Scientific Foundations for the Management of a Medical Organization in the Context of Healthcare System Decentralization

The dissertation is devoted to the scientific substantiation of the management of a medical organization in the conditions of decentralization of the healthcare system. The research was conducted on the example of municipal medical institutions of the City of Samara and Krasnoglinsky District. In the work, approaches to the management of a medical organization have been developed and substantiated, systematizing the main directions of its activity — curative-diagnostic, preventive, and managerial. The methodological approach is based on process management utilizing structural-functional modeling, realized in the form of manageable technologies and models, including a model for early detection of tuberculosis among the population and a technology for organizing entrepreneurial activity. The proposed approaches have been implemented in the practice of a number of therapeutic institutions of Samara and tested in the educational process.

Relevance of the Research

In the Russian Federation, problems of healthcare reform have been widely discussed in recent years. The necessity of conducting a reform is conditioned by unfavorable trends in the health status of the population, limited financial resources, and low efficiency in the utilization of available healthcare resources (O.P. Shchepin 2000; A.I. Vyalkov, 2001; V.I. Starodubov 2002; V.Z. Kucherenko, 2003; V.O. Shchepin, 2005).

Particular importance in the conditions of reform occupies the development of principles of functioning and management technology of the basic link of the healthcare system — a municipal medical institution. In Russia and abroad, research has been and is being conducted at present related to the study of management functions of medical organizations. The unsatisfactory functioning of the Russian healthcare system is a consequence not only of insufficient financing but also of inefficient management of the process of organizing medical care at the level of an economic entity — a medical organization. Contemporary research by such scholars as V.P. Korchagin, 1995; Yu.P. Lisitsyn, 1995; V.Z. Kucherenko, 1996; V.I. Starodubov, 1997; A.L. Lindenbraten, 1999; I.M. Sheyman, 2000; O.P. Shchepin, A.M. Taranov, 2000; I.N. Denisov, V.Z. Kucherenko, N.G. Shamshurina, 2002, confirm the need and relevance of a comprehensive solution for this range of medical, economic, legal, organizational, and informational problems.

At the same time, in the new conditions of reforming, there is insufficient work on ways and methods of developing a management technology in a municipal healthcare system at the level of a microorganization; many works on this topic are fragmentary in nature, concentrating on individual theoretical questions rather than covering all aspects of the management of medical institutions of the healthcare system. In this connection, healthcare institutions face the necessity of managing changes based on a substantiated procedure of their foresight, regulation, and adaptation to the goals of a curative-preventive institution, to changing external conditions (Yu.P. Lisitsyn, A.A. Kalmykov, A.Yu. Senchenko, 2005).

The above determines the scientific relevance of the research topic and the practical importance of studying the problem of managing a medical institution. Goal of the Research

The goal of this research is the substantiation and implementation of approaches to the management of a medical organization in modern conditions characterized by decentralization of management, legal, and economic independence. Tasks of the Research

1. To conduct a diagnosis of problems in the health status of the population on the example of Krasnoglinsky District of the City of Samara as a basis for changing the activity of a medical organization.

2. To develop and propose approaches to the management of a medical organization systematizing the main directions of its activity, in the conditions of decentralization of the healthcare system.

3. To implement the proposed approaches in the management of the curative-diagnostic process and entrepreneurial activity.

4. To analyze the results of the activity of a medical organization after the implementation of new principles of management.

Scientific Novelty of the Research

In the conducted research, for the first time:

Approaches to the management of a medical organization in the conditions of decentralization of the healthcare system have been developed and substantiated, allowing for the increase of the efficiency of activity.

The proposed methodological approach — process management based on structural-functional modeling — is presented in the form of manageable technologies and models: a model for early detection of tuberculosis among the population has been developed, as well as a technology for organizing and managing entrepreneurial activity in municipal medical institutions.

Scientific and Practical Significance and Implementation of the Results of the Research in Practice

The approaches to the management of a medical organization proposed on the basis of structural-functional modeling have systematized the directions of activity: curative-diagnostic, preventive, and managerial, allowing for a more efficient use of the potential of therapeutic institutions of the City of Samara at all stages of medical care provision — emergency, ambulatory, and inpatient.

The implementation in practice of process management based on structural-functional modeling made it possible to reduce unjustified expenditures and increase the efficiency of entrepreneurial activity; the development of a model for early detection of tuberculosis among the population made it possible to eliminate zones of inefficiency in the organization of work and to increase the detection rate of tuberculosis.

The results of the research have found practical application in the work of MHC No. 1; MHC No. 10; GP No. 6 of the City of Samara.

The experience of the work is used in the educational process for students, interns, and heads of curative-preventive institutions in the departments of public health and healthcare and healthcare of the Institute of Advanced Training of Samara State Medical University: educational topics "Modern Approaches to Prevention — Model for Early Detection of Tuberculosis Among the Population", "Model of Management of a Medical Organization".

Presentation of the Results of the Research

The main provisions and results of the dissertation research have been reported and discussed at congresses and conferences:

• IV regional congress of obstetricians-gynecologists, pediatricians, and therapists "Healthy Family — Medical Aspects and Problems" (Samara 1995)

• V regional congress of obstetricians-gynecologists, pediatricians, and therapists "From ATS — to a General Practitioner" (Samara 1997)

• VI interregional congress of obstetricians-gynecologists, pediatricians, and therapists "Prevention — the Foundation of the Activity of a Primary Care Physician" (Samara 1999)

• VII interregional congress of obstetricians-gynecologists, pediatricians, and therapists, general practitioners "Comprehensive Solution of Medical and Social Problems of the Family — the Foundation of the Health of Society" (Samara 2001)

• Conference "New Medical Technologies in the Treatment of Bronchial Asthma" (AAMC, USA, Samara 2004).

• Seminar-consultation "Modernization of Russian Healthcare" (Moscow, November 2004) at the Joint Session of the Department of Public Health and Healthcare and Healthcare of the Institute of Advanced Training of Samara State University. (Samara 2005).

• Conference "The Role of Healthcare in the Protection of Public Health" (Moscow, April 2005).

Main Propositions to be Defended

1. The basic approaches to the management of a medical organization in modern conditions, systematizing all directions of activity — curative-diagnostic, preventive, and managerial.

2. The improvement of management activity is based on the structural-functional modeling of basic technological processes in a medical organization.

Publications on the Topic of the Dissertation

The author has published 12 scientific works, including 2 in the central press and 3 in the interregional press.

Volume and Structure of the Work

The dissertation is presented in 167 pages and consists of an introduction, a literature review, a chapter describing the base and methods of research, four chapters of original research, a conclusion, conclusions, practical recommendations, a list of literature containing 159 domestic and 24 foreign sources, and 13 appendices. The materials of the scientific research include 18 tables, illustrated by 31 figures.