Manager, manager. Head of the department of the clinic as a key figure in the diagnostic and treatment process Head of the department or head of the department

The day-to-day activities of the medical institution are organized and managed by the heads of its departments. In a hospital and clinic, these are heads of departments, at an ambulance station, these are senior doctors on duty shifts, and also senior specialists and heads of substations. The role of these leaders is clear to every health worker. Let's talk more about the work of the head of the clinic.

Rights and responsibilities of the head of the department

The medical institution functions as a set of specialized units, each of which performs its own specific task. The head of the department manages the work of the attending physicians, often he himself leads the patients. He is always an experienced doctor and a good organizer. He is the one responsible for the results. In the hospital department - for treatment outcomes, expenditure of resources and use of the bed fund, in the clinic - for demographics, structure and dynamics of dispensary contingents in the service area, in the ambulance - for the timing of the arrival of teams on a call and for the results of the trips.

It is the manager who bears full responsibility for everything: for quality, for quantity, for rational use resources placed at his disposal.

The head of the clinic department is obliged to control and has the right to correct the work of the attending physician. He gives doctors instructions about actions in typical situations and comes to the rescue in atypical situations. He shares responsibility for outcomes and costs with them. Pain points are always in the zone of his close attention: severe and difficult patients, difficulties in obtaining the necessary resources, insufficient competence of a particular doctor, unoccupied beds (in a hospital), failures in mass preventive examinations (in a clinic), non-core use of mobile teams ( on SSMP), difficulties in obtaining the consent of the patient for the operation, conflicts between doctors and patients and their relatives, special life conflicts in the patient, which complicate his treatment. He delves into these situations, takes on their resolution.

At the disposal of the head are the nurses of the department, headed by the head nurse, as well as the nurses, headed by the housewife. Therefore, he is responsible for all the work of middle and junior medical personnel: for the fulfillment of medical prescriptions, for cleanliness and order in the premises, for the work schedule and its observance.

IMPORTANT!
The idea of many that the fate of the patient depends solely on the attending physician is erroneous. It also depends on the manager, on the order established by him and on his reaction to the unfavorable situations that arise with the patient. The head of the department of the clinic solves or smooths out those problems that the doctor himself does not know how or is not able to solve. It is thanks to the head that the fate of the patient does not depend on differences in the qualifications of residents of the same department, it is determined by the qualifications of his the best doctors who will be called to help.

The responsibility of the head is consistent with his rights. Within the department, he distributes work among doctors, ensures their interchangeability, evaluates their activities, and gives his conclusions about their qualifications. It is his authority that is needed in the occasional conflicts with adjacent units. These related units turn to him when they themselves need the help of the department's doctors. He has the right and opportunity to directly address the chief physician, and only through him the chief physician carries out his orders related to the department. Finally, no one has the right to interfere in the work of the department other than him.

Goals and objectives of the head of the department. Forms of communication with clinic staff

The goal of the head of the department is effective medical care (that is, a favorable structure of outcomes) with the resource provision provided by the head physician and within the boundaries of the service sector. The achievement of this goal is measured by well-known quantitative indicators, which are formed on the basis of case histories (in the SSMP - exit cards).

On the way to the goal, the manager is constantly occupied by three groups of objects:

situations with patients that are special in severity, complexity or danger;
scarce, as well as new and expensive, but highly effective medical and diagnostic resources;
the subjectivity of doctors, manifested in their actions.

The first is necessary for timely intervention in the "bottlenecks" of the work of attending physicians, to help them, for the timely correction of their work in cases of difficulties, complexities and dangers. To do this, you need to have an idea about the patients and the abilities of each doctor, the range of which can be very wide: one is able to help others, the other needs constant care.

The second object of the manager's control actions is resources. If scarce or especially expensive resources are assigned where they can be replaced without harm to the patient, the manager encourages such a replacement and helps to select it. The opposite is no less important: where the use of expensive, but highly effective diagnostic or therapeutic agents is directly indicated, the manager must insist on their use.

In a hospital, a special resource is the bed fund. The work of the hospital department and its interaction with the clinic should be organized in such a way as to prevent either empty beds or queues for hospitalization. The clinic must be managed in such a way that patients are sent for hospitalization in a timely manner and are prepared for it. In an ambulance, it is important to ensure a high percentage of the specialized use of specialized medical teams and their timely arrival to the patient.

The third object of effective attention of the head is the influence of the personal characteristics of doctors on their work with patients. Several residents are subordinate to the head. They can vary significantly in terms of qualifications, nature and style of work. One easily puts off until tomorrow what needs to be done today, the other sins with excessive medical appointments, the third is in a hurry to appoint a lot of consultations, the fourth is in a hurry to fix success where it still needs to be worked on.

IMPORTANT!
Adverse deviations from the optimal course of action, when they become systematic, can result in wasted time, resources, and clinical outcome.

The head of the department must identify such trends, take them into account when making decisions, counteract them in such a way that everyone in the department observes a common rational style of activity. The constant comparison of doctors allows you to find and include the best in this style. In fact, this is not so much monitoring professionalism in work, but the cultivation of professionalism.

To carry out his tasks, the head of the department uses the classical forms of management of the treatment and diagnostic process. This is a regular report (in the hospital and at the ambulance station - daily, in the clinic - weekly), weekly rounds of patients (in the hospital), consultations at the request of the attending physicians and clinical analysis.

IMPORTANT!
The report serves the manager for regular general orientation in the situation, for the timely identification of "bottlenecks", for giving orders to doctors and notes on the necessary immediate actions. All other forms of management allow the manager to timely delve into and engage in the actions of the attending physicians, approve these actions or give their mandatory orders, thereby sharing responsibility for the future result with the doctors.

The attending physician agrees on the most important turns in the management of the patient at clinical reviews under the guidance of the head. Such, for example, are decisions on a surgical operation, on referral to a sanatorium, on transfer from one hospital department to another, on the final diagnosis in case of death, on a dispensary registration group and transfer from group to group, and a number of similar ones.

Finally, the head of the department is an indispensable participant in weekly meetings with the head physician. There he receives the current orders of the first head and solves those problems of the department that are only within the competence of the latter.

Information problems of the head of the department

The described forms of management are designed to ensure the full awareness of the head of the department and the timeliness of all necessary for successful work contacts. It would seem that the basis of information for the head of the department should be the case history, but this document has become so cumbersome and inconvenient that the head has to rely on the oral report of the attending physician during the rounds, during the clinical analysis, and during the consultation, not being able to compare the received source information.

The same applies to a regular report: the head does not use the primary information, but the way it is presented in their reports by the doctor on duty at the hospital or district doctors at the clinic.

Oral exchange of information, hard-to-read case histories and sporadic, unregulated memos - these means have long been out of line with the current volume of important information available. Therefore, the information owned by the head of his department is sometimes deliberately incomplete, subject to distortion and not always timely. They are not enough to make accurate decisions, they have to be supplemented with assumptions, memories, subjective fears, intuition.

Insufficient awareness of the manager in traditional conditions is obvious to everyone. It is an objective basis for insufficiently accurate and not always timely management decisions, it seems to excuse the imperfection of the department management, reduces the responsibility of the head for the actions of his doctors, and hence for the results of the work of the entire department. Information insufficiency becomes a force majeure circumstance.

The continuation of this situation threatens serious secondary troubles. Heads of departments are not only experienced (and often the most experienced) doctors in their specialty, but people with leadership inclinations who can convince, demand, work hard and take responsibility. These people are the basis of the medical institution. But if the information support turns out to be such that it does not allow answering for everything, then the objective impossibility of taking responsibility will begin to repel those who know how to do it.

What justifies the need of the head of the department in the information system

The need for an information system is due to the very specifics of the work of the head of the department. The information system should cover the following needs:

the ability to manage based on information rather than intuition
awareness and understanding of what is behind the incoming information
facts for the timely correction of possible wrong actions
statistical generalizations of facts to distinguish randomness from patterns
comparing facts to understand connections, cause-and-effect relationships
information about the dynamics of statistically summarized data to understand trends.

Based on this, first of all, an electronic medical history is needed, logically ordered and recording all the facts, events, judgments and actions related to the patient. Such a document allows the manager to find out everything that is currently known about the patient, and compare this knowledge with what the attending physician reports. Then three-channel informing is carried out: from the medical history, from the report of the doctor and through personal communication with the patient on the round, on the clinical round, during the consultation. This gives the manager an idea of both the patient and his doctor.

For a regular report, a summary is compiled that highlights the very pain points mentioned above. For the clinical round, a list of patients is prepared by ward with the data on each patient, which immediately, even with a cursory glance, will be able to orient the head of the situation (age, duration of admission, diagnoses, risk factors, ongoing treatment, organizational difficulties).

Readiness for clinical analysis, decisions made during the analysis and their implementation are recorded by the doctor in the medical history, and this allows the head at any time to receive lists prepared for analysis, prepared for surgery, lists of completed and not yet implemented recommendations. The same applies to managerial consultations.
For comprehensive monitoring of work with patients, the head of the department can use more than two dozen thematic lists. These are, for example, defects in case histories, patients of privileged categories, the length of the sick leave, patients who have come off the dispensary observation, patients receiving / not receiving a certain medication or excessively delayed in the hospital, repeated admissions to the hospital, prepared for surgery, preparing for discharge from a hospital, to a sanatorium, who have not received timely consultations, newly diagnosed diseases, patients with a given diagnosis or with a given combination of diagnoses, etc., etc.

Such lists are needed by the head both to control the weaknesses of the department's work, and to test his fears and intuitive assumptions. Ultimately, they serve to timely correct the work of doctors.

IMPORTANT!
To characterize the situation as a whole, to detect systematic undesirable deviations from what should be, analytical numerical tables are issued with data for the department as a whole and for each doctor. This includes resource costs ( laboratory research, medicines, medical procedures, consultations, vaccinations, diets, the number of appointments in the clinic and visits to patients at home, the number of visits by specialized and linear ambulance teams).

To compare doctors by the main sections of their work with patients, statistics are used for a representative period (from one to three months). On their basis, the work of doctors is evaluated monthly not only quantitatively, but also according to its results, outcomes and costs. This opens up completely new opportunities for improving the efficiency of medical care.

Why does one doctor consistently do more significant work than another? Why, in the same diagnostic groups, does one doctor spend less time making a diagnosis than another, and at the same time spend less diagnostic tools? Why, with the same diagnoses, doctors use a different number of therapeutic agents, different terms and get different results? Why do district doctors have dispensary contingents that differ significantly in size, in the ratio of groups, and in the structure of diagnoses? All these questions should be asked by the manager, and the information system of the clinic should help him quickly answer them.

The appearance of such questions prompts the manager to peer into the details of the current work of the resident whose results are worse, to “catch” the inaccuracies, correct the doctor, show him that it is he who makes his colleagues worse and therefore does not achieve what they achieve. Thanks to this, there are internal reserves for improving results and reducing costs.

Monthly comparative analysis The work of the doctors of the department creates a special opportunity to evaluate the effectiveness of the specific work of the head, his ability to pull up lagging doctors to the level of the best. Differences in the performance of doctors engaged in the same case can be very large. This scatter, the dispersion of indicators, just characterizes the effectiveness of the manager's control action. A decrease in variance means control efficiency, while maintaining a significant variance suggests the opposite.

FACT
The information system based on the electronic medical history makes the manager fully informed. From huge amount of the most detailed information, it sorts out what requires its influence, and presents the information so that it is already prepared for decision-making.

For the impact itself, he also has suitable means. In the case history, his remarks and recommendations form a special section and cannot be forgotten. With the help of a special function - the compilation of therapeutic and diagnostic complexes - he can put into practice his guidelines for diagnosis and initial treatment in certain diagnostic groups. Such complexes, usually compiled on the advice of doctors, are then given to the doctor when working with a medical history and are easily entered into it as prescriptions. Integral scoring is based on a monthly automated comparison of the work of doctors - an essential way of moral stimulation, with which material incentives can also be associated.

We add that a specialized channel of communication between the department and the head physician is also based on the electronic medical history: the problems of the department are transferred to the first head both in regular summaries and reports, and in lists and analytical tables issued at his request, exactly the same that the head of the department has. The head does not need to contact the head physician personally with those problems that are already reflected in the summaries and lists. Of course, the information system frees the head from the preparation of official reports - a tedious job and not necessary for the department.

Full awareness and control of the situation return the head of the department to full responsibility. This is the necessary basis for improving the effectiveness of medical care. Therefore, the main task information system- creation of the necessary information environment for decision makers. Only thanks to this, the modern clinic will be able to achieve High Quality work.

head of sales department- commercial director - Topics oil and gas industry Synonyms commercial director EN sales manager ... Technical Translator's Handbook

HEAD OF THE DEPARTMENT (BUREAU) OF PROJECT MATERIALS REGISTRATION- Job responsibilities. Manages the work on the design of developed projects, scientific and technical reports on the results of research, information materials, methodological programs and other scientific and technical ... ...

manager, manager- Question What is correct: “manager (manager) of what” or “what”? The word manager (manager) manages TV. p .: head (head) than head, head of department, base, warehouse, department, sector, production, editorial office, personnel ... Dictionary of difficulties of the Russian language

Job responsibilities. Organizes the implementation of scientific research work, provided for in the thematic plan of the institution or department (department, laboratory) of the institute, and determines the prospects for their development on a fixed topic, selects ... ... Qualification directory of positions of managers, specialists and other employees

Job responsibilities. Organizes the implementation of scientific research work provided for the unit in the thematic plan of the institute, and determines the prospects for their development in the relevant field of knowledge, selects methods and means ... ... Qualification directory of positions of managers, specialists and other employees

MANAGER (HEAD) OF THE HR DEPARTMENT- Job responsibilities. Leads the work on providing personnel for managers, specialists, technical performers and workers with the required specialties and qualifications in accordance with the thematic areas of work and the structure of the institution ... Qualification directory of positions of managers, specialists and other employees

MANAGER (HEAD) OF THE DEPARTMENT OF SCIENTIFIC AND TECHNICAL INFORMATION- Job responsibilities. Organizes the provision of managers and specialists of the institution (organization) information materials about domestic and foreign achievements of science, technology and advanced production experience in order to provide ... ... Qualification directory of positions of managers, specialists and other employees

MANAGER (HEAD) OF STANDARDIZATION DEPARTMENT- Job responsibilities. Provides scientific, technical and organizational methodological guidance on certification and standardization in order to improve the technical level and quality of projects developed by the institution (organization). ... ... Qualification directory of positions of managers, specialists and other employees

MANAGER (HEAD) OF PLANNING AND ECONOMIC DEPARTMENT- Job responsibilities. Manages the work of planning and coordinating the scientific, technical and production activities of an institution (organization) in order to ensure the most appropriate use of material, ... ... Qualification directory of positions of managers, specialists and other employees

HEAD OF DESIGN DEPARTMENT- Job responsibilities. Supervises the design work carried out in the department. Carries out measures to improve the efficiency and competitiveness of developments, reduce the time and cost of design, reduce volumes ... ... Qualification directory of positions of managers, specialists and other employees

department head- head of department... Dictionary of abbreviations of the Russian language

Books

History of the Great Patriotic War of the Soviet Union: 1941-1945 (set of 6 books),. The six-volume work "History of the Great Patriotic War Soviet Union 1941-1945." was developed by a team of researchers from the Department of the History of the Great Patriotic War of the Institute ...
State Russian Museum. Almanac, No. 229, 2009. The artist Annamukhamed Zaripov and his collection of the 20th century,. "Zaripov is a unique phenomenon. Artists who deeply and disinterestedly perceive other people's work, although rare, are found. Alexander Benois was this peaceful in our culture ...

Good afternoon! Tell me: are the commas placed correctly? The raider, who turned out to be a 50-year-old resident of one of the neighboring countries, was taken into custody. A young man who heads the police department No. 1 of the urban-type settlement of Gvardeyskoye (Simferopol district) ... After the turnover with which is a comma needed? The offer continues. His two accomplices, who were able to escape from the scene of the crime, are now being sought.

Yes, in these and similar cases subordinate clauses with the word which separated by commas on both sides. Punctuation marks are placed correctly.


	Question #300762

How to write correctly. A person is appointed to the position of head of the therapeutic department No. 4 of a rheumatologist, ........ A person is appointed to the position of head of the therapeutic department No. 4 of a rheumatologist, ........

Answer help desk Russian language

Right: As Head of Therapy Department... See the question for details.


	Question No. 298232

Good afternoon. Do I need a comma - "I.O. chief physician (,?) Head of the orthopedic department", when indicating the position in the documents. Thank you.