's look at some of them.

1. Labor function(work according to the position in accordance with the staffing table, profession, specialty indicating qualifications, specific type of work assigned to the employee). Quite often, a job function is specified in a job description, and the employment contract contains a reference to it. This will not work with an effective contract: it should include all the rights and obligations of the employee.
2. Terms of payment. Since the remuneration of a medical worker depends on the quality of the work performed, an effective contract must not only fix the size of the tariff rate or salary (official salary) of the employee, but also specify the indicators and criteria for assessing performance, as well as the amount of remuneration and incentives for the results achieved. At the same time, one should not forget about additional payments of a compensatory nature. Moreover, this must be written in such a way that the health worker can understand for what and in what amount he will be paid, and so that the possibility of double interpretation is excluded.

Note! It is impossible to terminate an employment contract and conclude an effective contract. Even newly hired persons have an employment contract. However, it must contain all the terms of an effective contract.

Since an effective contract is the same employment contract (its approximate form is given in Appendix 3 to Order of the Government of the Russian Federation N 2190-r), the terms of remuneration contained in the employment contracts of already working medical workers are subject to change. For this purpose, an additional agreement to the employment contract is drawn up.

What is the procedure for amending the employment contracts of medical workers when switching to an effective contract?

In connection with the introduction of an effective contract, the terms of the employment contract change, and significant ones that cannot be easily adjusted: it is necessary to follow the procedure established by the Labor Code of the Russian Federation.

The Ministry of Labor in its Recommendations for formalizing labor relations with an employee of a state (municipal) institution when introducing an effective contract, approved by Order No. 167n dated April 26, 2013 (hereinafter referred to as the Recommendations), indicated the need to comply with Art. 74 of the Labor Code of the Russian Federation when amending an employment contract.

1. It is necessary to notify the employee of upcoming changes. According to Art. 74 of the Labor Code of the Russian Federation, if for reasons related to changes in organizational or technological working conditions (changes in equipment and production technology, structural reorganization of production, other reasons), the terms of the employment contract determined by the parties cannot be preserved, they can be changed at the initiative of the employer, for with the exception of changes in the employee’s labor function.

The employer is obliged to notify the employee in writing no later than two months in advance of upcoming changes to the terms of the employment contract determined by the parties, as well as the reasons that necessitated such changes.

Since the employer is obliged to indicate in the notification the reasons for changing the terms of the employment contract, many managers of medical institutions have a question: what to refer to, what reason to indicate in the notification? We believe that in this case we can refer to Order of the Government of the Russian Federation N 2190-r, as well as other regulations related to the introduction of an effective contract.

This notice must be drawn up in two copies. One is given to the employee, and on the other (which remains with the employer), the employee makes a note indicating receipt of a copy of the notice.

The employee’s consent or refusal to continue working after changing the terms of the employment contract can be expressed both in the notification itself (on the employer’s copy) and in a separate document.

Note! The medical worker may not give an answer immediately; the law gives him the right to make a decision within two months from the date of notification.

1. If the employee agrees to work under new conditions, an additional agreement to the employment contract is drawn up. The conditions to be included in the additional agreement are named in paragraph 8 of the Recommendations. In addition to the conditions regarding remuneration and labor functions discussed above, among them are, in particular:

• place of work, and in the case where an employee is hired to work in a specific branch, representative office or other separate (structural) subdivision of an institution located in another area - place of work indicating the separate (structural) subdivision and its location;
• the term of the employment contract (if a fixed-term employment contract was concluded - also its validity period and the circumstances (reasons) that served as the basis for its conclusion);
• working hours and rest hours (if for a given employee it differs from the general rules in force in the institution);
• compensation for hard work and work with harmful and (or) dangerous working conditions, if an employee of the institution is hired in appropriate conditions, indicating the characteristics of working conditions in the workplace;
• conditions that, if necessary, determine the nature of the work (mobile, traveling, on the road, etc.);
• condition on compulsory social insurance of the employee;
• the duration of the annual main (annual main extended) paid leave and additional leaves of an employee of the institution;
• social support measures.

Such an agreement is drawn up in two copies, signed by the employee and the employer, after which the health worker continues to work under the new conditions.

1. If the employee does not agree to work under the new conditions, the employer is obliged to offer him in writing another job available in the medical institution (both a vacant position or work corresponding to the employee’s qualifications, and a vacant lower position or lower-paid job), which the employee can perform taking into account his state of health. In this case, the employer is obliged to offer the employee all vacancies available in the given area that meet the specified requirements.

In the absence of the specified work or the employee refuses the offered work, the employment contract with him is terminated in accordance with clause 7, part 1, art. 77 Labor Code of the Russian Federation.

Is it possible not to comply with the two-month notice period for an employee to switch to an effective contract?

Let us recall that the Recommendations involve the introduction of an effective contract in accordance with Art. 74 Labor Code of the Russian Federation. But there is Art. 72 of the Labor Code of the Russian Federation, due to which changes in the terms of the employment contract determined by the parties are possible by agreement of the parties. In this case, no deadlines need to be observed. We believe that the management of a medical institution may well take advantage of the provisions of Art. 72 of the Labor Code of the Russian Federation and, having explained the need to switch to an effective contract, provide the medical worker with an additional agreement on changing the terms of the employment contract for review. If the employee agrees, then when he signs such an agreement, it will be considered that the change in the terms of the employment contract was made on the basis of Art. 72 Labor Code of the Russian Federation.

If the employee does not agree with the additional agreement drawn up, we recommend that you follow the scheme described above in accordance with Art. 74 Labor Code of the Russian Federation.

Conclusion

Of course, at present, managers of medical institutions are afraid of introducing an effective contract. They believe that there may be underfunding of other expenditure items or even a reduction in medical staff in order to bring wages to the required level. However, in order to increase the attractiveness and prestige of working in medical organizations and preserve the human resources potential of the entire industry, work will still have to be done to improve payment systems for medical workers, allowing doctors, as well as mid-level and junior medical personnel, to receive good wages for quality work done.

To do this, it is necessary to develop indicators and criteria for the performance of medical workers in each institution and consolidate them in employment contracts - effective contracts in such a way that each employee understands what payments he is entitled to and for what.

T.Shadrina

Journal expert

"Health care institutions:

accounting and taxation"

is a special form of employment contract with a health worker, which details and similarly sets out such provisions as his labor function, conditions for receiving earnings and calculating payments that stimulate effective activity.

The procedure for drawing up a new form of employment contract has its own characteristics, which are set out in legislative acts.

Transition to an effective contract in healthcare

The transition to an effective contract is legislatively enshrined in Decree of the Government of the Russian Federation No. 2190-dated November 26, 2012. The completion date for the planned activities is 2018.

In relation to the healthcare sector, it follows from the meaning of the document that changes in the budgetary sphere occur to motivate medical personnel in their activities, as well as to increase the attractiveness of the medical profession for young specialists.

In the new forms of employment contracts, the medical institution must clarify and detail the content of the employee’s duties, the criteria for assessing his work performance, the size and conditions of incentive and incentive payments.

The legislator clarifies that the conditions relating to the amount of remuneration must be stated in a form accessible to the employee and do not allow unambiguous wording.

Let us note that the concept of “effective contract” is not enshrined in the Labor Code of the Russian Federation. This means that the “employment contract” is used as the main wording.

Therefore, all legal relations that are, in one way or another, related to the conclusion or change of an effective contract occur according to the same rules as before. The employer should focus on them in the field of new rules.

Order of the Ministry of Labor of the Russian Federation No. 167n dated April 26, 2013 enshrines advisory provisions on the registration of employees of budgetary institutions with the conclusion of an effective contract under new conditions.

Let's consider the general provisions for concluding an effective contract with existing and newly hired employees, then we will move on to special cases.

Effective healthcare contract with a new healthcare worker

Since new standards have not been introduced in the Labor Code of the Russian Federation regarding the conclusion of an employment contract, a medical institution must conclude with its employees according to the previous rules.

However, in the context of the transition to an effective contract, it is necessary to take into account the provisions provided for in the main acts:

• labor standards existing in the medical institution;
• the current system for calculating the earnings of medical workers, the procedure for establishing bonuses and various payments to them, the amount of official salaries, etc.;
• labor conditions based on the results of the conducted special assessment;
• working hours for employees and their rest from their immediate duties;
• staffing schedule of a medical institution, which sets out its structure and the number of positions and rates by profession;
• specific working conditions for certain categories of workers, if present - for example, traveling work, mobile work, etc.

Since an effective contract involves working with criteria and performance indicators for health workers, the employer must take into account the guidelines on this issue, which are set out in the following documents:

1. Order of the Ministry of Health of the Russian Federation No. 421 dated June 28, 2013 (criteria and performance indicators of employees of subordinate medical institutions, managers and main categories of employees);
2. Order of the Ministry of Labor of the Russian Federation No. 287 dated July 1, 2013 (criteria and performance indicators for employees of social service institutions).

Each medical institution must develop and approve a standard effective contract (employment contract) according to the new rules, which is supplemented and specified for each new employee.

Transition to an effective contract for existing employees

If an employee already works in a medical institution, and a regular employment contract was previously concluded with him, then he must be notified in advance of changes to the employment contract. According to the rules of Part 2 of Art. 74 the employer’s obligation to comply with the notice period - no later than two months before the effective date of the new rules.

There is no need to conclude a new contract with the health worker - an additional agreement is concluded with him, which contains all the necessary changes due to the implementation of an effective contract.

Agreements are concluded only in writing.

The document is drawn up in two copies, one of which is stored in the personnel department of the medical institution, and the second is handed over to the employee for safekeeping.

The HR department must ensure that a copy of the additional agreement, which remains in the personal file of the health worker, is signed by him after conclusion.

Use the service of the Help System “Economics of Health Care Institutions”: it will help transfer an employee to an effective contract and tell you what to do if the employee does not agree to the transfer

Changing conditions when switching to an effective contract

Once again, we note the conditions that must be detailed in an effective contract as a form of employment contract:

• employee's labor function;
• the amount of the official salary;
• terms of provision and amounts of compensation payments;
• terms of provision and amounts of incentive payments.

In other words, this is still the same employment contract, but it describes in more detail what exactly the employee does in his position, what volumes of his work are envisaged and how his monetary remuneration is calculated for quality work done.

The program, approved by Government Decree No. 2190-r dated November 26, 2012, also provides an approximate form of an effective contract, which is the basis for budgetary organizations, including in the healthcare sector.

Let's consider several practical questions that arise for managers of medical institutions.

1. Is it necessary to terminate a previous employment contract with an employee who is already working in a medical institution?

• It is impossible to terminate a current employment contract with an employee, since only some of its provisions have changed. They are drawn up in the form of an additional agreement, which will be an integral part of the previous document.

2. Is it necessary to conclude an effective contract with a part-time employee, for example, with a paramedic who works at 1.75 times the salary?

• Any employment contract is concluded with all employees of a medical institution, and the form of an effective contract is no exception.
• If a paramedic is hired to work part-time, above the main rate, then two contracts are concluded with him - one at the main rate (1.0), and the second at 0.75 of the internal part-time rate.
• The same is true in the situation if a health worker has already been hired on a part-time basis and is undergoing the procedure for introducing an effective contract. Two additional agreements will be concluded with him - for the main place and for part-time work.
• The same rules apply to external part-time workers.
• These requirements are completely justified, since reforming the budgetary sector involves specifying the labor functions of workers and indicators of their effective performance. This means that changes in any case must be reflected in all employment contracts valid in the medical institution.

3. Is it necessary to draw up an effective contract in healthcare with specialist consultants (for example, doctors), if previously civil contracts, rather than employment contracts, were concluded with them?

In this situation, a transition to an effective contract is not provided.

• This is due to the fact that the relations of such specialists are regulated by civil law, in accordance with the provisions of which contracts for the provision of services are concluded with them. As a rule, this is one-time or episodic work, to which a specialist is temporarily involved.
• An effective contract is a type of employment contract. It is intended to bring labor relations between a medical institution and its employees into the legal field. And these relationships presuppose regular work, with a specific position and job function, as well as timely payment of labor by the employer.
• A civil contract cannot regulate labor relations, and its parties are not the employee or the employer. For example, a contract for the provision of services includes the contractor and the customer.
• A complete list of types of civil contracts is reflected in the second part of the Civil Code of the Russian Federation. For example, this is the same agreement for the provision of medical services for a fee or a contract agreement.
• So, if a doctor does not have a license to practice medicine because he is not an individual entrepreneur, a medical institution can draw up a civil contract with him. But within the framework of this agreement, not medical, but consulting services will be provided.

All other employees must be warned that the conditions previously set out in the employment contract are subject to change. The warning must be received by employees two months before they come into force.

The best examples of implementing an effective contract in Russia ,

The health worker refuses to switch to an effective contract

An effective contract in healthcare and its essence is not always clear to the employee, and he may refuse the new form of employment contract.

It is necessary to understand that such a refusal always entails certain legal consequences.

If a health worker does not want to sign an additional agreement to the concluded employment contract, in which the terms of his remuneration and job function are specifically stated, then the head of the medical institution must offer him another job.

The proposed job may not suit the health worker, or the employer may not have vacancies at the moment - in this case, the employment relationship with the employee is terminated.

We recommend that you initially explain in detail to the employee that the new form of the employment contract is amended, and it will always specify the employee’s working conditions and his remuneration for this work.

Resolution of the Plenum of the Supreme Court of the Russian Federation No. 2 dated March 17, 2004 stated that when an employer notifies an employee of a change in the employment agreement, it is his responsibility to indicate that the changes are due to new technological or organizational labor conditions.

Government Decree No. 2190-r states that the introduction of a new system of rationing and remuneration of employees in a medical institution can be specified as new organizational conditions.

In accordance with Art. 77 of the Labor Code of the Russian Federation, one of the grounds for ending an employment contract is the employee’s refusal to continue his activities under the changed conditions of the employment contract.

Let us summarize the procedure to follow if a health worker refuses to draw up an effective contract:

• The medical institution warns its employees in advance that the terms of their employment contracts will change two months in advance;
• If the health worker does not agree to continue working under the new conditions, then in writing the employer is obliged to offer him another available position that corresponds to the level of knowledge and qualifications of the employee. In another area, vacancies can also be offered, but only if this is provided for by the wording of the employment contract or the local act of the medical institution;
• If there is no suitable job or the health worker refuses it, then the employment relationship with him ends. The personnel department in the order to dismiss such a health worker must note the lack of a suitable position, or that the employee refused the proposed options.

How to draw up an additional agreement with an employee

All those sections and clauses of the additional agreement that contain the amended terms of the employment contract should begin with the words: “Section ... of this employment contract shall be stated in a new edition: ....”

The introductory section of the agreement with the health worker to the employment contract consists of the following information:

• details of the document, date of its preparation and registration number;
• date of conclusion of the agreement to the employment contract;
• full details of the health worker with whom the agreement is concluded (full name, position);
• the name of the employer and the legal basis for the actions of the official on whose behalf the agreement is concluded (for example, on the basis of a power of attorney or charter).

Below is an example of the design of the introductory section of an additional agreement with a health care worker.

Additional agreement

to employment contract No. ___ dated____

"__"___________ 20__

___________________________________________________________________________,

(name of the institution in accordance with the charter)

represented by _____________________________________________________________________,

(position, full name)

acting on the basis ___________________________________________________

(charter, power of attorney)

__________________________________________________, hereinafter referred to as

the employer, on the one hand, and ________________________________________,

(Full name.)

hereinafter referred to as the employee, on the other hand (hereinafter referred to as the parties)

have entered into this additional agreement as follows:

Download the additional agreement with the employee, sample/form >>

Description of the labor function of a health worker

When concluding an effective contract with a specific health worker, it is necessary to indicate in its text:

1. the name of his position (for specialists, employees and managers);

2.working specialty or profession (for working personnel);

3. what work is specifically assigned to the employee.

It must be remembered that if work in a specific profession or position is associated with the employee receiving any preferences and benefits (preferential professions), its name must correspond to the professional standard and qualification directory.

The correct job titles are given for medical workers in the nomenclature of medical specialists, which was approved by order of the Ministry of Health of the Russian Federation No. 1183n dated December 20, 2012.

To find the correct job title or profession for non-medical personnel, you should refer to the following sources:

• unified qualification directory (order of the Ministry of Health and Social Development No. 541n dated July 23, 2010);
• positions of managers and specialists (Resolution of the Ministry of Labor of the Russian Federation No. 37 of August 21, 1998);
• tariff and qualification reference books for working positions;
• all-Russian classifiers approved by Rosstandart (for example, Rosstandart order No. 2020-st dated December 12, 2014, Gosstandart resolution No. 367 dated December 26, 1994);

For some positions you additionally need to indicate:

• specialty - for a medical specialist, in the area in which he is trained and directly performs these duties (for example, an endocrinologist);
• the name of the section of medical activity - for deputy chief physicians (for example, deputy chief physician for medical affairs);
• full name of the medical position according to the profile - for the head of a department of a medical institution (for example, the head of a surgical department - a surgeon);
• job title with specialty - for a doctor in the emergency department (for example, a doctor in the emergency department - a general practitioner).

For the titles of medical workers’ positions, in accordance with Decree of the State Standard of the Russian Federation No. 367 of December 26, 1994, the words “senior”, “district”, “leading”, “precinct”, “chief” can be used in addition.

For example, senior midwife, district pediatrician, senior nurse, chief nurse, etc..

Let's consider a practical situation:

It is necessary to correctly indicate the position of the head of the medical laboratory, who does not have a medical education.

The correct title for the position of the head of the clinical laboratory is “head of a clinical diagnostic laboratory - laboratory assistant.” A specialist who worked as a laboratory doctor before 10/01/1999 can be appointed to such a position.

As follows from the nomenclature of medical workers, approved by order of the Ministry of Health of the Russian Federation No. 1183n dated December 20, 2012, the name of the medical position according to the profile of activity must be added to the title of the position of the head of the department of a medical institution.

The only position that a specialist without a medical education can occupy is a laboratory doctor. In this case, the document contains a clause stating that only a specialist who was hired for this position before October 1, 1999 can work as a laboratory doctor. If the corresponding specialist was hired later, then he cannot occupy the position of head of the clinical laboratory or laboratory doctor.

Specifying the labor function in an effective contract

Effective contracting in healthcare allows you to disclose in detail the employee’s work responsibilities during his working hours.

It is not necessary to indicate exactly how many positions the employee holds, for example, 0.25 wages. The total number of hours worked per week must be entered.

Also, in an effective contract that specifies the working conditions of a health worker, it is possible to indicate that the employee combines several positions or professions.

For example, in conditions of staff shortages, many nurses also perform the functions of a nurse. This time is not worked in excess of the norm, since the employee performs this work during his main working day in addition to the main duties stipulated by the employment contract.

The employee is involved in the combination by agreement with the employer, the volume, content and payment of additional work are discussed.

The employee's consent is reflected in writing. So, you can enter into an additional agreement with the employee or take written consent from him, after which the corresponding order of the chief physician is issued.

The description of the job function should be supplemented with specific duties performed.

It can be indicated that the labor standards of a health worker are established by the official labor standardization system of a medical institution.

Job descriptions can be taken from job descriptions, which are drawn up on the basis of qualification characteristics approved by Order of the Ministry of Health and Social Development No. 541n dated July 23, 2010.

If a professional standard has been developed for a specific position, the necessary wording can be taken from this document.

Below is an example of a description of the labor function of a pediatrician.

The employee’s responsibilities are to provide medical care to the child population. Including:

• Examination of the patient in order to establish his diagnosis;
• Prescribing therapeutic and diagnostic measures for the children's population, monitoring their safety and effectiveness;
• Development and implementation of individual rehabilitation programs;
• Sanitary educational work with children and their parents, formation of a healthy lifestyle of the population;
• Preventive activities on the health status of children in different age groups, as well as analysis of its effectiveness;
• Monitoring the activities of subordinate nursing and junior medical personnel.

It is not advisable to make a note in an additional agreement that the employee must perform a certain amount of work (for example, conducting a certain number of tests, studies, appointments, medical examinations).

It also cannot be said that a health worker provides assistance only to certain groups of the population, for example, only for paid medical services.

An indication of the specific type of work assigned to the employee

An indication of the specific duties assigned to the employee must be made in the event that the health worker will not perform all the duties provided for the position of a doctor, but, for example, part of them.

The job responsibilities of specialists are formed based on the qualification characteristics approved by Order of the Ministry of Health and Social Development No. 541n dated July 23, 2010.

If a doctor will perform only part of the functions provided for a specific position, for example, he will conduct an appointment and consultation, or conduct only a specific study - an ECG, then they must be listed in an effective contract.

Also, the specific type of work assigned is indicated when concluding a fixed-term employment contract. For example, if an employee is hired to carry out preventive vaccinations for specific indications, for example, during a flu epidemic.

An employment contract or an effective contract in healthcare must necessarily contain the name of the structural unit in which the health worker will carry out his activities.

When specifying a structural unit, it is important to check the staffing schedule of the medical institution and the list of departments of medical institutions, which are approved by Decree of the Government of the Russian Federation No. 781 of October 29, 2002.

The employer's mistakes will lead to negative consequences for the employee - if the wording is inaccurate, the employee may lose his right to receive a preferential early pension.

Salary levels in an effective contract

When reflecting the official salary of a specific health worker in the text of an effective contract, it is necessary to indicate its amount in accordance with the regulations of the constituent entity of the Russian Federation, which determine salaries according to the PKG.

PKG are reflected in the following regulations:

• Order of the Ministry of Health and Social Development of the Russian Federation No. 526 of 08/06/2007 (for pharmaceutical and medical workers);
• Order of the Ministry of Health and Social Development of the Russian Federation No. 247n dated May 29, 2008 (general industry titles of specialists, managers and employees); Order of the Ministry of Health and Social Development of the Russian Federation No. 248n dated May 29, 2008 (working specialties and professions).

In which PCG is the position of the head (chief physician) of a medical institution located? Professional qualification groups in accordance with Art. 144 of the Labor Code of the Russian Federation represent separate groups of specialist positions and worker professions. They do not include the positions of heads of medical institutions, including the chief physician. In addition, the doctor’s PKG is not provided for by orders of the Ministry of Health and Social Development No. 526 and No. 247n. Remuneration for the heads of medical institutions is established in the manner established by Decree of the Government of the Russian Federation No. 583 of 08/05/2008, in regional acts, in documents of municipalities and in the constituent documentation of a medical institution.

In regional medical institutions, it is possible to establish official salaries of employees not in accordance with the PCG, if such a procedure is directly regulated by a regional act.

Federal medical institutions can also use salaries not according to the PCG, however, this procedure is not recommended.

Let's consider two practical situations that are related to the establishment of salaries for health workers.

1. Can an employee have a salary lower than the minimum wage?

• A medical institution can set official salaries that are lower than the minimum wage, but the amount of a health worker’s total monthly earnings cannot be lower than the minimum wage established for the region or country.
• It is necessary to take into account that the earnings of health workers consist, in addition to salary, of other payments - incentive and compensatory nature. Therefore, a salary that is below the minimum wage cannot be regarded as a violation.
• However, it is important to remember that often other payments may depend on the employee fulfilling certain conditions in his activities, so it is important to take this into account when determining the salary.
• In recent years, medical institutions and other public sector organizations have been striving to increase the guaranteed part of their wages for their employees, i.e. increase their official salaries first of all.

2. Is it possible for a medical worker to have a reduced basic salary for the probationary period?

• This approach does not comply with legal requirements.
• When hiring an employee for a probationary period, this condition must be spelled out in his effective contract. It also specifies the terms of payment for his work, including the specific amount of the official salary.
• In accordance with the requirements of Art. 22 and 56 of the Labor Code of the Russian Federation, a medical institution, as an employer, must pay its employees wages in full, and equally evaluate the equal work of its employees, including in monetary terms.
• This is due to the fact that the probationary period in accordance with Art. 70 of the Labor Code of the Russian Federation is initially established in order to check whether the health worker is suitable for the work entrusted to him.
• Official salaries are always set in monetary terms, in Russian rubles.

3. Is it necessary to reflect in an effective contract the amount of the employee’s official salary, taking into account personal income tax?

• An employment contract and an effective contract in healthcare assume that the employee’s salary will be set taking into account the individual’s income tax. As you know, personal income tax must tax all employee income, including his entire salary.
• In this case, the medical institution acts as the employee’s tax agent, transferring the withheld amounts to the appropriate budget.
• Also, in a medical institution, it is permissible to use, in addition to official salaries, daily or hourly fixed wage rates when a health worker performs certain complex work in a certain unit of time.
• This rate does not include social, incentive and compensation payments.

Effective healthcare contract and employee compensation payments

In order to reflect in an effective contract the compensation payments due to the employee, it is recommended to reflect them in the following table:

• in an effective contract it is worth mentioning only those payments that form the salary of the health worker;
• it is not worth mentioning compensation related to overtime for an employee who has exceeded the monthly work quota;
• You can indicate fixed amounts of payments in rubles, or reflect them as a percentage of the salary amount (for example, payment for continuous work experience in healthcare - 30% of the official salary);
• if the amount of a particular payment and the conditions for its calculation are precisely determined by the legislator, you can use the following wording in the contract - “other compensation payments are made to the employee in the amount determined by the legislation of the Russian Federation.”

Order of the Ministry of Health and Social Development of the Russian Federation No. 822 dated December 29, 2007 established lists of compensation payments for employees of budgetary and government organizations.

The Labor Code of the Russian Federation establishes the following types of such payments:

• for night work;
• for working in working conditions that deviate from normal(harmful production factors);
• for working under irregular working hours;
• for work in special climatic conditions (Far North);
• for working on weekends and holidays.

Incentive payments for health workers in an effective contract

An effective contract in healthcare, among other things, is designed to stimulate effective work activity of employees. In this regard, it provides detailed criteria and performance indicators for an employee to receive these payments.

Reflect the conditions and amounts of these payments in a special table, which will include the following information:

• the name of the payment due to the employee;
• the condition for its accrual;
• criteria for evaluating employee performance;
• the goal of achieving one or another criterion (its indicator);
• payment terms and frequency;
• amounts or amounts of payments in relation to the official salary.

All payments included in an effective contract must correspond to the payments and their values ​​approved by the medical institution’s remuneration system.

It is not recommended to establish payments that are not related to the performance of the employee and medical institutions, as well as immeasurable and specifically uncertain payments and their conditions, for example, incentive payments for intensive work.

On one-time bonuses and payments, an effective contract in healthcare may provide the following wording: “based on local acts of a medical institution, an employee may be provided with one-time incentive payments, which are provided for by the current remuneration system.”

The condition of the incentive payment is a specific requirement that the health worker must fulfill in the course of fulfilling his professional duties in order for it to be accrued.

For example, such a requirement may be the absence of comments from management or disciplinary sanctions.

Order of the Ministry of Health of the Russian Federation No. 421 dated June 28, 2013 refers to the use of the scoring principle for calculating incentive payments. However, this provision is advisory in nature.

The frequency of specific payments may be different - once a month, once a year, once a quarter, based on work results.

Let us summarize the content of this article on the implementation of an effective contract in healthcare:

What should not be forgotten when implementing an effective contract?	What should be done
Concluding additional agreements with current employees of a medical institution	All employees are warned in advance that an employment contract is being introduced in the medical institution in the form of an effective contract two months in advance. The basis for concluding the agreement is a change in technological and organizational labor conditions
Labor function of a health worker	For managers and specialists of a medical institution, a specific position is indicated, for workers - a specialty or profession. An effective contract must indicate the department or unit of the medical institution in which it is accepted.
Official salaries	The salary of a health worker is indicated in rubles. The salary amount corresponds to regional regulations, according to the specific PCG to which the employee’s position belongs.
Compensatory payments	An effective contract lists all payments and specifies the basis for their payment.
Incentive payments	Payments must not only be listed, but also indicate what indicators the employee must achieve to receive them, and within what period they are paid.

Over the past five years, the state has been taking a number of measures to increase the motivation of medical workers and the prestige of the profession. One of the ways to achieve these goals was the reconstruction of the wage system and the introduction of an effective contract in the public sector. In this article you will learn all the nuances of the new remuneration system, and also find an example of an effective contract in healthcare.

Criteria for an effective contract in healthcare

The term “effective contract” appeared five years ago, after the Government of the Russian Federation adopted the Program for Improving the Remuneration System in Budgetary Institutions (Order No. 2190-r dated November 26, 2012). In accordance with this document, employers in the public sector of the economy, including the healthcare sector, are required to conclude effective contracts with all employees until 2019.

In essence, this is a standard employment contract, which regulates in more detail the issues of monetary payments, namely:

• the employee’s job functions are specified;
• the terms of remuneration were clarified;
• performance indicators are recorded;
• the procedure for receiving incentive payments and compensation is described in detail;
• social support measures are prescribed.

At the same time, when concluding an effective contract with an employee of a medical institution, it is necessary to indicate his position (for specialists, employees and managers).

For some positions you additionally need to indicate:

• speciality. So, for a medical specialist, this is the area in which he has been trained and directly practices (for example, a gynecologist);
• section of medical activities. This applies, first of all, to deputy chief physicians (for example, deputy chief physician for clinical expert work);
• name of the medical position according to the profile. This category includes heads of hospital departments (for example, the head of the surgical department - a surgeon);
• job title with specialty. For example, an emergency department doctor is a general practitioner.

It is worth noting that the concept of an effective contract implies not only the employment contract itself, but also a set of measures aimed at improving the quality and accessibility of medical services. Work should become more efficient, and employees should be motivated to achieve maximum professional results. To do this, the terms of special incentive payments are included in the employment contract. Moreover, such payments are made only when the employee achieves the contractual targets.

How to switch to an effective contract

Employees who are employed in a medical institution for the first time sign a contract using a new form. And with employees who are already in an employment relationship, additional agreements must be signed that will contain all the innovations that are characteristic of effective contracts.

In this case, amendments to the contract must be made in accordance with the procedure established Article 74 of the Labor Code of the Russian Federation. This provision provides that changes in wage conditions associated with organizational innovations can be carried out by the employer unilaterally. However, it is necessary to notify the employee about the upcoming changes at least two months before their introduction.

If an employee refuses to work under new conditions, then the employment relationship with him can be terminated in the manner provided for in clause 7 Art. 77 Labor Code of the Russian Federation.

Normative base

• Decree of the President of the Russian Federation dated May 7, 2012 No. 598 “On improving state policy in the field of healthcare”;
• Order of the Government of the Russian Federation dated November 26, 2012 No. 2190-r, which contains the Program for improving the remuneration system in budgetary institutions;
• Order of the Ministry of Health of the Russian Federation No. 421 dated June 28, 2013 (criteria and indicators of effective work of employees of medical institutions);
• Order of the Government of the Russian Federation dated December 28, 2012 No. 2599-r (Plan of measures aimed at increasing the efficiency of healthcare);
• State program of the Russian Federation “Healthcare Development”, approved by Decree of the Government of the Russian Federation of April 15, 2014 No. 294.
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Effective contract in healthcare: criteria for evaluating work

The size and conditions for establishing incentive payments for employees should be determined taking into account the indicators and criteria for assessing the effectiveness of their work developed in the institution. Such criteria should be enshrined in collective and labor contracts, agreements, and local regulations (for example, in the Regulations on remuneration, Regulations on incentive payments).

So, what criteria for a high level of work can be enshrined in local acts? For example, assessing how effective a doctor’s work can be considered is often done through the absence of:

• Emergency situations, deaths and medical errors;
• justified claims regarding the quality of medical care provided;
• errors when preparing documentation;
• violations of the rules of document flow and reporting, compliance with administration orders;
• comments on the performance of job duties and relevant instructions.

For nursing staff, such indicators may be the absence of:

• violations of the rules for obtaining, recording and storing medicines;
• Emergency in the department;
• complaints when carrying out medical prescriptions, caring for patients and preparing them for tests;
• violations in the organization of proper monitoring of patients.

In addition, indicators such as the number of medical examinations, vaccinations, patient surveys and feedback, and for pediatricians the level of breastfeeding can be established as performance criteria.

Compensation and incentive payments

The salary of employees of medical institutions consists of the official salary, incentive and compensation payments, as well as bonuses (if such practice is established by local regulations). The amount of compensation is set as a percentage of salaries, wage rates or in absolute amounts. They cannot be lower than the amounts established by labor legislation and are appointed for:

• working under difficult, harmful or dangerous working conditions;
• work in areas with special climatic conditions (desert, arid areas, high mountain areas, regions of the Far North);
• combination of positions;
• increase in work volume;
• fulfilling the duties of an absent colleague (without releasing oneself from one’s work);
• work at night;
• working with information constituting state secrets;
• other compensation payments provided for by law or collective agreement.

As for incentive payments, in accordance with Letter of the Ministry of Health of Russia dated September 4, 2014 No. 16-3/10/2-6752, which provides guidance on improving the remuneration system for medical workers, these include:

1. Payments for intensity and high performance results.
2. Payments for the quality of medical services provided (a bonus for having a qualification category; a bonus for completing a particularly important state or municipal task.
3. Payments for length of service, length of service.
4. Performance bonuses:
   • per month;
   • for the quarter;
   • in a year.

We draw your attention to the fact that the conditions for the provision of these payments should be individualized and prescribed in relation to a specific employee and the type of his activity.

Algorithm of actions

When making the transition to an effective contract in a healthcare institution, the employer must go through the following stages:

1. Responsible employees - study the regulatory framework.
2. Heads of the Ministry of Defense authorized to adopt regulatory legal acts in the field of healthcare - develop performance indicators for subordinate organizations.
3. Healthcare institutions, guided by current legislation, should develop their own performance criteria and make changes to the Regulations on remuneration.
4. The department responsible for formalizing labor relations is to develop a form of effective contracts and additional agreements, focusing on Appendix No. 3 to Program No. 2190-r.
5. The employer must notify the staff of the upcoming changes 2 months in advance (if the employee refuses to work under the new conditions, the employer will have to offer this employee other available vacancies; in case of refusal, dismissal will follow in accordance with paragraph 7 of part one of Article 77 of the Labor Code of the Russian Federation).

At the end of the procedure, additional agreements are concluded with employees.