Improvement of Healthcare Management of Open Joint-Stock Company "Russian Railways" in the Context of Structural Reform (Based on Materials from the Far Eastern Railway)

The dissertation is devoted to improving the system of healthcare management of Open Joint-Stock Company "Russian Railways" (OJSC "RZD") in the context of structural reform of the transport industry. The research was conducted on materials from the Far Eastern Railway (FER) and covers the period from 2000 to 2010. The work comprehensively analyzes key health indicators of railway transport workers — dynamics of morbidity, trends in primary disability certification and professional incapacity, indicators of premature mortality and years of potential life lost — employing methods of potential demography and quality of life measurement technology (SF-36 questionnaire). Special attention is given to the evaluation of resource provision and workforce problems of branch-owned healthcare, the level and quality of life of medical workers under conditions of changing the organizational and legal form of institutions. Based on the conducted analysis, priority directions of development strategy and methodological approaches to improving the healthcare effectiveness evaluation system in railway transport are scientifically substantiated.

Relevance of the Problem. Health, as a socio-economic category, constitutes a vital element of national wealth: maintaining health requires a certain portion of the gross national product, yet health itself must be regarded as a resource essential for the production of material goods (Bedny M.S., 1984; Valentei D.I., 1999; Korchagin V.P., 1999; Lisitsyn Yu.P., 1986, 1987, 1992, 2001; 2003; Starodubov V.I., 2000, 2001, 2003, 2004; Saltman R.B., 2000; Shchepin O.P., Ovcharov V.K., Maximova T.M., 2003, et al.).

Preserving the health of the economically active population, timely detection and treatment of occupational and work-related diseases constitute an important condition for the development of all sectors of the economy and the effective resolution of a complex of paramount national tasks (Putin V.V., 2004).

In this context, healthcare in railway transport is regarded as an integral component of the technological process, an important constituent of the life activity and sustainable functioning of the industry, and an instrument for enhancing the efficiency of production activity (Yakunin V.I., 2004; Atykov O.Yu., 2004, et al.). It is capable of ensuring the sustainable operation of railway transport and thereby contributing to the resolution of issues associated with its modernization (Atykov O.Yu., 2005).

One of the principal tasks facing Open Joint-Stock Company "Russian Railways" (OJSC "RZD") in its relations with society is the concern for maintaining its own economic viability as a producer of freight and passenger transportation services. Consequently, improving the manageability of the healthcare system and enhancing its medical and economic results will contribute to reducing the cost of transportation and increasing the safety of these transports from the perspective of the human factor (Atykov O.Yu., 2003; 2004; 2005; Azarov A.V., 2003, 2004; Kalugina E.A., 2003, 2004; Shumilina E.G., 2003, et al.).

At present, there is an evident deficit of specialized scientific research evaluating the health of specific population groups, including railway transport workers, using specialized indicators based on methods of potential demography and self-perceived quality of life.

Furthermore, research devoted to studying the level and quality of life of medical workers in branch-owned institutions under conditions of changing their organizational and legal form, as a basis for forming effective labor motivation in the context of structural reform in railway transport, have also not been conducted.

Multifaceted information on the state of health of railway transport workers and its trends during the transitional period allows not only to provide an assessment of the adequacy of the structural transformations being carried out in healthcare but also requires the creation of new forms and methods for evaluating the effectiveness of these transformations, and serves as a foundation for scientifically grounded managerial activity of the medical services of the Company.

In connection with this, the goal of the present research is — on the basis of a comprehensive socio-hygienic study of the health of Far Eastern Railway workers — to substantiate proposals for improving the management of branch-owned healthcare in the context of reforming.

Main Objectives of the Research

- to analyze the patterns of formation of the key characteristics of health of Far Eastern Railway workers and their trends during the reform period in railway transport;

- to provide an assessment of the conducted structural transformations and the resource base under new economic conditions;

- to analyze the level and quality of life of medical workers and the problems of healthcare workforce management they engender;

- to study the quality of life of locomotive crew workers based on survey data;

- to scientifically substantiate the priorities for further corporate development of healthcare institutions and develop proposals aimed at improving the manageability of the healthcare system in railway transport.

Scientific Novelty of the Research

The scientific novelty consists in the fact that for the first time

A comprehensive study of the key characteristics of health of Far Eastern Railway workers during the period of structural reform in railway transport was conducted using methods of potential demography and quality of life measurement technology.

Structural changes were studied, and the resource base of branch-owned healthcare was evaluated in the transitional period of reforming, which made it possible to assess the accessibility of medical care and determine priority directions for investment programs.

Based on the study of the level and quality of life of medical workers of healthcare institutions at the Far Eastern Railway, factors negatively affecting the formation of labor motivation were identified.

A systemic analysis made it possible to scientifically substantiate the main directions of the healthcare development strategy at the Far Eastern Railway and develop proposals for improving healthcare management in the context of structural reform in railway transport.

Practical Significance

The practical significance of the work is determined by the results of the research, which made it possible to scientifically substantiate proposals for improving the efficiency of management of the healthcare system, and to implement them in the practical activities of non-state healthcare institutions of the Far Eastern Railway — a branch of OJSC "RZD", the Medical Service.

An in-depth comprehensive socio-hygienic research dedicated to questions of the state of health of workers of OJSC "RZD" during the period of reforming allowed the Medical Service at the Far Eastern Railway to purposefully plan and implement a complex of curative-preventive and restorative technologies for reducing the level of leading diseases leading to professional incapacity, disability, and mortality.

Materials of the research were used: in the activities of the plenipotentiary representative of the President of the Russian Federation in the Far Eastern Federal District, as well as in the preparation of reports to the President of the Russian Federation and the Administration of the President of the Russian Federation; in the preparation of 7 normative and methodological documents of the Department of Healthcare of OJSC "RZD", including the "Concept for the Development of Healthcare of Open Joint-Stock Company "Russian Railways" for the Period up to 2010."

The results of the present research are used in the educational process at the Department of Public Health and Healthcare of the Far Eastern State Medical University during lectures and qualification improvement cycles for healthcare organizers.

Principal Propositions to be Defended

1. A comprehensive analysis of health indicators of Far Eastern Railway workers, using methods of potential demography, quality of life indicators (questionnaire 8R-36), revealed their specific features during the period of structural reform in railway transport.

2. Analysis of the resource base established investment priorities in human resources and fixed assets of healthcare institutions.

3. Improving healthcare management at the Far Eastern Railway based on strategic planning made it possible to determine priority directions for the corporate development of healthcare institutions of OJSC "RZD" and to use adequate indicators for evaluating their effectiveness.

Validation of the Research Results

The results of the conducted research were reported and discussed at the regional scientific-practical conference "Modern Problems of Railway and Clinical Medicine in the Far East" (Vladivostok, 2001); "Branch-Owned Healthcare: Problems and Prospects" (Khabarovsk, 2001); sessions of the Coordinating Council on Healthcare in the Far Eastern Federal District (2002–2003); the Russian scientific-practical conference "Population Health, Policy and Technology of Healthcare Development" (Moscow, 2003); the international scientific-practical conference "Healthcare in Railway Transport of States — Participants of the CIS" (Moscow, 2003); the regional scientific-practical conference dedicated to the 50th anniversary of the branch hospital at Komsomolskaya Station (Kommersolsk-on-Amur, 2003); at the 1st Congress of Physicians of Railway Transport of Russia (Moscow, 2004), Medical Councils of the Department of Medical Provision of OJSC "RZD".

The results of the scientific research are presented in 15 printed works. Personal contribution of the author:

- development of the research plan and program;

- analytical review of publications, statistical data, and research works on the research topic;

- development of questionnaires for the sociological survey of medical workers;

- collection and discussion of obtained materials;

- mathematical processing, analysis, and generalization of research results.

Overall, the author's personal contribution exceeds 95%.

The dissertation consists of an introduction, five chapters, conclusion, conclusions and recommendations, a list of references comprising 240 sources, of which 205 are domestic and 35 are foreign, and appendices. The total volume of the work is 175 typed pages. The dissertation is illustrated with 48 tables and 24 figures.