What is an effective contract in medicine? Effective contracting in healthcare

Until recently, domestic legislation did not contain not only a model of an effective contract, but also the very concept of such an instrument. However, with the adoption of the Program for the gradual improvement of the wage system in state (municipal) institutions for 2012 - 2018, approved by Order of the Government of the Russian Federation dated November 26, 2012 N 2190-r, this mechanism registration of labor relations has appeared in domestic practice.

Effective employment contract

The Government of the Russian Federation, by its order, defined an effective contract as an employment contract that has specific and understandable criteria for assessing the work of an individual employee for the purpose of calculating incentive payments.

It should be taken into account that the transition to this type of registration of legal relations with employees must be carried out in strict accordance with the requirements of the Labor Code of the Russian Federation.

Moreover, domestic legislation currently in force allows only employees of state and municipal organizations to be transferred to effective contracts.

Employees of private enterprises cannot be transferred to this form of registration of relations.

When introducing this type of agreement, each employer must perform the following steps:

• specifically define the responsibilities and functionality of each employee of the enterprise;
• develop criteria for evaluating effectiveness labor activity;
• agree not only on the level of payment, but also on incentives;
• obtain the employee's consent to switch to the new kind agreement.

An approximate example of an effective contract (employment contract) is approved in the above-mentioned Order of the Russian Government. Its form can be obtained using the Consultant Plus legal reference system or downloaded from the websites of the authorities of the Russian Federation.

It's important to remember that ultimate goal Transferring employees to an effective remuneration system is to ensure that the amount of income matches the complexity of the functions performed by the employee.

Effective contract after 2018

Currently, the end date for applying an effective approach to the remuneration of civil servants is 2018.

However, the Government of the Russian Federation did not indicate the termination of its program even after such a date.

For the period of 2017, it is planned to analyze the implementation of the initiative and develop recommendations for its further use.

Taking into account the stated goals, it can be assumed that after 2018, the institution of an effective contract will not disappear from the domestic practice of hiring civil servants.

Effective employment contract: sample

It should be especially emphasized that the Government of the Russian Federation has approved only an approximate form of effective labor agreement.

Each state and municipal structure has the right to develop its own version of such a document used to transfer employees to effective method wages.

However, given the relative novelty of such a tool, it is reasonable to use the developed form.

When introducing this system of remuneration for employees, the employer must use the following types of formalization of new relationships:

• upon initial employment - conclude an appropriate agreement;
• To transfer existing employees, it is necessary to resort to additional agreements to existing contracts.

Ignoring this algorithm will not allow you to correctly transfer workers to an effective remuneration system. The new conditions will simply not apply to eligible employees.

Sample of an effective contract

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.

Effective contract 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 assessing the performance of employees are established ONLY by the institution on the basis 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 order of application 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 due to the employee incentive payments, the conditions for their non-accrual and the criteria by which they are awarded, 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 on changing the terms of the employment contract determined by the parties (transfer to a new remuneration 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, done general meeting, where 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, provisions on incentives (since incentive payments will be specified in the additional agreement, most likely with reference to the collective agreement and internal position about stimulants).
Only after this can changes be made to the employment contract with the employee.
Speaking of the collective agreement, standard form it 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 circle of your job responsibilities– so don’t miss the opportunity to get 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 tariff insurance premium».

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 at one 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, to go home on time, or to external part-time job and receive a base salary of 17 thousand plus incentives up to 47 thousand or work two jobs in one institution, earn a salary of 34 thousand and receive incentives in the amount of 13 thousand?
Therefore, many workers see a way out in “Italian strikes” - work strictly according to labor code, with the fulfillment of official duties, admission standards no more than at the rate, in compliance with the admission regulations.

The implementation of an effective contract for health workers is intended to lead to new level the quality of services provided and increase the interest of employees in achieving high performance results. For this purpose, special criteria for an effective contract (in healthcare) are established for health workers. In fact, the introduction of an effective contract makes it possible to establish a direct connection between the quantity and quality of work performed by an employee and the amount of remuneration for a particular employee.

The basic task for healthcare is to improve the quality of services for the population in the coming years. To achieve the goal, it was decided to move from estimated financing to a more advanced remuneration system - an effective contract in healthcare. The size of incentive payments, salaries, job evaluation criteria - these indicators will affect the level of income of medical personnel. Officials are confident that the transition to effective contracts in healthcare will improve working conditions for staff, improve the quality of services for the population and stop the outflow of qualified personnel.

Objectives and criteria for an effective contract in healthcare

The concept of an effective contract has been present in legislation for quite a short time. It was introduced by order of the Russian Government of November 26, 2012 No. 2190-r. This regulatory act approved a special program, according to which there will be a stepwise improvement in the procedure for remuneration of workers budgetary institutions.

In order to increase the efficiency of employees and motivate them to achieve maximum professional results, provisions for special incentive payments are included in the employment contract. Moreover, such payments are made only when the employee achieves the contractual targets.

In this regard, information about the list of incentive payments established in relation to each specific employee is included in an effective contract. In addition, the indicators upon achievement of which the employee receives payments stipulated by the contract are clearly stated.

Most often, to introduce performance indicators, the current employment contract with the employee is supplemented with special provisions that include the criteria for an effective contract in healthcare. For this purpose, an additional agreement is concluded to the current employment contract, which lists performance indicators, incentive payments and their amount.

You can download an effective healthcare contract on our website. Here we bring to your attention an additional agreement to the employment contract, which contains information characteristic of an effective contract. Such an additional agreement to the employment contract (an effective contract in healthcare sample)

Sample of an effective contract in healthcare

An effective contract is a new type of employment agreement that clearly defines the responsibilities of each employee. An effective contract in healthcare will change the attitude of employees to their responsibilities and increase the level of services provided to the population. The goal of the reform is to analyze the work of both an individual specialist and the entire medical organization. Main goals of the state program:

• Retain human resources.
• Ensure decent wages in every medical organization.
• Increase the prestige of the profession.
• Significantly improve the quality of services.
• Encourage employees to improve their skills.

To achieve the goals in the new employment contract Special attention is devoted to the section “Payment”. An effective healthcare contract provides for several types of payments:

• Rate and salary.
• Compensatory payments – bonuses for length of service, working conditions, etc.
• Incentive payments - this clause enshrines the developed system of personnel evaluation criteria.

Please note that the “incentives” will not be permanent. To receive them, the employee must fulfill certain conditions, have no complaints from patients, follow the established plan, etc.

A sample of an effective contract in healthcare can be supplemented with other conditions:

• Introduction of a point system for job evaluation.
• Cash reward for exceeding the plan (for example, carrying out medical examinations, etc.).
• Specification of job responsibilities for each employee.
• Frequency of payments.

Transition to effective contracts in healthcare

Reforms are always scary, but an effective contract in healthcare is the same as an employment contract. The main difference is that all job responsibilities will be specified in the document. The transition to an effective contract in healthcare requires compliance with certain conditions:

Step 1. Preparation and delivery of notice to each employee.

At least 2 months before the transition to a new remuneration system, the manager must familiarize the staff with the innovation (under signature).

Step 2. Development of an additional agreement to the current employment contract.

New working conditions are discussed here. Since there will be many changes, the parties “agree” on new edition agreements.

Step 3. Issuance of an order (effective health care contract).

The document informs about the transition to a new wage system.

If an employee does not agree to continue working under the new conditions, he can be dismissed under clause 7 of part 1 of Art. 77 Labor Code of the Russian Federation.

Next, a commission is created that will formulate criteria for evaluating personnel according to certain indicators. Changes are being developed and made to local acts organizations – collective agreement, internal rules labor regulations, job descriptions, regulations on remuneration.

The employer must indicate a deadline for the transition of the entire organization to an effective healthcare contract.

Prerequisites for reform - why is the transition to an effective contract in healthcare necessary?

An effective contract in healthcare is necessary to improve the remuneration system: each employee receives incentive payments for providing quality services. The prerequisites for the reform were the most important tasks:

• Implementation of the national project “Health” - additional payments to health workers.
• Regional modernization program - implementation high standards services provided and improving the quality of medical care.

During the analysis of the existing remuneration system in healthcare, it was found that it is not effective. Workers receive different bonuses, salaries, and hazard pay. But there are no incentive payments for the quality of services and personal achievements. An effective contract in healthcare will make it possible to change the payroll mechanism itself, motivating employees to improve their skills and hone their professionalism.

The transition to effective contracts in healthcare is a complex process solely in organizational terms. But this approach will increase the level of income of workers and introduce new standards for the quality of medical services.

The concept of an effective contract is enshrined in the Order of the Government of the Russian Federation dated November 26, 2012 No. 2190-r, which approved the Program for the gradual improvement of the remuneration system in state (municipal) institutions for 2012-2018. It is an employment contract, which describes in detail the scheme for calculating the amount of remuneration depending on its effectiveness. All public sector employers were required to enter into such contracts with employees. Healthcare workers were no exception.

Objectives and criteria for an effective contract in healthcare

The introduction of a system of effective contracts in the healthcare system pursues the following objectives:

• increasing the prestige of work in budgetary medical institutions;
• preservation human resources;
• bringing wages into line with the quality and volume of services provided.

From these tasks it follows that the main goal of the new type of contracts is to motivate medical workers to achieve better results in professional activity, as well as a comprehensive improvement in the quality of services. For this purpose, special criteria for assessing performance are introduced, which are enshrined in the employment contract. When determining them, it is recommended to rely on Order of the Ministry of Health of the Russian Federation No. 421 dated June 28, 2013 and Order of the Ministry of Labor of the Russian Federation No. 287 dated July 1, 2013.

Effective contract in healthcare: criteria for evaluating work

Examples of criteria for assessing the quality of doctors’ work include the absence of:

• medical errors and deaths;
• errors when working with documentation, violations of document flow and other procedures;
• justified complaints about the quality of work;
• violations related to the performance of official duties and instructions.

As for nurses and other paramedical personnel, their work should not include:

• violations in reporting, storage and accounting of drugs;
• violations in the care and monitoring of patients;
• complaints from doctors, etc.

The list of criteria is far from complete; it may include various statistical indicators, such as the number of patients accepted, the percentage of vaccinated people, and so on.

An example of an effective contract in healthcare

The new contract, in addition to the scheme for assessing the quality of work, should describe the procedure for various payments. Typically, payment in medical institutions consists of salary, incentive payments, compensation and bonuses. The amount of compensation cannot be lower than established in labor legislation. They can be awarded for combining positions, difficult and harmful working conditions, night work, replacing an absent employee, etc.

Incentive payments, according to Letter of the Ministry of Health No. 16-3/10/2-6752 dated 09/04/2014, are paid for:

• high labor intensity;
• quality of services provided;
• work experience and length of service;
• performance results for a specific period.

All conditions for accrual of additional payments must be agreed upon in relation to each employee.

You can download a sample of an effective healthcare contract below.

Transition to effective contracts in healthcare

An employee who gets a job signs an agreement drawn up according to the new rules. An additional agreement is concluded with those who previously worked in the organization, which includes all innovations. In this case, the employer is obliged to notify employees about the planned changes at least two months before their introduction. If an employee refuses to sign an additional agreement, then the employment contract with him can be terminated, in accordance with paragraph 7 Article 77 of the Labor Code of the Russian Federation. It is recommended to make the transition in accordance with the following algorithm:

1. The manager issues an order to implement new contracts.
2. A working group is created, including representatives of the trade union, workers, and managers.
3. Performance criteria are being developed.
4. Standard employment contracts for new employees and additional agreements for existing employees.
5. Employees are notified of upcoming changes.
6. Changes are being made to the Regulations on Remuneration (on the introduction of incentive payments depending on work results), employees familiarize themselves with the document and sign it.
7. Changes are made to job descriptions, and employees familiarize themselves with them and sign them.