Effective contract in healthcare 2020

Why is an effective contract needed in healthcare? What does it have in common with an employment contract and what is the difference? By what criteria is effectiveness assessed? Is it possible to refuse to enter into a new form of contract? Answers to questions are in the article on the website. In the magazine “I Am a Personnel Officer” we have already repeatedly examined issues related to the introduction of an effective contract: we talked about the successful experience of transitioning to a new remuneration system; on how to prepare documents and make changes to the HR automation program and where to get a sample of an effective contract.

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.

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.

Next, we will talk about the main nuances of drawing up an effective contract in healthcare using examples of practical situations.

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

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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.

With whom and why is this agreement concluded?

Labor relations in the form of an effective contract must be formalized with employees of all organizations financed from the budget : municipal, regional or state.

Such organizations include educational, medical organizations, cultural institutions (libraries, museums, etc.). The regulations emphasize that an effective contract must be concluded with:

teaching staff (teacher, educator);
doctors;
librarians;
curators of museum funds and others;
with junior service personnel (office cleaners, watchmen, cloakroom attendants, janitors, school and kindergarten guards).

Concluding an effective contract has certain goals, the main ones being the following:

evaluate the performance of employees using a number of indicators and, on this basis, make a decision on rewarding each employee, designed to increase his interest in the quality and results of his work;
refuse those payments that turned out to be ineffective and did not give the expected result.

Each indicator must be accompanied by specific criteria that help individualize the approach to how the work of an individual employee will be assessed (qualitative and quantitative).

Based on an effective contract, there is a transition to remuneration, which creates opportunities to increase the incentive for qualitative improvement of work.

Find out more about an effective contract:

https://youtu.be/M8bYrEIYplQ

Disadvantages and advantages

While there is much to be gained from the idea of an effective contract, the likelihood of risks must be taken into account when implementing one. Especially at the initial stage of work under the new remuneration system, when many questions arise regarding how much money and for what exactly health care facility employees will receive.

“It was supposed to organize the payroll system in such a way that both the complexity of the work and its quality were taken into account,” says Alina GALIULINA, project manager at SKB Kontur. “But this requires resolving the issue of the wage structure. So far, all proposed systems for assessing the work of doctors have a number of shortcomings. The original idea was to introduce performance criteria for each position, such as a point system. Each indicator for each specialty is assessed in points. Then the employee’s points are summed up, multiplied by a certain constant, and the resulting amount is paid to the person. Everything seems to be logical, but this option is bad because every month you have to calculate the points (and there can be several hundred workers in health care facilities), submit this data to economists, and they have to calculate the amount of bonuses in a short time. This is simply unrealistic; to calculate points, you need a department or at least one employee who will only do this.”

Therefore, many health care institutions, in order to avoid the huge amount of work with counting points, introduced a system of coefficients and were faced with a deficit in the wage fund. This happened partly because the payroll was not designed for 100% implementation of the plan by all employees, and partly due to the general underfunding of the healthcare sector.

According to the Accounts Chamber of the Russian Federation, the deficit of funds in the healthcare sector in 2014 amounted to 55.3 billion rubles due to compulsory medical insurance.

According to Irina TITOVA, head of the personnel department of the Krasnoufimskaya RB, there were many problems with payment in their medical institution. Despite the fact that, according to the roadmap, the basic and incentive parts of the payment should be 60 and 40%, respectively, in practice this is far from the case and the base part is much smaller. So it is not yet entirely clear how to achieve the level of wages provided for by the order approved by the President of the Russian Federation.

However, at the same time, Irina TITOVA notes the advantages of paying part of the salary in accordance with the labor assessment criteria: this stimulates workers to complete the assigned tasks one hundred percent.

“With the introduction of a new remuneration system, the efficiency of the staff has increased and their efficiency has increased,” says Elena SERMYAGINA, head of the personnel department of the Sverdlovsk Regional Clinical Hospital No. 1. — Of course, a large amount of work has been added for personnel officers and economists. And we need to continue to analyze the effectiveness of an effective contract, but so far we have not particularly noticed any disadvantages. And today a lot of systematic work is still expected, which justifies the essence of introducing effective contracts. Many more organizational measures need to be carried out, but in the end an effective contract will truly be effective in the full sense of the word. And then a person will know what and for what he works, the quality of his work and his attitude towards work will become better and better. I don’t see anything negative in introducing an effective contract. It’s just that people perceive everything new with caution, and there are always those who do not accept the new and like to live in the old way.”

In some health care facilities in the Sverdlovsk region, the transition to an effective contract occurred quite recently, but due to underfunding, it is unlikely that any positive changes can be expected.

“Yes, they renamed the employment contract, expanded it, and added responsibilities,” says the head of the human resources department of one of the regional hospitals. “But if there is no money, then this is just another government profanation.” Perhaps, with the introduction of an effective contract, the situation at some health facilities has improved due to the reduction of key positions, but not all. But new responsibilities fall on HR officers like a snowball; reporting has increased fourfold.”

Effective contract in healthcare: pros and cons of the new system

In this issue we will tell you what risks healthcare facilities face in practice after switching to an effective contract.

Goals and objectives of an effective contract

The Program for the gradual improvement of remuneration systems in state (municipal) institutions, which was approved by the Government of the Russian Federation on November 26, 2012, set clear goals:

maintain human resources potential;
increase the prestige of working in budgetary medical institutions;
Bring the remuneration of medical workers in line with the level of quality of the work they perform.

To achieve these goals by 2020 in the healthcare sector, it is necessary to solve a number of tasks:

Disadvantages and advantages

So far, all proposed systems for assessing the work of doctors have a number of shortcomings. The original idea was to introduce performance criteria for each position, such as a point system. Each indicator for each specialty is assessed in points.

Then the employee’s points are summed up, multiplied by a certain constant, and the resulting amount is paid to the person.

Everything seems to be logical, but this option is bad because every month you need to calculate points (and there can be several hundred workers in health care facilities), submit this data to economists, and they must quickly calculate the amount of bonuses. This is simply unrealistic; to calculate points, you need a department or at least one employee who will only do this.”

According to the Accounts Chamber of the Russian Federation, the deficit of funds in the healthcare sector in 2014 amounted to 55.3 billion rubles due to compulsory medical insurance.

https://youtu.be/vhFWzqE4siU

According to Irina TITOVA, head of the personnel department of the Krasnoufimskaya RB, there were many problems with payment in their medical institution.

Despite the fact that, according to the roadmap, the basic and incentive parts of the payment should be 60 and 40%, respectively, in practice this is far from the case and the base part is much smaller.

So it is not yet entirely clear how to achieve the level of wages provided for by the order approved by the President of the Russian Federation.

And we need to continue to analyze the effectiveness of an effective contract, but so far we have not particularly noticed any disadvantages. And today a lot of systematic work is still expected, which justifies the essence of introducing effective contracts.

Many more organizational measures need to be carried out, but in the end an effective contract will truly be effective in the full sense of the word. And then a person will know what and for what he works, the quality of his work and his attitude towards work will become better and better.

I don’t see anything negative in introducing an effective contract. It’s just that people perceive everything new with caution, and there are always those who do not accept the new and like to live in the old way.”

In some health care facilities in the Sverdlovsk region, the transition to an effective contract occurred quite recently, but due to underfunding, it is unlikely that any positive changes can be expected.

Perhaps, with the introduction of an effective contract, the situation at some health facilities has improved due to the reduction of key positions, but not all.

But new responsibilities fall on HR officers like a snowball; reporting has increased fourfold.”

Possible Solution

Regional departments do not give a clear answer on what to do if there are not enough funds to pay the incentive part of the salary. Therefore, personnel officers and economists from various medical institutions are trying to find a way out of this situation on their own.

The Karpinskaya Central City Hospital also faced a payroll deficit, and, as the head of the HR department Tatyana VASILISHINA says, she had to talk to employees, explain the situation, why the amounts received were less than expected, and also introduce new agreements to the payment agreement every month. All this, of course, adds paperwork to personnel officers.

In turn, in the Malyshevskaya GB GBUZ SO the introduction of a directly effective contract did not cause economic troubles, but the subsequent cut in hospital funding for 2020 also baffled hospital economists.

“Alternatively, you need to initially make a small coefficient for incentive payments in order to meet the planned payroll. But how can you predict in advance how much an employee will fulfill the plan? - says Alina GALIULINA.

“That’s why now most health care facilities conclude effective contracts either with vague wording or without specifying indicators at all. But then any audit will reveal that there is no point in concluding an effective contract.

The best way is to calculate the correct coefficient by analyzing work under an effective contract for six months. It takes a lot of effort and time.”

Source: https://kontur.ru/articles/2311

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.

Download additional agreement with employee, sample/form >>

Objectives and criteria for an effective contract in healthcare

The program for the gradual improvement of remuneration systems in state (municipal) institutions, which was approved by the Government of the Russian Federation, set clear goals:

maintain human resources potential;
increase the prestige of working in budgetary medical institutions;
Bring the remuneration of medical workers in line with the level of quality of the work they perform.

One of the mechanisms for achieving these goals is the introduction of an effective contract, including in healthcare. The term itself is not fixed in labor legislation and implies an employment contract containing criteria for assessing labor efficiency, which are needed to determine the size and conditions for incentive payments. We give an example of an effective contract in healthcare for a nurse.

Goals and objectives of an effective contract

maintain human resources potential;
increase the prestige of working in budgetary medical institutions;
Bring the remuneration of medical workers in line with the level of quality of the work they perform.

To achieve these goals by 2020 in the healthcare sector, it is necessary to solve a number of tasks:

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.

Assessment of the quality of work of inpatient doctors in the clinic

At the Meditsina OJSC clinic, a doctor’s salary consists of two parts: a fixed salary, which is guaranteed to be paid to the doctor, and a bonus part. The premium part depends on 3 main indicators:

1. Compliance with labor discipline (from 5 to 50% of the bonus part of the salary).

2. Patient satisfaction (presence of justified patient complaints and rating data) (from 5 to 20% of the bonus part of the salary).

3. Assessing the quality of medical care provided and patient safety in accordance with JCI international quality standards, compliance with protocols for the management of patients with various nosologies. The size of the bonus depends on the quality assessment, which is determined in points (the maximum doctor can receive is 20 points).

An example of calculating the bonus part of a doctor’s salary using the criteria of an effective contract.

1. Evaluation of an inpatient case. When checking the inpatient card, the head of the department identified the following defects:

the patient is recommended dietary supplements that are not in the hospital formula – 1 point;
the medical history does not include an assessment of pain in the postoperative period – 1 point;
the time-out procedure was not carried out before the operation – 1 point.

Thus, the score for this case of inpatient treatment is 17 points.
If the doctor treated 3 patients, and there were no comments on the remaining cases, then the final quality score will be: (17 + 20 + 20)/3 = 19 points.

2. The patient filed a complaint against the doctor, which was found to be justified during a commission review. This reduces the doctor's score by another 4 points. The overall quality rating becomes

19 – 4=15 points.

3. During the month, the doctor was late for work once, and this reduces his quality rating by another 1 point. The overall quality rating becomes

15 – 1=14 points. 4.

According to the rating, the doctor has average ratings, so there is no reason for additional payments.

Thus, the final quality score will be 14 points out of 20 possible, or 70% (see figure). The size of the bonus, which is half of the doctor’s total income, will be reduced by 30% when paying wages.

Drawing. Formation of doctor quality assessment

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). 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 2020.

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.

Criteria for evaluating work in healthcare

An effective contract, at its core, is a type of employment contract. It, like a regular agreement between the employer and the staff, stipulates the rights and obligations of the parties, wages and other mandatory conditions.

The main difference between an effective contract and a standard employment contract is the structure of incentive payments and other incentive measures for the employee.

In this type of contract, the employee incentive system contains several types of additional payments:

payments for achieving certain indicators (employee performance);
compensation for working conditions or social status of the employee;
internal incentive measures determined by collective or trade union agreement.

The criteria for assessing personnel effectiveness in the new system of labor relations should be clear to employees and not cause differences in their interpretation.

Therefore, it is necessary to detail in employment contracts the responsibilities of employees and their contribution to the achievement of each performance indicator.

The program for a gradual transition from a standard system of labor relations to an effective contract was approved by Decree of the Government of the Russian Federation No. 2190-r. The transfer of public sector workers to an effective contract was supposed to be completed in 2018. In addition to the program itself, this order also contains an example of an effective contract that can be used, including in healthcare.

Transition to an effective contract in healthcare

The implementation of an effective contract in healthcare is associated with a number of industry specific features, which we will discuss below.

First of all, we note that the Government approved the standard form of such an employment contract in Order No. 2190-r of the year (Appendix No. 3).

A new form of employment contract is concluded with all newly hired employees of medical institutions.

There is no need to terminate it for existing employees who already have an employment contract. HR employees must supplement the current version of the employee’s employment contract with new requirements by drawing up an additional agreement to it.

It is necessary to conclude an effective contract with all employees, even those who work part-time.

Let's consider some features of concluding an additional agreement:

If the terms of the contract change due to the implementation of a new system, it is necessary to notify the employee 2 months in advance that the terms of the employment contract are changing. It is necessary to indicate the reason for such changes, for example, indicate that the changes are related to the implementation of the remuneration system, which is approved by the Government of the Russian Federation.
Those clauses of the additional agreement that change the specific terms of the employment contract must begin something like this: “State clause _____ of this employment contract in the following wording.”

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 by 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.

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:

The name of his position (for specialists, employees and managers).
Working specialty or profession (for working personnel).
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 comply with the professional standard and qualification directory.

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

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);
positions of managers and specialists (Resolution of the Ministry of Labor of the Russian Federation No. 37 of the year);
tariff and qualification reference books for working positions;
all-Russian classifiers approved by Rosstandart (for example, Rosstandart order No. 2020-st dated, Gosstandart resolution No. 367 dated);

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 positions of medical workers, in accordance with the Decree of the State Standard of the Russian Federation No. 367 of the year, you can use in addition the words “senior”, “district”, “leading”, “precinct”, “chief”.

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 has worked as a laboratory doctor for up to a year 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 from the year, 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 has been hired for this position for up to a year 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.

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 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 the year.

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.

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 No. 16-3/10/2-6752, which provides guidance on improving the remuneration system for medical workers, these include:

Payments for intensity and high performance results.
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.
Payments for length of service, length of service.
Performance bonuses:
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.

Specifying incentive payments in an effective contract

An effective contract in healthcare involves, among other things, financial incentives for healthcare workers. Therefore, incentive payments should also be reflected in the text of the agreement with the employee.

In this case, the employer must establish not only the names and conditions for receiving payments, but also their frequency, size and criteria for assessing the effectiveness of activities.

It is not recommended to establish incentive payments at the level of a medical institution that are not directly related to the performance indicators of the health worker and the institution. For example, additional payment for continuous work experience in healthcare, for the intensity of the work process, etc.

Let us note other features of reflecting incentive payments in the text of an effective contract:

the contract may provide conditions for receiving one-time incentive payments in accordance with the current wage system;
The condition for receiving the payment is understood as a requirement that the health worker must fulfill in order to receive it. For example, such a requirement may be the absence of disciplinary sanctions;
evaluation criteria are certain performance indicators that are applicable to evaluate the performance of a particular employee;
it is recommended to establish such performance indicators that are approved at the legislative level in the Russian Federation or regions;
it is recommended to use a point system for assessing incentive payments, which is provided for by Order of the Ministry of Health of the Russian Federation No. 421 of the year;
it is permissible to establish certain periods for the accrual of certain payments to a health worker, for example, one payment can be accrued monthly, another - based on quarterly or annual performance results.

What to include in an effective healthcare contract

The parameters of the incentive part of wages in healthcare should ensure:

differentiation of wages for those who perform work of varying complexity;
remuneration scheme depending on performance;
activities according to specified indicators.

In an effective healthcare contract, performance evaluation criteria might include:

fulfillment of production and load standards;
patient satisfaction with treatment results;
no complaints;
absence of complaints during the quality examination (internal and external);
maintaining discipline;
completeness of fulfillment of official duties, etc.

The provisions on payment for healthcare institutions, as a rule, also provide for other incentive and compensation payments:

bonus for labor intensity;
premium for high results;
bonus for performing particularly important and responsible work;
for quality;
bonus for having a qualification category;
long service bonus;
bonus for continuous service;
additional payment for performing work of various qualifications;
surcharge for night work.

IMPORTANT!
In addition to the agreement itself, which will be concluded with new employees, the budgetary institution must also develop an additional agreement to the employment contract, which will be concluded with existing employees upon transition to an effective contract.

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.

Effective contracting in healthcare

This program defines that an effective employment contract means a formal agreement with a medical professional that specifies the following conditions:

employee's job responsibilities;
system of employee remuneration conditions;
criteria and indicators for assessing the effectiveness of labor activity when assigning incentives and other payments;
specific results of work and quality of services provided;
measures of social incentives for employees.

The establishment of additional criteria and indicators for assessing the effectiveness of employees in performing their ore functions is dictated by the same Government Order No. 2190-r.

In addition, the introduction of a new form into an effective contract in healthcare does not in any way contradict the requirements of the labor code; Article 57 of the Labor Code states that the employment contract may additionally indicate conditions that do not worsen the position of the employee, in particular, working conditions, his rights and obligations and comply with the requirements of current legislation.

Thus, the introduction of an effective contract represents a specification of a standard employment contract, which describes exactly what duties the employee must perform and how the amount of his remuneration will be determined.

Such an agreement must describe in detail the conditions for calculating compensation and incentive payments, as well as the amount of the health worker’s salary and his job function.

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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 Resolution No. 2190-r of the year, 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?

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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, download / view >>

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 No. 2 of the Plenum of the Supreme Court of the Russian Federation stated that when an employer notifies an employee of a change in an 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.

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 that 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, 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.

An effective contract in healthcare can be found below.

Normative base

Decree of the President of the Russian Federation No. 597;
Decree of the President of the Russian Federation No. 598 “On improving state policy in the field of healthcare”;
Order of the Government of the Russian Federation 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 (criteria and indicators of effective work of employees of medical institutions);
Order of the Government of the Russian Federation No. 2599-r (Plan of measures aimed at improving the efficiency of healthcare);
State program of the Russian Federation “Healthcare Development”, approved by Decree of the Government of the Russian Federation No. 294. .

Criteria as mandatory terms of the contract

Since 2012, Russia has had a program for the gradual improvement of the remuneration system in state and municipal institutions, approved by Decree of the Government of Russia dated November 26, 2012 No. 2190-. Among other things, it obliges the content of an effective contract to include criteria for assessing the performance of a given employee in accordance with accepted indicators.

The practice so far is that often the indicators and criteria for the effectiveness of an effective employee contract are:

insufficiently developed;
their use is formal.

Incentive payments have low effectiveness if the system of remuneration of employees of an institution leaves without specifying specific measurable parameters such criteria as:

conscientious performance of duties;
labor intensity;
quality of work, etc.

This practice should become a thing of the past. The performance evaluation criteria in an effective contract must be specific and quantifiable.

In addition, the management of a budgetary organization is obliged not to rest on its laurels and constantly improve the system of criteria.

The mentioned Program for the gradual improvement of the remuneration system in state and municipal institutions requires clarification of the criteria for assessing the performance of each employee. It is when:

the conditions for receiving remuneration are clear to both management and the employee;
the criteria do not allow for double interpretation.

EXAMPLE

One of the criteria for assessing the performance of a manager when assigning incentive payments to him is the ratio of the average salary of the staff of the institution he heads for the official duties assigned to them from all sources and the average salary for a given region, taking into account the achievement of average indicators for certain categories of employees for each subject of the Russian Federation.

Description of the labor function in an effective contract

The description of a specific job function depends on the position with which the contract or additional agreement is concluded with the employee.

As a rule, the following information is indicated:

the position of a medical worker in accordance with the staffing schedule of the medical institution and the nomenclature of medical positions;
specialty or profession of the worker, as well as his qualification level (group);
a list of specific duties that the employee must perform.

In addition, the position of the health worker must indicate the following information:

the name of a specific section of medical activity - for the deputy chief physician who heads this section;
the full name of the medical position of the relevant department - for the head of the department of the medical institution;
the name of the medical specialty in which the employee has professional training and the work for which he performs;
for the doctor of the emergency department - the full name of the medical specialty.

Here are some examples of correct job titles:

medical psychologist;
midwife (obstetrician);
emergency department doctor - general practitioner;
deputy chief physician for outpatient work.

In accordance with Decree of the State Standard of the Russian Federation No. 367 of the year, it is permissible to use the words “leading”, “district”, “senior”, “district” (senior midwife, district pediatrician, local general practitioner, etc.) in the job title.

An effective contract in healthcare involves specifying the employee’s labor function:

you should not indicate the number of positions held by the employee (for example, if he works at 0.5 times the rate), his length of working hours per week should be indicated);
it is necessary to supplement the description of the employee’s labor function with his specific job responsibilities, and also indicate that the current labor standardization system determines the labor standards of employees.

When formulating the job responsibilities of employees, one should use professional standards and qualification characteristics, which are approved by order of the Ministry of Health and Social Development No. -n of the year.

The additional agreement should not indicate the conditions for the employee to perform a specific amount of work, for example, that he must accept a certain number of patients, or that he provides medical services to certain categories of patients.

To indicate the names of structural departments of a medical institution, it is necessary to check the List of structural divisions of medical institutions, which are approved by Decree of the Government of the Russian Federation No. 781 of the year.