Problems factors system of motivation of nurses. Course work: Features of motivation of labor activity of health workers. Systematization of payments included in the wages of employees, strengthening their incentive effect

"Determination of the demographic situation and features of demographic policy in different countries and regions"

Objectives of the work:

Educational: to systematize knowledge about demographic policy in countries with different types of reproduction;

Developing: to develop the ability to systematize the knowledge gained from various sources of geographic information, to organize, evaluate and correct their own activities;

Educational: bring up responsibility, hard work, accuracy.

The list of tools used in the performance of work: political map of the world, age-sex pyramids, atlas, textbook "Economic and social geography of the world."

Basic theoretical information:

Reproduction of the population is the cumulative process of fertility, mortality, natural population growth, which ensures the continuous renewal of the change of human generations. In the modern world, 2 types of population reproduction can be distinguished. Type 1 differs in low birth rate, mortality and natural population growth, Type 2 characterized by high birth rates, high natural population growth and relatively low mortality rates.

Currently, there is a gradual transition from 2 to 1 type of population reproduction.

In the modern world, most countries seek to manage population reproduction by pursuing a certain demographic policy.

Demographic policy is a system of various measures taken by the state with the aim of influencing the natural movement of the population in the direction it desires.

Stages of work:

Exercise 1... Using the textbook Maksakovsky V.P. (pp. 57 - 66 and the statistics of Table 1 (see below), fill it in, specifying the type of reproduction and demographic stage for each region;

Table 1 - Main indicators of population reproduction by regions of the world.

Regions of the world	Fertility rate (‰)	Death rate (‰)	Natural growth rate (‰)	Reproduction type	Demographic stage
The whole world
CIS			-1
Overseas Europe
Overseas asia
Southwest Asia
East Asia
Africa
North America
Latin America
Australia
Oceania

Assignment 2... Describe the demographic situation in India and Germany according to the following plan:

Record the population, average density, and the most densely populated areas in the country.

Draw the most densely populated areas on a contour map.

Determine the features of natural and mechanical population growth in the country.

Determine the characteristics of the age and gender composition of the population in the country.

Determine and write down the peculiarities of employment, the proportion of urban and rural population.

Determine the security of the country with labor resources.

Formulate a conclusion about the demographic policy pursued by the states of India and Germany.

The total population growth is the difference between the population at the end of the billing period and at the beginning of the billing period.

H pr. = H 1 - H 0

Population growth can be positive if H 1 H 0 and negative if H 1 0.

The total population growth is subdivided into two components:

1. Natural population growth;

2. Mechanical population growth

Natural population growth is the difference between the number of births and the number of people who died during the same period or at a specific point in time, i.e. it is the difference between fertility and mortality rates.

He eats. = H genus. - H mind.

Mechanical population growth is the difference between the number of people who arrived in the city and the number of people who left the city at a particular point in time.

Mechanical population growth reflects the process of population migration and can also be both positive and negative.

N fur. = H approx. - N ub.

Issues related to the definition of natural and mechanical population growth, the characteristics of migration processes in the territory of a city, a constituent entity of the Russian Federation or the country as a whole are of great socio-economic importance for the integrated development of branches of the national economy and the creation of favorable and comfortable living conditions for the population.

Table 17.

City population growth distribution

natural and mechanical.

Below are examples of solving typical problems to determine population growth and its structure.

In the structure of employment of the city's population, the non-self-employed population is 130 thousand people, and the self-employed population of the city makes up 60% of the total urban population. To calculate for a five-year perspective, natural population growth of 4 people per 1000 inhabitants and mechanical growth were adopted: the first two years - 2 thousand people each, the next three years - 3 thousand people each. Determine the population of the city for a five-year perspective, divide the population growth into natural and mechanical by the years of the forecast period.

1) Determine the total population at the end of the five-year period.

N non-samod. = 130 thousand people

N samod. = 60%

On the basis of these conditions, it is possible to draw up a consolidated structure of employment of the population.

3) Calculation of natural population growth.

He eats. = thousand people

The calculation is carried out for each next year.

He eats. = 6.6 thousand people N fur. = 13 thousand people

4) Determine the overall population growth of the city.

N pr. = 344.6 - 325 = 19.6 thousand people.

The absolute number of the population employed in the urban services sector of the city is 180 thousand people or 20% of the total population of the city. For the calculation for a five-year perspective, the following population growth is adopted:

Natural increase - 10 people per 1000 inhabitants;

Mechanical growth - 5 thousand people annually.

Determine the size of the population for a five-year perspective with the division of population growth into natural and mechanical by the years of the five-year plan.

1) Determine the population at the end of the forecast period.

H 1 = thousand people

2) Divide the population growth into natural and mechanical by the years of the forecast period.

3) Determine the natural population growth.

He eats. = thousand people

The calculation is carried out for each year of the forecast period.

The population of the city at the beginning of the forecast period is 300 thousand people. The average annual population growth rate is 2% and remains stable for the next ten years. To calculate for the future, natural population growth was adopted at the rate of 5 people per 1000 inhabitants. The mechanical population growth is distributed over the years of the forecast period as follows: in the first six years - 4 thousand people, the next four years - 5 thousand people.

1) Calculation of the population of the city at the end of the forecast period.

H 1 = 300 thousand people

2) Distribution of population growth into natural and mechanical over the years of the forecast period.

Tasks for self-study of the issues of this topic.

Task 3.1.

The population of the city in the base period is 360 thousand people. According to the plans for the development of the city-forming sphere, the number of workers in it at the end of the prospective period is 125 thousand people, or 30% of the total population of the city. According to statistical data, the natural population growth per 1000 inhabitants is 4 people. Mechanical population growth is taken in the second and third years for 2 thousand people, the fourth and fifth - for 3 thousand people, from the sixth to the ninth year inclusively for 5 thousand people, the tenth - six thousand people.

Determine the predicted population of the city and divide the population growth into natural and mechanical by the years of the forecast period.

Task 3.2.

The employable population of the city is 260 thousand people, the non-active population is 40% of the total urban population. To calculate for the long term (10 years), the natural population growth is taken at the level of the previously formed 5 people per 1000 inhabitants. Mechanical population growth is accepted: from the first to the fifth year inclusive - 3 thousand people, from the sixth to the tenth year - 5 thousand people.

Determine the size of the city's population at the end of the forecast period, dividing by years of population growth into natural and mechanical.

Task 3.3.

The absolute number of people employed in the urban services sector of the city is 180 thousand people, or 20% of the total population of the city. For the calculation for a five-year perspective, the following population growth is adopted:

Natural increase - 5 people per 1000 inhabitants;

Mechanical growth in the first three years - 1.5 thousand people, the next two years - 3 thousand people.

Determine the population growth of the city at the end of the fifth year, dividing it into natural and mechanical by the years of the forecast period.

Task 3.4.

In the city-forming sphere of the city, 150 thousand people are employed, and in the city-serving sphere - 80 thousand people. The non-self-employed part of the population makes up 45% of the total population of the city. To calculate for a five-year perspective, the following population growth was adopted: natural - 5 people per 1000 inhabitants and mechanical - 2 thousand people annually. Determine the planned population of the city at the end of the five-year plan, dividing it into natural and mechanical growth.

Task 3.5.

The absolute number of city-forming personnel is 150 thousand people. In the total number of the urban population, the share of urban service personnel and the non-self-employed part of the population is 65%. To calculate for a five-year perspective, the following population growth was adopted: natural - 3 people per 1000 inhabitants and mechanical growth - 6 thousand people annually.

Determine the population growth at the end of the five-year plan and distribute it to natural and mechanical weather of the forecast period.

Task 3.6.

The absolute number of people employed in the urban services sector of the city is 210 thousand people, or 25% of the total population of the city. To calculate for a five-year perspective, the following population growth was adopted: natural - 8 people per 1000 inhabitants, mechanical - 3.6 thousand people annually.

Determine the population size for a five-year perspective and divide the population growth into natural and mechanical by the years of the forecast period.

Task 3.7.

The non-self-employed population of the city includes 230 thousand people, and the self-employed population of the city makes up 60% of the total population. To calculate for a ten-year perspective, natural population growth was adopted - 5 people per 1000 inhabitants and mechanical population growth (for the first five years - 4 thousand people and for the next 5 years - 8 thousand people).

Determine the population size of the city for a ten-year perspective with the division of population growth by year into natural and mechanical.

Task 3.8.

The amateur population of the city is 380 thousand people. The non-self-employed population makes up 40% of the total population of the city. To calculate for the future, natural population growth of 6 people per 1000 inhabitants and mechanical growth were adopted (the first five years - 4.5 thousand people each and the next five years - 7 thousand people each).

Determine the population growth of the city at the end of the tenth year, broken down into natural and mechanical.

Task 3.9.

270 thousand people are employed in the city-forming sphere of the city, and 120 thousand people are employed in the city-serving sphere. the non-self-employed part of the city's population makes up 40% of the total population of the city.

To calculate for a ten-year perspective, the following population growth was adopted: natural - 4 people per 1000 inhabitants and mechanical - in the first five years, 2 thousand people, in the second five years - 4 thousand people.

Determine the population growth of the city at the end of the tenth year, dividing it into natural and mechanical.

Task 3.10.

The population of the city in the base period is 420 thousand people. According to the development of the branches of the city-forming sphere, the number of workers in them at the end of the forecast period will be 150 thousand, or 30% of the total population of the city. According to statistical data, the natural population growth per 1000 inhabitants is 4 people. The mechanical population growth over the years is distributed as follows: the second and third years - 1.5 thousand each, the fourth and fifth - 3 thousand people each, from the sixth to the ninth inclusive - 4.7 thousand people and the tenth year - 2.3 thousand people.

Determine the growth of the city's population by years of the forecast period.

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Ministry of Health and Social Development of the Russian Federation

State budgetary educational institution of higher professional education

"Chita State Medical Academy

Ministry of Health and Social Development "

Department of Public Health and Health Care

Internship in Nursing Management

Topic: "Motivation in the work of nursing staff"

Completed by: N.V. Podorozhnaya

Chita, 2013

Introduction

Chapter 2. Practical study of job satisfaction and increasing production motivation of nurses on the example of 321 OVKG

Conclusion

Bibliography

Introduction

The stability of the workforce is one of the conditions for the effective work of any company, and the struggle for low staff turnover is a problem that is especially relevant for such areas as healthcare and pedagogy. To solve it, you need to be able to predict the situation, learn to manage the process of staff turnover. And one of the first steps here can be research showing how satisfied employees are with their jobs. Satisfaction is often understood to mean retention of an employee in the enterprise.

Problems of increasing labor motivation of medical workers are the most important function of healthcare management. Without their solution, a real improvement in the quality and culture of providing medical care to the population is hardly possible, as well as an increase in the efficiency of the activities of medical and preventive institutions (LPI) and the industry as a whole on the basis of the rational use of financial, material and human resources. It has now been proven that money does not always induce a person to work harder (although no one belittles the role of material incentives!). The problems of increasing labor motivation are of a systemic nature and require an integrated approach to their solution.

The relevance of the study lies in the fact that by studying satisfaction, one can obtain information about the strength of the staff's attachment to the enterprise. Here it is appropriate to talk about both material and moral incentives for workers. Employee satisfaction data is information about personnel risks. It is important for any leader who does not want to be hostage to the current situation. The problems of staff motivation and incentives are widely considered today in scientific and journalistic literature. However, attempts to adapt classical theories of motivation to the present are largely not systematized, which complicates the practical use of technologies and methods of motivation. The complexity of the practical organization of the personnel motivation system is also determined by the poor knowledge of the features of the motivation of workers employed in certain sectors of the economy and types of production. It is quite obvious that in different spheres of activity there is a professional specificity of motivation. The urgency of the problem is also due to the rigidity of the management system itself in health care, which has retained in many ways the features of management characteristic of the socialist planned system and did not fit into modern market conditions. In most health care institutions, the possibilities of material stimulation of labor are limited by a shortage of funds, therefore, special attention should be paid to the means of non-material motivation of nurses. Taking into account the limited material resources of health care, an effective and adequate value orientation of the personnel of a particular medical institution, an intangible form of motivation, is of particular relevance. As the material and technical base of health care is strengthened, the issues of personnel management in its not material, but socio-psychological aspect will increasingly arise before the heads of medical and preventive institutions. Increasing the labor motivation of nurses is an urgent problem, the importance of which is especially high in connection with the reform of health care and the implementation of the National Health Project. Leaders must clearly understand the importance of motivation as a management function and use every opportunity to reduce demotivating factors for nurses.

The purpose of the study is to consider the essence of motivation in the work of nursing staff, while analyzing the factors of motivation for their work.

1. Consider and systematize the theoretical foundations of the study of motivational orientation in work.

2. Summarize information about the motivational orientation of medical workers.

3. Conduct a practical study of job satisfaction and increasing the production motivation of nurses using the example of 321 OVKG.

The object of the study is the nurses of the medical institution.

The subject of the research is the peculiarities of the motivational orientation of nurses.

When conducting this study, research methods were used:

Analytical (analysis of the received data);

Sociological (questionnaire survey);

Statistical (data from reporting documents).

The course work consists of an introduction, two chapters - theoretical and practical, a conclusion and a list of references.

Chapter 1. Theoretical aspects of labor motivation in medicine

1.1 Problems of labor motivation in medicine

Increasing the labor motivation of personnel is one of the priority tasks of management in any area of ​​activity. The solution of this problem in the healthcare sector is of particular importance in connection with the tasks set in the "Concept for the development of the healthcare system in the Russian Federation until 2020" ...

Nursing is an integral part of the health care system aimed at solving the problems of individual and public health of the population in a changing environment. Nursing includes activities to promote health, prevent disease, provide psychosocial assistance and care to people with physical and / or mental illness, as well as disabled people of all age groups. According to the Central Research Institute of Organization and Informatization of Health Care, in 2012 the number of nurses in the Russian Federation was 1,327.8 thousand people. Nursing is part of the health care system, which has significant human resources and real potential to meet the needs of the population for quality and affordable health care.

Despite the tasks set for health care, at present, in the development of nursing, some trends continue to exist that negatively affect the state of work motivation of nurses.

One of the main reasons influencing the labor motivation of personnel is the level of material remuneration for work and a sense of the fairness of this remuneration. For workers with extrinsic motivation, this factor can be of decisive importance not only as a supporting and regulating factor of the motivational state, but often play a decisive role in deciding whether to continue working in a particular organization and in medicine in principle. For internally motivated workers, other factors are undoubtedly more important, but low wages also make them feel significant dissatisfaction.

An overwhelming number of both patients and doctors underestimate the contribution of the nurse to the treatment and diagnostic process; doctors do not know how and are not focused on building equal partnerships with nurses, do not recognize higher nursing education, and even more so, the increased level of secondary vocational education of nurses. Historically, the idea of ​​a nurse as a doctor's assistant, his "right hand", an appendage has developed. “[The nurse] must begin her work with a thought firmly embedded in her head, the thought that she is just a tool with which the doctor carries out his instructions; it does not take an independent position in the treatment of a sick person ”(McGregor-Robertson, 1904).

Despite a whole century that separates us from this statement, at present such a mentality has changed little in what. Many doctors directly or indirectly express their superiority, admit incorrectness in relation to nursing staff, all this is a factor that significantly reduces the desire to work.

A high degree of physical and psychological stress on nurses, underdevelopment of copping strategies, as well as a number of organizational factors contribute to the rapid development of professional burnout syndrome, which, according to various authors, affects 40 to 95% of nurses. Burnout of health workers significantly deforms the system of personal value orientations, emphasizing material values ​​to the detriment of spiritual values, and shifts labor motivation from internal to external.

Low wages provoke informal sources of income, with the help of which workers try to satisfy not only the need for fair material remuneration for work, but also the need for recognition and respect. It is she who is one of the leading in the structure of labor motivation of internally motivated workers, which are often doctors. The deficit in recognition is compensated by replacing it with a cash equivalent and material symbols, with an obvious lack of the ability to do this with the help of wages, there is a shift in emphasis to unofficial sources. Although it should be noted that we are talking more about doctors; average health workers are much less able to use informal means of remuneration. Moreover, it is less opportunities, but no less desire. In this situation, nurses experience a growing sense of injustice, which entails dissociation of the doctor-nurse tandem, affecting the quality of treatment and reducing the work motivation of the latter. But the problem of deformation of the value-motivational system of medical workers is of particular importance in this situation. Behind the visible side of the named problem lies another one: unofficial payments are beginning to be recognized as a significant incentive for nurses to work better and students to choose a medical profession, i.e. is included in the system of labor motivation. The collection of unofficial payments, in addition to the legal aspect of the problem, fundamentally contradicts the principles of biomedical ethics, discredits the public health system, negatively affects the quality of medical care and the prestige of the medical profession.

Opportunities for self-improvement and training of nurses remain very limited: compulsory advanced training is carried out once every 5 years, opportunities for exchange of experience between the middle staff of various medical institutions are not used enough, methods of intra-organizational training are little used: horizontal rotation of personnel, "school of a young nurse" and other forms of education. Meanwhile, the fulfillment of the need for training and development, on the one hand, and the participation of nurses themselves in pedagogical activities, on the other hand, have a powerful motivational potential for a significant part of employees.

In the "Concept for the development of the health care system in the Russian Federation until 2020" one of the priority tasks is the development of "infrastructure and resource provision of health care, including financial, material, technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization", which is designed not only to improve the quality of medical care, but also to contribute to the development labor motivation of personnel.

The personnel management system needs to be improved. Currently, there is practically no hierarchy in the nursing organization system. Career opportunities are very limited: nurse, older sister, head nurse. Only in some health care facilities such positions as specialist in nursing personnel training, specialist in quality control of nursing activities appear. For example, such positions as foreman or shift supervisor, nurse mentor are not provided. The introduction of a number of such positions could serve the career aspirations of some nurses and a more differentiated approach to the issue of remuneration.

The prestige of the profession of a nurse, as noted earlier, plays one of the essential roles in the structure of work motivation of nurses. Most of the above reasons are directly or indirectly related to the position that this profession occupies in society. It is not so easy to raise the prestige of the profession, and this is a common task not only of the health care system, but also of the cultural state of the whole society, the hierarchy of social values. The labor motives and values ​​of the Western model, introduced into the mass consciousness of Russians from the outside, do not correspond to the model of attitude to work that has been formed over the centuries-old history of Russia on the basis of internal prerequisites and requirements of economic development. The decline in the general cultural level of the population, of which nurses are a part, leads to the primitivization of needs, the underdevelopment of the motivational sphere. There is no widespread propaganda of the public importance of the nursing profession at all levels. Insufficient attention in health care institutions is paid to the development and maintenance of the culture of the organization, in particular, the popularization of the mission of the institution, the formation of loyalty and commitment to the organization of personnel, and other specific aspects of the formation of organizational culture. Increasing the labor motivation of nurses is an urgent problem, the importance of which is especially high in connection with the reform of health care and the implementation of the National Health Project.

1.2 Concept and essence of personnel motivation

Motivation is a complex psychological phenomenon that causes a lot of controversy among psychologists who adhere to various psychological concepts.

Motivation can be defined in different ways. On the one hand, motivation is the process of encouraging oneself and others to act in order to achieve personal goals or the goals of an organization. On the other hand, motivation is the process of a person's conscious choice of a particular type of behavior, determined by the complex influence of external (stimuli) and internal (motives) factors. In the process of production activities, motivation allows employees to meet their basic needs through the performance of work duties.

In the most approximate sense, such a definition reflects the inner state of a person, however, it should be noted that the forces that induce action are outside and inside a person and make him consciously or unconsciously perform some actions. At the same time, the connection between individual forces and human actions is mediated by a very complex system of interactions, as a result of which different people can react in completely different ways to the same influences from the same forces.

Based on this, it can be assumed that the process of human motivation is subject to both internal and external determination. Hence the concept of motivation stands out. Motivation is an activity aimed at activating the workforce and everyone working in the organization and encouraging employees to work effectively to achieve the goals formulated in the plans.

The function of motivation lies in the fact that it affects the workforce of the organization in the form of incentives for effective work, social impact, collective and individual incentive measures. These forms of influence activate the work of the subjects of management, increase the efficiency of the entire management system of the organization.

The essence of motivation lies in the fact that, focusing on the system of workers' needs, to ensure the full and effective use of their labor potential for the earliest possible achievement of the goals of the organization.

Labor motivation is the desire of an employee to satisfy needs (to receive certain benefits) through labor activity.

The structure of the labor motive includes:

The need that the employee wants to satisfy;

A blessing that can satisfy this need;

Labor action required to obtain the good;

Price - costs of a material and moral nature associated with the implementation of a labor action.

Fig. 1. The relationship between the need for work and job satisfaction, attitude to work

motivation nursing staff

Labor motivation is the most important factor in the effectiveness of work, and in this capacity it forms the basis of an employee's labor potential, i.e. the entire set of properties affecting production activities. Labor potential consists of psychophysiological potential (abilities and inclinations of a person, his health, performance, endurance, type of nervous system) and personal (motivational) potential. Motivational potential plays the role of a trigger that determines what abilities and to what extent the employee will develop and use in the process of work. Motivation is also the process of creating such conditions that regulate labor relations, within which the employee has a need to work selflessly, since this is the only way for him to achieve his optimum in meeting his needs. Motivation is the process of combining the goals of the company and the goals of the employee for the fullest satisfaction of the needs of both, the process of encouraging oneself and others to act in order to achieve common goals. Motivation is the creation of conditions for the identification of the interests of the organization and the employee, in which what is beneficial and necessary to one, becomes just as necessary and beneficial to another [22].

There are various ways to motivate, of which the following can be distinguished:

1. Normative motivation - motivation of a person to a certain behavior by means of ideological and psychological influence: persuasion, suggestion, information, psychological infection, and the like;

2. Compulsory motivation based on the use of power and the threat of deterioration in meeting the needs of the employee in the event that he does not meet the relevant requirements;

3. Stimulation - the impact not directly on the personality, but on external circumstances with the help of benefits - incentives that induce the employee to certain behavior.

The first two methods of motivation are direct, since they involve a direct impact on a person, stimulation is an indirect method, since it is based on the influence of external factors-stimuli.

The motivation system can be presented in the form of a special table.

Table 1

Labor motivation system

The main tasks of motivation are the following:

1) Formation of each employee's understanding of the essence and meaning of motivation in the labor process;

2) Training of personnel and management personnel in the psychological foundations of intra-company communication;

3) Formation of democratic approaches to personnel management for each manager using modern methods of motivation.

To solve these problems, various methods of motivation are used.

Four main methods of motivation:

1. Coercion - based on the fear of dismissal, punishment.

2. Remuneration - carried out in the form of systems of material and non-material incentives for labor.

3. Solidarity - is realized through the formation of personnel values ​​and goals that are close to or coincide with the values ​​and goals of the organization, and is carried out through persuasion, education, training and the creation of a favorable working climate.

4. Adjustment - implies influencing the goals and objectives of the organization by partially adapting them to the goals of top and middle managers. This type of motivation requires the transfer of authority to lower levels, and this becomes an internal motive that unites the goals of management and personnel of the organization.

The essence of personnel motivation lies precisely in the fact that the personnel of the enterprise efficiently perform the work, guided by each of their rights and responsibilities, in accordance with the decisions of the management staff of the enterprise.

The types of staff motivation differ slightly among different authors, but it is easy to single out several main ones.

Types of staff motivation according to the main groups of needs: material (the employee's desire for prosperity), labor (the content and working conditions), status (the individual's desire to take a higher position in the team, to be responsible for more complex and qualified work).

Types of staff motivation according to the methods used: normative (influence through information, suggestion, persuasion), compulsory (use of the threat of dissatisfaction with needs, coercion, power), incentives (indirect impact on the personality, benefits and incentives that induce the employee to the desired behavior).

Types of motives by sources of origin: internal and external. External motives are influence from the outside, with the help of certain rules of behavior in the team, through orders and instructions, payment for work, etc. Internal motives are an impact from within, when a person himself forms motives (for example, knowledge, fear, desire to achieve a certain goal or results, etc.). The latter type of incentive is much more effective than the first, since the work is done better and less effort is spent on it.

Types of personnel motivation by focus on achieving the goals and objectives of the organization: positive and negative. Positive - these are personal bonuses and bonuses, assignment of the most important work and VIP clients, etc. Negative - these are various remarks, reprimands and penalties, psychological isolation, transfer to a lower position, etc., and all types of penalties should be communicated and explained to the entire team, and not just to a specific individual.

The factors of personnel motivation are the following:

1. The need to work for a successful and well-known company. Here the prestige or “brand name of the enterprise” plays the main role, when its employees are proud of the fact that they take an active part in the life of the organization.

2. Fascinating and interesting work. The best option when hobbies and work are synonymous. If the employee's work activity allows him to self-actualize and brings pleasure, then the work of the individual will be successful and effective. The status of an employee, the possibility of his development and acquisition of new knowledge, his participation in planning the tasks of the enterprise play an important role here.

3. Material incentives. All types of bonuses, bonuses and, in fact, the salary are components of this factor.

It is impossible to legislatively change people's attitudes to work, since this is a long evolutionary process, but it can be accelerated if a sober assessment of a specific situation and the reasons that gave rise to it are taken into account.

Leaders are always aware of the need to encourage people to work for the organization, but at the same time they believe that for this, a simple material reward is enough. In some cases, such a policy is successful, although in essence it is not correct.

People who work in modern organizations are usually much more educated and wealthy than in the past, so the motives for their work are more complex and difficult to influence. There is no single recipe for developing a mechanism for effectively motivating workers to work. The effectiveness of motivation, like other problems in management, is always associated with a specific situation.

1.3 Factors of motivation for work of nurses in health care facilities and the main directions of its increase

Motivation of personnel labor is a key direction of the personnel policy of any enterprise. However, not all tools that allow highly effective management of the behavior of employees of commercial companies are also effective in managing medical personnel.

In the health care system, nursing staff are the most significant part of the workforce. The professional activities of nurses are particularly influenced by such negative factors as insufficient prestige of the profession, relatively low wages, difficult working conditions, which complicates the management process. In this regard, it is extremely important to clearly motivate the activities of nurses in the changing management structure of medical institutions.

The concept of labor motivation in the economic sense appeared relatively recently. Previously, the concept of motivation was replaced by the concept of stimulation and was used mainly in pedagogy, sociology, psychology. This limited understanding of the motivational process led to a focus on getting immediate results. This did not cause significant interest of the nursing staff in their own development, which is the most important reserve for increasing labor efficiency. Labor has ceased to be the meaning of life for many people and has turned into a means of survival. And in such conditions, it is impossible to talk about the formation of a strong work motivation, about the efficiency of work, the improvement of the qualifications of workers and the development of initiative.

In health care, simple material rewards are considered sufficient as the main motivational factor. Sometimes this policy is successful. And since a motive is a conscious urge to achieve a certain goal, understood by a person as a personal need, a need, then the structure of the motive includes, in addition to needs, actions to achieve them, and the costs associated with these actions.

Motivation is represented by motivation and stimulation. If motivation is the process of influencing a person in order to induce him to certain actions by awakening certain motives in him, then stimulation consists in using these motives.

With the development of health care, more and more attention is paid to the motivational function of management, when preference is given to motivation over administrative and strict control. Moreover, the most common group of motivating factors is not "carrots and sticks" and not fear and disciplinary responsibility, but a group of factors including trust, authority, and reward. Employment guarantees and working conditions are of great importance.

Five levels in the system of motivation for the work of nursing personnel of medical institutions can be presented in the form of a kind of pyramid, at the base of which there is such a component of motivation as the principles of leadership, the other components of motivation can have the following arrangement according to the levels of the pyramid (see Fig. 2).

Fig. 2. Nursing incentive system

The motivation of medical personnel and their actions to achieve certain goals are guided by values ​​that are prioritized. At the same time, research often refers to the scoring of values.

On the example of one of the medical institutions in Novosibirsk, in 2012, studies of the distribution of values ​​by priorities of nurses were carried out (researchers A.I. Kochetov and E.I. Loginova). As a result of the survey, nurses put salaries, health care, and job satisfaction first. The second and third places are the respect of colleagues, good relations with them, as well as encouragement from the administration. Equally important for nursing staff is the possibility of self-realization, social package and recognition in the organization. The possibility of self-realization in the profession was indicated by 23% of the respondents. This figure is explained by the fact that the functions of nursing staff are more limited in comparison with doctors. The work is perceived as monotonous. The sisters often perform it mechanically, without delving into the essence of new tasks. Professionalism in narrow specialization is growing and interest in self-education is declining. It should be emphasized that when asked about further cooperation with the organization, 7% of the nursing staff of the medical institution expressed dissatisfaction with the current state of affairs, and 22% left the answer to this question. Thus, a survey of nurses showed that about 30% of staff do not agree to continue working on the same conditions. This suggests that in order to retain staff, changes are needed both in the remuneration system and in the nursing staff management structure.

In order to identify the preferred types of labor stimulation for nursing personnel, the same researchers (A.I. Kochetov and E.I. Loginova) conducted a survey of nurses at one of the clinical diagnostic centers in Novosibirsk. The research results showed that 77.5% of respondents preferred material incentives. Among non-monetary material incentives, nurses preferred the provision of preferential vouchers for rest and treatment (71.5%); improvement of working conditions, ergonomics of the workplace (66.5%); introduction of flexible working hours (62.5%); provision of benefits for payment of departmental housing and utilities (59%); voluntary medical insurance of personnel (44%); organization of reduced price meals (44%). Among the preferred forms of moral encouragement, the majority of respondents noted: attentive attitude to individual proposals aimed at improving the common cause (69%); announcement of gratitude (59%); one-time granting of powers in solving certain production issues (22%).

After analyzing the data on the preferred types of motivation, we can conclude that each specific employee has a motivational system peculiar only to him, which depends on the personal qualities of the person and the life circumstances in which he is currently. It is necessary to strive to orientate motivation to values ​​that are of priority importance for a particular nurse.

The prestige of the profession of a nurse, as noted earlier, plays one of the essential roles in the structure of work motivation of nurses. It is not so easy to raise the prestige of the profession, and this is a common task not only of the health care system, but also of the cultural state of the whole society, the hierarchy of social values. The labor motives and values ​​of the Western model, introduced into the mass consciousness of Russians from the outside, do not correspond to the model of attitude to work that has been formed over the centuries-old history of Russia on the basis of internal prerequisites and requirements of economic development. The decline in the general cultural level of the population, of which nurses are a part, leads to the primitivization of needs, the underdevelopment of the motivational sphere.

There is no widespread propaganda of the public importance of the nursing profession at all levels. Insufficient attention in health care institutions is paid to the development and maintenance of the culture of the organization, in particular, the popularization of the mission of the institution, the formation of loyalty and commitment to the organization of personnel, and other specific aspects of the formation of organizational culture.

Thus, it is possible to determine the main areas of activity of healthcare leaders at various levels of management, aimed at maintaining and increasing the work motivation of nurses (Table 2).

table 2

The main directions of increasing the work motivation of nurses

at the level of government	at the local government level	at the management level of the organization
1. Increasing the prestige and widespread promotion of the public importance of the nursing profession. Rendering recognition to employees and veterans of the profession.
2. Establishing a decent level of wages for nurses.	2. Organization of seminars, conferences, competitions at city, district, regional levels, exchange of experience between various medical institutions.	2. Development of a system of additional material incentives for employees, creating opportunities for preferential medical care for employees and their families.
3. Equipping medical institutions with modern equipment and the introduction of modern technologies.	3. Allocation of additional funds for technical and technological equipment of medical institutions.	3. Development of organizational culture: popularization of the mission, the formation of loyalty and commitment of employees of the organization and other specific aspects.
4. Popularization of an increased level of secondary and higher nursing education.	4. Organization of targeted recruits to higher educational institutions of graduates of medical schools and colleges, who have shown themselves excellently during their studies.	4. Attention to personnel work: the creation of adaptation programs for young specialists, the study of labor motivation of personnel and the creation of motivational programs, etc.
5. Expansion of the hierarchical structure of health care institutions, creation of career opportunities and more differentiated pay for nurses.	5. Attracting schoolchildren and students of medical schools and colleges to research work and popularization of medical knowledge, the establishment of personal scholarships.	5. Prevention of professional stress and professional burnout syndrome: introduction of the position of a psychologist, training staff in anti-stress behavior skills, conducting social and psychological trainings.
6. Development of load standards and standards for the provision of medical care. Introduction to the staff of health care facilities of the position of HR manager and psychologist.		6. Creating a comfortable working environment. Monitoring compliance with safety regulations. Implementation health-saving technologies.
7. Introduction of compulsory socio-psychological trainings (at least 24 hours) into advanced training programs for nurses.	7. Wide involvement of highly qualified medical personnel in teaching at the departments of advanced training of nurses.	7. Development of the nursing process as the main model for the provision of nursing care.

Some of the measures listed in the table are being successfully implemented in the field of domestic health care at the present time, while the other part requires its detailed consideration and application.

1.4 Methods and indicators of job satisfaction for nurses

In recent years, increased attention has been paid to assessing customer satisfaction. Interest in this problem is associated with the formation of a client-oriented approach and the creation of a quality management system, which is an indispensable attribute of increasing the competitiveness of a medical institution.

At the same time, insufficient attention is paid to assessing staff satisfaction. Meanwhile, the urgency and importance of solving this problem is due to a number of factors. Here is some of them .

Taking into account in the framework of personnel management the needs and expectations of their employees in the recognition of their activities, job satisfaction, as well as in their development, helps to ensure their strongest motivation, and, consequently, to retain qualified employees and attract new ones. High personnel satisfaction allows the organization not only to reduce staff turnover, but also to confront the problem of a shortage of labor resources, which today is especially acute in relation to highly qualified specialists who provide key areas of activity of health care facilities. The satisfaction of the organization's employees largely determines the degree of satisfaction of its customers.

Thus, in order to improve the organization's personnel management policy, the existing quality standards recommend conducting an assessment of personnel satisfaction, which will help form a feedback system with employees.

What is staff satisfaction with work? Employee satisfaction with labor should be understood as the fact that employees perceive the degree to which the conditions, content, remuneration (and other factors) provided by the organization correspond to the needs and requests of employees, i.e., what they consider important.

Table 1

Different forms of job satisfaction

Progressive job satisfaction:	The person feels satisfied with the work as a whole. By increasing the level of aspiration, a person tries to achieve an even higher level of satisfaction. Therefore, "creative dissatisfaction" about certain aspects of the work situation may be an integral part of this form.
Stable job satisfaction:	The person feels satisfied with a particular job, but is motivated to maintain a level of aspiration and a pleasant state of satisfaction. The increase in the level of aspiration is focused on other areas of life due to insufficient work incentives.
Satisfaction with work in humility (satisfaction with the work of a humble person):	The person feels vaguely dissatisfied with the work and lowers the level of aspiration in order to adjust to the negative aspects of the work situation at a lower level. By reducing the level of aspiration, he is able to re-achieve a positive state of satisfaction.
Constructive dissatisfaction with work:	The person feels dissatisfied with the job. While maintaining the level of aspiration, he tries to cope with the situation by trying to solve problems on the basis of developing sufficient tolerance for frustration, annoyance. In addition, he has access to meaningful actions within the framework of target orientation and motivation, aimed at changing the work situation.
Fixed dissatisfaction with work:	The person feels dissatisfied with the job. Keeping the level of aspiration at a constant level, he does not try to cope with the situation by trying to solve problems. Tolerance of frustration makes the defense mechanisms needed to make the effort to solve the problem seem out of bounds. Therefore, the individual gets stuck on his problems, and pathological development of events is not excluded.
Pseudo work satisfaction:	The person feels dissatisfied with the job. When confronted with intractable problems or annoying work conditions and maintaining the same level of aspiration, for example, due to motivation for a certain type of achievement or due to strict social standards, distorted perceptions or denial of a negative work situation can result in pseudo job satisfaction.

According to this model, the development of job satisfaction is a three-step process. Depending on the combination between expectations, needs and motives, on the one hand, and the work situation, on the other, a person forms a certain degree of satisfaction or dissatisfaction with her / his work. In addition, depending on subsequent changes in aspiration levels and on subsequent problem-oriented behavior (aimed at solving a problem), six forms of satisfaction or dissatisfaction with work can develop.

In the case of uncertain dissatisfaction at the first step, i.e. in the case of differences between the actual values ​​of the work situation and the nominal (own) values ​​of a person, this model offers two different results depending on the level of aspiration strength, which corresponds to the second step: a decrease in aspiration or maintaining the level of aspiration. A decrease in the level of aspiration should lead to what is called job satisfaction "in humility, obedience." This form of job satisfaction is confirmed by the results of qualitative interviews, during which a lot of people are identified who adapt to work situations either by reducing their level of motivation to work and aspirations, or by shifting their motivation and aspirations to non-work activity. It can be argued that the high proportion of satisfied workers participating in this type of research is due to a more or less high proportion of those who passively shifted their aspirations far beyond the work situation. Therefore, according to this model, satisfaction in humility is only one of three forms of job satisfaction, and must be distinguished from them.

Maintaining aspiration at the same level in the case of indefinite dissatisfaction with one's work can end in three forms, of which the most important is pseudo- (or false) work satisfaction. Previously, it was ignored in research because the authors doubted the possibility of finding the rationale. This model assumes that the other two forms, fixed and constructive dissatisfaction with work, are closely related to the mastery of other options, to the mastery of resources, and to problem-oriented human behavior. All these models are relevant variables in this case, "working" at the third stage of development of various forms of job satisfaction. Both fixed and constructive work dissatisfaction seem to depend heavily on well-known organizational features such as control or social support at work, in one connection, and on what is briefly called the ability to master resources - the ability to use this parameter - in another. Constructive dissatisfaction is clearly in addition to the satisfaction of work in humility.

The model of different forms of job satisfaction points to the lack of a simple quantitative representation, even if this representation is rather complex and includes several aspects, such as work colleagues, working conditions, work content, promotion, and so on. Therefore, job satisfaction, which we usually think about and which we traditionally measure, must be differentiated. Presented in the form of stable, progressive and humble job satisfaction, on the one hand, and fixed and constructive dissatisfaction, on the other, job satisfaction (dissatisfaction) simply can no longer be regarded and used as a product; rather, it should be seen as a process-oriented outcome of human-work interaction, highly dependent on the control mechanisms that govern this interaction.

To date, studies using a model of different forms of job satisfaction have yielded three important results.

First, the forms of job satisfaction can be, according to this model, reasonably differentiated; While the relationship between forms in different samples may change, several forms (eg, satisfied in humility, constructively dissatisfied) continually emerge in research (Bussing, 1992; Bussing et al, 1997).

Secondly, the forms of job satisfaction depend rather on situational factors, for example, the degree of control by an employee of his workplace, than on the disposition of factors.

Third, the forms of job satisfaction do not function like psychological types, that is, they are unstable over a long period of time. Although this model is considered progressive among other models, little is known about the prerequisites and consequences associated with different forms of job satisfaction. In addition, there is still a lack of in-depth research comparing this model with other common concepts of job satisfaction.

The inability to meet the urgent needs of workers through labor activity leads to an increase in the importance of additional ways of "earning", including the search for other sources of employment, theft, corruption and other negative trends.

Job satisfaction depends on a number of factors, including wages, sanitary and hygienic conditions, the prestige of the profession, employment stability, etc. include the theory of two factors by F. Herzberg, the theory of human relations by E. Mayo and Rotlisberger, the Lawler-Porter model of motivation, etc. Soviet sociologists such as V.A. At the same time, some researchers note the presence of direct or indirect links between the satisfaction of personnel with their loyalty (dedication) to the organization, as well as with the effectiveness of their work. The presence of these links allows you to identify the assessment of satisfaction.

Assessment of personnel satisfaction with work contributes to the adoption of balanced, well-grounded decisions by the management, for which it is necessary to have reliable, timely, complete information about the state of labor resources in the organization.

For the assessment, you can use a complex of medico-social research methods: sociological (questionnaire survey), sociohygienic (data from reporting documents), the method of expert assessments. Sources of information about the opinions of employees can be group (for example, a survey of a particular category of personnel) and individual interviews, questionnaires, etc.

You can also determine the structure of motivation and highlight the actual factors of satisfaction or dissatisfaction with work using the Herzberg test.

The reasons for dissatisfaction identified through the assessment can be eliminated using the available management actions (for example, referral to training, bonuses, rotation, etc.).

Summing up, we note that in order to increase the level of personnel satisfaction (and, thereby, achieve significant advantages of the company over competitors) through the introduction of a system for assessing the satisfaction of the organization, the following main steps must be taken.

Step 1. Assess the current level of staff satisfaction (in general, by key employees, etc.).

A survey of personnel will allow us to determine the level of their current job satisfaction and highlight the most problematic areas, as well as gaps (discrepancies) between the current and the desired state.

The necessary components for organizing a survey are the development of a questionnaire, the choice of a method for processing and analyzing the information received, etc.

The assessment can be carried out both independently, with the involvement of, for example, the personnel department, and with the help of third-party organizations professionally engaged in such research.

Both methods of assessment have their advantages and disadvantages. Assessment of staff satisfaction with labor by the organization itself is certainly cheaper in cost. At the same time, in this case, there is a risk of receiving distorted, inaccurate information due to the fact that the employees conducting the survey are deeply involved in industrial relations and are subject to an interest in the results of the assessment.

A third party organization that has no interest in the results of the assessment can conduct an independent survey. Implementation of this option will require certain financial costs, perhaps slightly exceeding the amount of funds for conducting a survey “on their own”. However, having experience in providing such a service, an external organization will be able to implement it more quickly and efficiently. Thus, at this stage, the involvement of an external organization for the survey seems more preferable.

Step 2. Organization of a system of regular monitoring of personnel satisfaction with labor and the use of information to make informed managerial decisions in the field of personnel management.

Conducting employee satisfaction surveys at regular intervals will help prevent potential problems from arising at an early stage. In this way, it will enable the organization to retain key employees. The costs of conducting surveys are paid off by significant savings in money and time for the selection, training and adaptation of new employees.

At this stage, it is advisable to transfer the main emphasis in the work to the personnel service of the organization itself, outsourcing only some functions or business processes (for example, assistance in organizing the system, designing the distribution of functions between structural divisions, preparing drafts of the necessary regulations, methodological and information support ).

Step 3. Improving the system of regular monitoring (using opportunities to improve the activities of personnel management)

Taking into account the changes taking place in the external environment and in the organization itself, it is necessary to improve the assessment methodology (for example, change the survey questionnaire, sample, etc.), information analysis methods, etc. organizations for more accurate results.

It seems that the main activities of this stage should be entrusted to a third-party organization, which will be able to professionally audit the existing system for assessing personnel satisfaction and develop the necessary recommendations for its improvement.

Finishing the first theoretical chapter of the course work, we can draw the following conclusion.

Bibliography

1. Alekseeva O.D., Solovieva A.V. The role of the head of the nursing service in creating the "motivational" environment of the institution // Nurse. - 2008. - No. 4

2. Antipova IN, Shlykova IN, Matveeva EV. Management of labor motivation for medical nurses // Main nurse. - 2010. - No. 6.

3. Bochkarev A.A. Labor motivation as a problem of social philosophy [Electronic resource]: Dis ... Candidate of Philosophy: 09.00.11. - M .: RSL, 2005

4. Butenko T.V. Mental burnout and labor motivation of nursing staff [Text] // Young scientist. 2010. No. 11. - P. 157 - 161.

5. Butenko T.V. Labor motivation of nurses: problems and prospects for solutions [Text] / TV Butenko // Psychological sciences: theory and practice: materials of the international. correspondence course scientific. conf. (Moscow, February 2012). - M .: Buki-Vedi, 2012 .-- S. 72-75

6. Vesenin V.R. Practical personnel management: a manual for personnel work / V.R. Vesnin. - M.: Yurist, 2007 .-- 495 p.

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The function of motivation in health care facilities influences the staff of departments in the form of incentives for effective work, social impact, collective and individual incentive measures, etc. These forms of influence activate the work of specific performers, increase the efficiency of the entire management system of the medical diagnostic process in health care facilities.

Motivation is a set of actions of the chief physician, encouraging employees to carry out the assigned work. In addition, motivation in health care facilities involves the establishment of relationships between team members, encouraging them to perform the work necessary, from the point of view of the chief physician,.

When motivating and stimulating personnel, the following aspects must be taken into account:

People, working in health care facilities, strive to achieve or avoid something, realizing their own interests;

Individual motives are highly subjective and complex and can be influenced even by the mood of employees;

There are no optimal methods of motivation, so there is a need to use all types of incentives, not just material motives.

A special place in this process is occupied by a motive, which, on the one hand, is a connecting link between a person's needs and his behavior, and, on the other hand, his inner stimulus to action. The motives of any employee, like every person, are quite flexible and varied. At the same time, it seems realistic to single out the main ones:

security motives associated with a set of material

funds necessary to ensure the well-being of the employee and his family; they are reflected in the material interest of the employee, in his orientation towards earnings,

Motives of vocation, consisting in the desire of medical workers to realize their noble feelings of compassion for the patient in the process of work;

Motives of prestige, expressed in the desire of employees to fulfill their social role, to take part in socially significant activities.

Socio-psychological methods of motivation in LPO are precisely based on the use of social (system of relationships in a team, social needs, etc.) and personal (respect, power, success, self-realization) motives of people's behavior. The specificity of these methods lies in a significant proportion of the use of informal factors, the interests of an individual, a group, a team in the process of managing health care personnel.

In this regard, an important role is assigned to the optimization of educational and ideological work as an integral and integral part of the work on personnel management of structural units on the part of the LPO administration.

The growing role of educational and ideological work is due to the growing need for each person to deeply understand their objective needs and interests in achieving the goals and objectives of social development of modern Belarusian society. This is the only way to form in each individual person a sense of patriotism and collectivism, and at the same time personal inner responsibility for what they have done, instilling a desire to constantly improve, including in a professional way, and, therefore, to provide hourly real help to the patient at the level of modern achievements of clinical thought.

The main directions, forms and methods of educational

ideological work with the team are presented in the figure.

Directions	Forms	Methods
1. Information support of the team's activities 2. Labor rivalry, the formation of high professional qualities and labor discipline 3. Education of high patriotic and spiritual moral qualities 4. Formation of the need for a healthy lifestyle and physical culture 5. Protection of the collective of workers from negative ideological and information-psychological impact 6. Organizational and methodological assistance to public organizations 7. Training an ideological asset 8. Ideological and organizational support for holding elections and referenda 9. Provision of technical means for ideological work and periodical press of an ideological asset 10. Interaction with local government authorities.	Oral propaganda and agitation Individual educational work Working with the media Cultural educational work Analytical work Working with citizens' appeals Visual agitation Local media	Meetings (conferences) of the labor collective Common days for informing employees and patients Participation in meetings Meetings of the administration with the labor collectives of structural divisions Executive reports Interviews and articles in the media Honoring leaders and veterans Public opinion polls (questionnaire) Conversations (collective and individual) Reports Q&A evenings Newsletters and stands Radio broadcasts Campaign flyers and posters Sport competitions Round table discussions Theme nights

The economic aspects of motivating LITO medical personnel are largely related to the optimization of work processes.

With the help of economic methods, material incentives for the teams of structural divisions are carried out based on the results of achieving a model KRD department or LPO, as well as the achievements of individual employees.

Since a service is a form of the result of labor, the main contribution to the process of providing a service is made by labor.

Labor, as a factor of production, is able to bring income to its owner in the form of wages.

It is the ratio of the result of labor and its costs that is the object of economic management in health care facilities.

The development of market principles for the functioning of medical treatment facilities requires a new approach to labor management, in accordance with which the level of the quality of working life largely influences the final result of medical activity.

Effective management presupposes a clear organization of all labor activity processes as a guarantee of achieving high quality medical services and obtaining a positive economic effect for health care facilities as a whole.

The efficiency of labor organization in health care facilities is ensured by:

S efficiency of the remuneration system;

S the current system of organization of medical services;

S psychophysiological factors;

S features of the ecological environment;

^ factors associated with the nature of the tasks solved in various links of the control system.

Economic and socio-psychological methods of motivation are of an indirect nature of managerial impact on personnel. At the same time, it is difficult for the administration to rely on the automatic action of these methods and to determine the strength of their influence on the final result of the activity of this or that employee.

Therefore, administrative methods are widely used in health care practice.

Administrative methods of management are characterized by their compliance with the legal norms in force at the present stage, as well as with the acts and orders of higher healthcare management bodies.

Administrative methods are focused on such motives of behavior as the perceived need for production and technological discipline, a sense of duty, the desire to work in a respected organization, and the culture of activity. These methods of influence are distinguished by the direct nature of the impact, since any regulatory and administrative act of the administration of the health care facility is subject to mandatory execution.

Administrative methods are reflected in the Internal Regulations for Health Care Employees.

Internal labor regulations are the rules for the performance of work by employees at the employer under his guidance and control.

Internal labor regulations are governed by the internal labor regulations approved by the employer with the participation of trade unions and other local labor regulations.

The employer can demand, and the employees are obliged to perform the work stipulated by the employment contract, subject to the internal labor regulations.

The approved internal labor regulations are mandatory for both employees and the employer.

On behalf of the employer, his rights and obligations are exercised by authorized officials - the head of the institution (his deputies), the head of the department and service (their deputies), a foreman or another employee who is empowered by law or the employer to make all or individual decisions arising from labor and related relationship with them.

The following duties are established for employees:

a) work conscientiously;

b) obey the established internal labor regulations, comply with written and oral instructions of the employer that do not contradict legislation and local acts;

c) not to allow actions that interfere with other employees to fulfill their labor duties;

d) comply with the established requirements for labor protection, safety, industrial sanitation and fire safety, work in the issued special clothing, special footwear, use other personal protective equipment;

e) treat the property of the employer with care, use it rationally, take measures to prevent damage;

f) take measures to immediately eliminate the causes and conditions that impede the normal performance of work (accident, downtime, etc.) and immediately report them to the employer;

h) comply with the established procedure for storing documents, material and monetary values.

The range of functional types of duties (work) that each employee must perform in one or more professions, specialties or positions of relevant qualifications is determined by qualification reference books, approved in the prescribed manner by the relevant technical rules, job descriptions, regulations, other local regulations, as well as labor agreement.

For non-fulfillment or improper fulfillment of his duties, the employee is liable under the Labor Code and other legislative acts.

The employer is obliged:

a) provide the employee with work in accordance with the law, the collective agreement (agreement) and the labor contract;

b) pay wages on time, but at least once a month;

c) create healthy and safe working conditions, comply with the established rules and regulations for labor protection, ensure the proper technical equipment of all workplaces (if there are no requirements in the rules and regulations, compliance with which is necessary in the performance of work to ensure the safety of working conditions, the employer takes measures to ensuring safe working conditions);

d) take the necessary measures to prevent industrial injuries, occupational and other diseases of employees - constantly monitor the knowledge and compliance by employees with the requirements of safety instructions, industrial sanitation and fire safety, promptly and correctly conduct an investigation and record of accidents at work;

e) in cases stipulated by legislation and local acts, timely provide benefits and compensations in connection with harmful working conditions (shortened working hours, additional vacations, therapeutic and prophylactic nutrition, etc.); comply with labor protection standards for women, youth, disabled people;

f) provide employees in accordance with the established provisions with special clothing, special footwear and other personal protective equipment, organize proper storage and care of these means;

g) comply with labor legislation, the conditions established by collective agreements (agreements), other local acts and labor contracts;

h) develop and approve job descriptions and other local regulations governing the functional responsibilities of employees;

i) provide advanced training for employees, create the necessary conditions for combining work with training;

j) ensure the participation of employees in the management of the institution, timely consider the criticisms of employees and inform them about the measures taken;

k) submit statistical data on labor in the amount and in the manner determined by the legislation;

l) suspend employees from work in cases stipulated by the Labor Code of the Republic of Belarus;

m) be attentive to the needs and requests of employees;

n) fulfill other obligations arising from legislation, local acts and employment contracts.

For non-fulfillment or improper fulfillment of his duties, the employer (authorized official of the employer) is liable under the Labor Code and other legislative acts.

For exemplary performance of labor duties, improving the quality of work, long and flawless work, increasing the efficiency of medical care, innovation and other achievements in work, the incentives provided by the collective agreement are applied.

Incentives can be announced by order of the employer and brought to the attention of workers. The incentives announced by the order are entered in the prescribed manner in the employee's work book. The incentives announced by the order (order, decree) are entered in the prescribed manner in the employee's work book.

For unlawful, guilty failure or improper performance by an employee of his job duties, the employer may apply the following disciplinary measures:

a) remark;

b) a reprimand;

c) dismissal (clauses 4,5,7,8,9 of Article 42 of the Labor Code).

When imposing a disciplinary sanction, the severity of the act, the circumstances under which it was committed, the previous work and the employee's behavior in production must be taken into account.

A disciplinary sanction can be lifted by the employer before the expiration of the term on his own initiative, at the request of the immediate supervisor, the trade union, as well as at the request of the employee in cases of conscientious performance of his labor duties. Early withdrawal of a disciplinary sanction is formalized by order.

"Personnel officer. Personnel management", 2007, N 3

The predominantly retrospective methods of payment for medical care existing in Russian health care contribute to a decrease in the efficiency of the use of labor and material resources. Understanding the process of labor motivation and how citizens make choices in the process of organizing their behavior, allows you to develop a more effective system of influence on them from the leader.

In this regard, it is advisable to dwell in more detail on the distinctive features of the motivational attitudes of workers, methods of influencing and regulating the behavior of individuals in accordance with the goals of the Samara Clinical Ophthalmological Hospital (hereinafter SKOB) named after N.I. T.I. Eroshevsky, which is a municipal enterprise belonging to the Health Department of the Samara Region, the Ministry of Health of the Russian Federation. Particular attention should be paid to the relationship between the satisfaction of SKOB personnel. T.I. Eroshevsky's work and the productivity of their labor, taking into account the criteria for the effectiveness of the organization, as well as to study the role and place of motivation in the personnel management system, the structure of incentives, the role of the system of payment for medical care in the formation of the motivation system.

In SKOB them. T.I. Eroshevsky, mainly economic methods of managing labor motivation are used:

1) the salary of an employee, determined by budgetary funding at the level of UTS rates;

2) the practice of awarding bonuses to employees for the volume and quality of work performed;

3) allowances, additional payments for work experience (in accordance with the current regulations), the use of scientific achievements and advanced labor methods, service of especially dangerous categories of patients.

Unfortunately, budget funding at the level of the Unified Tariff Schedule (UTS) rates does not provide adequate motivation for the work of physicians. UTS rates do not even exceed the subsistence level in Samara, the value of which in the fourth quarter of 2005 was equal to 3433 rubles per capita of the able-bodied population. Therefore, in order to attract and retain highly qualified specialists, it is necessary to find ways to increase wages at least to the level of the regional average. Bringing economic incentives to the subdivision of a medical organization and a specific medical worker at SKOB them. T.I. Eroshevsky is ensured by saving funds received by the organization as part of payment for medical care on the basis of fund holding (on-farm settlements).

At this stage of the implementation of on-farm settlements, due to the complexity of accounting, settlements are carried out only for the payroll based on internal tariffs, which conditionally include only the costs of wages.

The main motivational provisions of the system

on-farm settlements

The system of on-farm settlements includes the following provisions:

A clear definition used for planning, accounting, encouraging quantitative and qualitative indicators of the final results of the work of the team of the unit;

Effective planning of the work of departments, timely delivery of planned performance indicators to it;

Strict accounting of the results of the activities of the departments;

A direct connection between the amount of funds for the remuneration of the team's labor and the final results of its work, a guarantee to the team of the subdivision of the payment of the total amount of wages for the volume of work performed with the required quality in a given time, regardless of how many employees the specified volume is completed;

Providing the team with independence in choosing specific forms of organizing their work, using the equipment and other resources assigned to it, in the distribution of collective earnings;

Distribution of collective earnings between employees, taking into account the quantity, quality and final results of each labor in accordance with the coefficient of labor participation;

Mutual responsibility of the administration of a medical organization and a structural unit, as well as units among themselves for non-performance (low-quality, untimely performance) of work or contractual obligations.

A medical organization, forming a wage fund within the income included in the production and financial plan, makes contributions:

A reserve fund to help with seasonal fluctuations in work volume and other unforeseen circumstances;

The remaining wage fund is used to pay employees, depending on the volume and quality of work performed by them. For poor-quality performance of work, penalties are applied in the manner and amount approved by the head of the medical organization.

On-farm settlements are based on the principles of end-to-end brigade contracting. In this case, this or that structural unit of a medical organization (children's ophthalmological department) acts as a brigade. The salary fund of the brigade is determined not by the staffing table, but by the volume of work performed, taking into account its quality. Internal tariffs for medical services are a measure of labor costs and material resources, i.e. in a brigade contract, the labor expended is measured using tariffs and the money actually earned is paid.

It is often believed that with brigade forms of labor organization, the task of accounting for labor contribution becomes irrelevant. However, it is not. Brigade forms are advisable not at all because collective wages stimulate labor better, but because it is far from always possible to accurately assess the work of each individual worker. Only the peculiarities of the modern division of labor, when the result, drawn up in terms of quantitative and qualitative parameters, can often be distinguished only by a group of workers (where each of them performs partial operations or work that only summarizes the final result, for example, during a surgical operation), create the need for remuneration for overall result. In addition, the brigade forms themselves do not at all deny individual payment. On the contrary, brigade forms are most effective precisely when there is a brigade form of remuneration for each member of the brigade through the coefficient of labor participation (KTU), points, etc. The funds earned in the current month by the divisions are used to reimburse costs, including for the remuneration of employees, taking into account the KTU of mutual settlements, the payment of penalties, and the creation of a reserve.

Study of the labor motivation system

The study of the system of motivation for the labor activity of employees using a modified questionnaire developed by the Research Institute of Labor was carried out in the children's department of the hospital. The conditions for sampling respondents according to the “Motivation for Activity” questionnaire are shown in Table 1.

Table 1

Sampling conditions for the "Activity motivation" questionnaire

Mathematical analysis of the results of the questionnaire data allows us to determine the level of employee satisfaction with the existing system of motivation (Table 2).

table 2

Satisfaction of employees of SKOB children's department

them. T.I. Eroshevsky motivation system

The survey data show that the level of employee satisfaction with material incentives, although it leaves much to be desired, is nevertheless significantly higher than the same indicator for non-material incentives and is 0.66 points.

One of the most important elements characterizing the system of labor motivation for SKOB im. T.I. Eroshevsky, is the salary. The performance indicators of not only a particular employee, but also the organization as a whole depend on how much the size of wages encourages employees to work effectively (Table 3).

Table 3

Distribution of respondents' answers to the question "Does

the size of your wages to work effectively? "

The system of remuneration used stimulates only 17% of respondents to work efficiently, this indicator is very low, 39% of employees reduce the labor intensity, 9% are looking for "left wages", 35% generally find it difficult to answer the question about wages. Thus, the loss of working time, a decrease in labor intensity, additional vacations, absenteeism, downtime - all this can be explained by the low level of wages.

The size of wages is influenced by a large number of factors. Their impact can be viewed from both the employer's and the employee's perspective. Within the framework of this study, of particular interest is the analysis of respondents' opinions on this issue (Table 4).

Table 4

Distribution of respondents' answers (in%) to questions

on the degree of influence of factors on the size of wages

According to the results of the questionnaire survey, the following factors have the greatest influence on the size of wages: education and experience, initiative, enterprise, energy and efforts of the employee himself. Such a factor as the interest of the administration in the employee does not affect the amount of wages. This can be explained by the use in SKOB them. T.I. Eroshevsky tariff system of remuneration and insufficient efficiency of the administration in the field of improving the system of labor motivation. The above data indicate that such an element of the motivation system as remuneration is an inhibiting factor, which indicates its extremely unfavorable effect on the climate of the team. Measures are needed to increase employee satisfaction with this factor.

A direct impact on the degree of employee satisfaction is exerted not only by economic incentives, but also by such components of production life as: the content of work, the conditions and organization of work, the workplace, the distribution of work. Judging by the results of the survey, the satisfaction of the department specialists with the above elements is quite high.

Let us turn to the data in Table 5. Analyzing the data in Table 5, we can conclude that all factors of the social and production environment, with the exception of satisfaction with growth prospects, are stimulating in nature. On average, about 70% of employees are quite satisfied with their work. Slightly more than 20% expressed incomplete satisfaction with various elements of the social and industrial environment. About 7% found it difficult to answer, and only 3% were generally not satisfied with their work.

Table 5

Satisfaction of employees with some elements

social and industrial environment of the children's department

SKOB them. T.I. Eroshevsky

The elements	Total polled		Level satisfy raven - ness
Satisfied	Partially	Not satisfied
Conditions labor
The Organization labor
Work place
His specialty
Perspectives growth
By distribution works

Judging by the survey data, workers are most satisfied with the existing level of organization of workplaces and working conditions. The level of satisfaction for these elements is 0.83 and 0.76 points, respectively. And here it is important to note that the administration of the department has made a lot of efforts to obtain such a high mark. Each workplace is provided with everything necessary both directly for the work itself (computer equipment, telephone communications, etc.), and for creating favorable working conditions (modern comfortable furniture, air conditioners, etc.).

Few are satisfied with the prospects of their professional growth in the department. According to the majority of respondents, professional growth is associated only with career advancement. It is difficult to achieve this in the department, since all the vacant positions have been occupied for a long time, and the situation is unlikely to change in the near future. Although for some members of the team, growth prospects are primarily an opportunity to improve their professional level, gain work experience, etc.

The state of motivation is also influenced by intangible incentives, for example, the distribution of vacations. At first glance, it may seem that the influence of this factor is insignificant in comparison with such as: conditions and wages, labor organization, growth prospects, etc. Nevertheless, the emergence of frequent disagreements on this basis can subsequently lead to destructive conflicts, which ultimately will adversely affect the psychological climate of the team.

This does not threaten the staff of the children's department. The majority of employees are quite satisfied with the distribution of vacations (Table 6).

Table 6

Employee satisfaction with the distribution of vacations

children's department SKOB them. T.I. Eroshevsky

The percentage ratio of the degree of satisfaction of employees of the children's ophthalmology department with the distribution of vacations is presented in Diagram 1.

Chart 1. Percentage of degree

satisfaction of SKOB employees

them. T.I. Eroshevsky distribution of vacations

│ ┌───┐

│ │ │ ┌───┐

│ │ │ │ │ 13%

│ │ │ │ │ ┌───┐ 7%

│ │ │ │ │ │ │ ┌───┐

│ │ │ │ │ │ │ │ │

┼─┴───┴─┴───┴─┴───┴─┴───┴─

60% - Quite satisfied

20% - Not quite satisfied

13% - I don't know

7% - Not satisfied

It is important to note that there are no people dissatisfied with the distribution of vacations in the team. About 20%, or 3 people, expressed their incomplete satisfaction with this factor. And this is quite understandable: the team is female, and such a personal issue as vacation time is far from indifferent to any woman. As a rule, most of those who want to relax always have to take place in the summer. It is impossible to let all workers go on vacation in the summer. Hence, there is some discontent, but the administration of the department is always trying to reduce it. If possible, all comers are provided with a full vacation during the summer months. In the absence of such an opportunity, the vacation is divided into parts, and one of which necessarily falls on the summer.

After analyzing the data obtained as a result of the questionnaire, it is possible to draw conclusions about the insufficient elaboration of the motivation system for the employees of the Samara Clinical Ophthalmological Hospital. T.I. Eroshevsky and the need for its further improvement.

Retrospective methods of payment for medical care dominate in the Russian compulsory medical insurance system. Having fulfilled its main task of ensuring payment for the real result of the activities of medical institutions, including SKOB them. T.I. Eroshevsky, these methods today require serious modification, since the prevailing principle of additional payments upon the provision of services does not correspond to the new tasks of Russian healthcare. Any health policy, no matter how reasonable it may be, needs constant monitoring and adjustment.

Consider the technology of assessment and selection of new payment methods in the Samara Clinical Ophthalmological Hospital named after V.I. T.I. Eroshevsky, the application of which will facilitate this process, as well as forms of modification of the old method.

The existing methods of payment for medical care have indisputable advantages, that they are familiar, computer technologies have been created for them, and do not require special efforts from the organization. The change in these methods is associated with serious changes in activities like SKOB im. T.I. Eroshevsky and insurers.

Methodology for assessing and choosing payment methods

medical care

As a methodology for assessing and choosing methods of payment for medical care, a formalized decision-making technology is proposed. The use of this technology makes it possible to reduce or eliminate psychological obstacles to changing the payment method and to choose the best option, taking into account the required organizational measures and financial costs.

The main steps of decision technology include:

1) analysis of the situation and the formation of goals for changes;

2) the choice of criteria by which the options for changes will be assessed;

3) establishing the rank values ​​of the criteria;

4) development of alternative options for changes;

5) comparison of alternative options for changes according to the selected criteria;

6) selection of the optimal variant of changes;

7) analysis of the consequences of implementation.

Acting in SKOB them. T.I. Eroshevsky, the payment system provides for financing polyclinics according to cost estimates and payment for inpatient care for the actual number of completed treatment cases at tariffs in the context of medical and economic standards (MES).

Conducting a SWOT analysis allows you to present both the strengths and weaknesses of the current payment system in the Samara Clinical Ophthalmological Hospital named after V.I. T.I. Eroshevsky, and also to outline the directions of its change in the conditions of the current restrictions. The results of a SWOT analysis of the current payment system are presented in Table 7.

Table 7

SWOT analysis of the current payment system

in SKOB them T.I. Eroshevsky

Strengths	Weak sides
Provided predictability outpatient clinic expenses - The system has been worked out tariff setting - The collection system has been worked out information on inpatient care - There is a non-departmental quality control system - Introduction of elements fund keeping for polyclinics and hospitals	Absent interest of clinics and hospitals in resource saving - Low level of motivation physicians - There is no incentive to develop inpatient technologies - Unpredictable costs hospitals - There are no economic incentives for polyclinics to decrease hospitalization rate - Not stimulated preventive work
Possibilities	Restrictions
Go to preliminary payment methods - Use of royalties payment methods substitute hospital and preventive services	Imperfection legislative and regulatory base - Lack of compliance state obligations in compulsory health insurance system allocated financial resources

The analysis showed that the current payment system does not contribute to the solution of the main tasks of the payment system - to facilitate the restructuring of medical care and ensure the predictability of costs.

Eliminating the weaknesses of the existing system involves solving the following tasks:

to ensure the interest of polyclinics and hospitals in resource conservation;

create incentives for the development of hospital-replacement technologies;

ensure the predictability of inpatient costs;

create incentives for polyclinics to reduce the hospitalization rate of the attached population;

motivate employees of the organization;

create incentives for medical prevention.

The problem of optimizing the economic mechanisms of personnel management at SKOB im. T.I. Eroshevsky will be solved by improving the system of payment for medical care. Currently, only the top management of the organization is involved in determining the size of quotas for all categories of personnel working in the organization. The provisions on material incentives do not clearly describe the criteria and set of performance indicators for the categories of personnel for which the incentive is provided. Often, the criteria and the system of indicators do not have a clear logical rationale, are not communicated to the working personnel. There is no feedback on the results of the distribution of the material incentive fund (FMP).

The purpose of the proposed methodological approaches is to eliminate some of the listed shortcomings of the mechanism for managing the distribution of the material incentive fund. First of all, we are talking about the democratization of the mechanism for determining the share of remuneration for each category of the organization's personnel and the formalization of the feedback mechanism in the management scheme for the distribution of FME.

The proposed management model of the FMP in SKOB im. T.I. Eroshevsky will look like this (diagram 1).

Scheme 1. Proposed model of FMP control

in SKOB them. T.I. Eroshevsky

┌──────────────────────────────────┐

├──────────────────────────────────┤

│Provision on material incentives│

└────────────────┬─────────────────┘

┌───────────────────────────────┴────────────────────────────────┐

│ Elements of the system of material incentives in medical │

│ organizations │

│ Top management, head. subdivisions of a medical organization│

└────┬───────────────────────────────────────────────────────────┘

┌────┴───────────────────────────────────────────────────────────┐

│ List of types of labor activities for material incentives │

└────┬───────────────────────────────────────────────────────────┘

┌────┴───────────────────────────────────────────────────────────┐

│ List of activities against material incentives │

└────┬───────────────────────────────────────────────────────────┘

┌────┴───────────────────────────────────────────────────────────┐

│ Sizes of material incentives, determined by the highest │

│ management, head. subdivisions, other formal and │

│ informal leaders of professional medical groups │

│ organizations │

└────┬───────────────────────────────────────────────────────────┘

┌────┴───────────────────────────────────────────────────────────┐

│ Issuance of remuneration to personnel │

└────┬───────────────────────────────────────────────────────────┘

┌────┴───────────────────────────────────────────────────────────┐

│ Creation of tool and behavior of opinion polls by │

│ FMP distribution results │

└────────────────────────────────────────────────────────────────┘

As can be seen from the presented two models of FMP management of a medical organization, at least two essential features come to the fore, in our opinion, optimizing the management system in the second model:

1. Involvement in the mechanism for differentiating the size of remuneration of formal and informal leaders of all levels of management of a medical organization. The management tool in this case is the so-called matrix of preferences (paired comparisons) for the leaders of each professional group of a medical organization.

2. Strengthening the feedback of the object of management (employees) with the subjects of management of all levels of management of the medical organization.

Based on the study, the following conclusions were made:

1. The strength of the mechanism for motivating the labor activity of employees at the enterprise determines the completeness of the use of personnel potential, and also ensures a high level of services provided, which is especially important for enterprises providing medical services.

2. In Russian healthcare, there is a particularly great need to revise the existing payment methods. There is a need to move from a predominantly retrospective payment principle to a preliminary payment principle.

3. The use of promising methods of payment for medical care will ensure adequate funding for health care organizations and create an effective system for motivating health workers.

N. Prokhorenko

Deputy General Director

CJSC "Insurance company

"Samara-Med"

G. Gagarinskaya

Professor,

head of department

Samara State

technical university

O. Kalmykova

associate professor of the department

"Economics and Organization Management"

Samara State

technical university

A. Shavdina

Postgraduate student of the department

"Economics and Organization Management"

Samara State

technical university