Over the past five years, the state has taken a number of measures to increase the motivation of medical workers and the prestige of the profession. One of the ways to achieve these goals was the reconstruction of the wage system and the introduction of an effective contract in the public sector. In this article, you will learn all the nuances of the new wage system, as well as find an example of an effective contract in healthcare.
Criteria for an effective contract in healthcare
The term "effective contract" appeared five years ago, after the Government of the Russian Federation adopted the Program for Improving the Remuneration System in Budgetary Institutions (Decree No. 2190-r dated November 26, 2012). In accordance with this document, employers in the public sector of the economy, including the healthcare sector, are required to conclude effective contracts with all employees until 2019.
In fact, this is a standard employment contract, which regulates the issues of cash payments in more detail, namely:
- the labor functions of the employee are specified;
- clarified the terms of remuneration;
- performance indicators are fixed;
- the procedure for obtaining incentive payments and compensations is described in detail;
- measures of social support are prescribed.
At the same time, when concluding an effective contract with an employee of a medical institution, it is necessary to indicate his position (for specialists, employees and managers).
For some positions, you additionally need to specify:
- speciality. So, for a specialist doctor, this is the direction in which he has been trained and directly practices (for example, a gynecologist);
- section of medical activity. This applies, first of all, to the deputy chief physicians (for example, the deputy chief physician for clinical and expert work);
- the name of the medical position according to the profile. This category includes heads of departments of the hospital (for example, the head of the surgical department - a surgeon);
- job title with specialization. For example, a doctor in the emergency department is a general practitioner.
It should be noted that the concept of an effective contract implies not only the labor contract itself, but also a set of measures aimed at improving the quality and accessibility of medical services. Work should become more efficient, and employees should be motivated to achieve maximum professional results. For this, conditions on special incentive payments are introduced into the employment contract. At the same time, such payments are made only when the employee reaches the indicators stipulated by the contract.
How is the transition to an effective contract
Employees who get a job in a medical facility for the first time sign a contract in a new form. And with employees who are already in an employment relationship, additional agreements must be signed, which will contain all the innovations that are characteristic of effective contracts.
At the same time, amendments to the contract must be made in accordance with the procedure established by article 74 of the Labor Code of the Russian Federation. This rule provides that a change in the conditions of remuneration associated with organizational innovations can be carried out by the employer unilaterally. However, at the same time, it is necessary to notify the employee about the upcoming changes at least two months before they are introduced.
If the employee refuses to work under the new conditions, then the employment relationship with him can be terminated in the manner provided for in clause 7 Art. 77 Labor Code of the Russian Federation.
Normative base
- Decree of the President of the Russian Federation of May 7, 2012 No. 598 “On improving the state policy in the field of healthcare”;
- Decree of the Government of the Russian Federation of November 26, 2012 No. 2190-r, which contains the Program for Improving the Remuneration System in Budgetary Institutions;
- Order of the Ministry of Health of the Russian Federation No. 421 dated 06/28/2013 (criteria and indicators of the effective work of employees of medical institutions);
- Decree of the Government of the Russian Federation of December 28, 2012 No. 2599-r (Plan of measures aimed at improving the efficiency of healthcare);
- The state program of the Russian Federation "Health Development", approved by the Decree of the Government of the Russian Federation of April 15, 2014 No. 294.
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An effective contract in healthcare: performance evaluation criteria
The amount and conditions for establishing incentive payments for employees should be determined taking into account the indicators and criteria for evaluating the effectiveness of their work, developed in the institution. Such criteria should be enshrined in collective and labor contracts, agreements, local acts (for example, in the Regulation on wages, the Regulation on incentive payments).
So, what criteria for a high level of work can be enshrined in local acts? For example, an assessment of how effective a doctor's work can be considered is often done through the absence of:
- emergency, deaths and medical errors;
- justified claims to the quality of medical care provided;
- errors in the preparation of documentation;
- violations of the rules of document circulation and reporting, the implementation of orders of the administration;
- comments on the performance of official duties and the corresponding instructions.
For paramedical personnel, such indicators may be the absence of:
- violations of the rules for obtaining, recording and storing medicines;
- emergency in the department;
- complaints when performing medical appointments, caring for patients and preparing them for tests;
- violations in the organization of proper monitoring of patients.
In addition, indicators such as the number of physical examinations, vaccinations, patient questionnaires and feedback received as performance criteria can be established as performance criteria, and for pediatricians, the level of breastfeeding.
Compensatory and incentive payments
The monetary allowance of employees of medical institutions consists of an official salary, incentive and compensation payments, as well as bonuses (if such a practice is established by local acts). The amount of compensation is set as a percentage of salaries, wage rates or in absolute terms. They cannot be lower than the sizes established by labor legislation, and are appointed for:
- work with difficult, harmful or dangerous working conditions;
- work in areas with special climatic conditions (desert, waterless areas, high mountain regions, regions of the Far North);
- combination of positions;
- increase in the volume of work;
- fulfillment of duties of an absent colleague (without release from his work);
- work at night;
- work with information constituting a state secret;
- other compensation payments provided for by law or a collective agreement.
As for incentive payments, in accordance with the Letter of the Ministry of Health of Russia dated September 4, 2014 No. 16-3/10/2-6752, which provides guidance on improving the system of remuneration of medical workers, these include:
- Payments for intensity and high performance.
- Payments for the quality of medical services provided (surcharge for the presence of a qualification category; bonus for the performance of a particularly important state or municipal task.
- Payments for work experience, length of service.
- Performance Awards:
- per month;
- for the quarter;
- in a year.
Please note that the conditions for the provision of these payments should be individualized and prescribed in relation to a particular employee and his type of activity.
Action algorithm
Making the transition to an effective contract in a healthcare institution, the employer must go through the following steps:
- Responsible employees - to study the regulatory framework.
- The heads of the medical organizations authorized to adopt legal acts in the field of health care - to develop performance indicators for subordinate organizations.
- Health care institutions, guided by the current legislation, should develop their own performance criteria and amend the Regulation on remuneration.
- The department responsible for formalizing labor relations is to develop a form of effective contracts and additional agreements, focusing on Appendix No. 3 to Program No. 2190-r.
- Employer - notify staff of upcoming changes 2 months in advance (if the employee refuses to work under the new conditions, the employer will have to offer this employee other available vacancies, in case of refusal, dismissal will follow in accordance with clause 7 of part one of Article 77 of the Labor Code of the Russian Federation).
At the end of the procedure, additional agreements are concluded with employees.
For any employee of a budgetary organization, the criteria for an effective contract (an employment contract with him) are extremely important. After all, the labor income of the employee, as well as the social package, directly depends on the quality of the performance of the relevant specified indicators in his position. We tell how the criteria are set and what they are.
Criteria as mandatory terms of the contract
Since 2012, Russia has been implementing the Program for the gradual improvement of the wage system in state and municipal institutions approved by the Decree of the Government of Russia dated November 26, 2012 No. 2190-r. Among other things, it obliges to include in the content of an effective contract criteria for evaluating the performance of a given employee in accordance with accepted indicators.
The practice so far is such that often indicators and criteria for the effectiveness of an effective employee contract:
- underdeveloped;
- their application is formal.
Incentive payments are of low efficiency if the system of remuneration of employees of the institution has left WITHOUT specifying specific measurable parameters such criteria as:
- conscientious performance of duties;
- labor intensity;
- quality of work, etc.
This practice should be a thing of the past. Performance criteria in an effective contract must be specific and quantifiable.
In addition, the management of a budgetary organization is obliged not to stop there and constantly improve the system of criteria.
The aforementioned Program for the gradual improvement of the wage system in state and municipal institutions prescribes to clarify the criteria for evaluating the effectiveness of activities for each employee. It is when:
- the conditions for receiving remuneration are clear to both the management and the employee;
- criteria are not ambiguous.
EXAMPLE
One of the criteria for evaluating the performance of a manager when assigning incentive payments to him is the ratio of the average salary of the staff of the institution he leads for the duties assigned to them from all sources and the average salary for this region, taking into account the achievement of average indicators for certain categories of employees for each subject of the Russian Federation.
Establishment procedure
At the institution level, the criteria for evaluating the effectiveness of an effective contract are prescribed in an internal regulatory act. Usually - in the Regulations on wages. It can also be:
- collective agreement;
- agreements;
- employment contracts.
At the same time, the position of the trade union, another representative body of workers, must be taken into account.
The criteria for an effective contract are always determined taking into account the achievement of the goals and performance indicators of the institution itself.
Each state institution is supervised by the corresponding higher ministry or department. They also set the criteria for an effective labor contract for their industry.
For example, the criteria for an effective contract in healthcare are enshrined in Order No. 696n of October 31, 2014 of the Russian Ministry of Health (as amended in 2018).
Here is a sample of criteria for an effective contract for a general practitioner:
| № | Index | Criterion | Periodicity |
| 1 | Defects in the quality of medical care based on the results of inspections by the medical commission, higher and supervisory authorities | Absence / 1 or more | Every quarter |
| 2 | Reasonable complaints about the quality, volume of medical care, compliance with the dental aspects of the activity on the conclusion of the medical commission | Absence / 1 or more | |
| 3 | Compliance of the quality of medical care with the established requirements (compliance with the timing of the examination of the patient, the volume and timeliness of diagnostic and therapeutic measures, etc.) | Compliance / Non-compliance | |
| 4 | Coincidence of clinical and pathoanatomical diagnoses | Match/Divergence | |
| 5 | Defects in the preparation of medical documentation, non-compliance with the deadlines for reporting | Absence / 1 or more |
Below is an example of an effective contract criteria for the chief accountant of a medical institution:
| № | Index | Criterion | Periodicity |
| 1 | Compliance with the requirements of budget and tax legislation, resolutions of the Government of the Russian Federation, orders of the Ministry of Health of Russia and other regulatory legal acts | Compliance / 1 or more cases | Every quarter |
| 2 | Compliance with reporting deadlines | Compliance/Non-compliance | |
| 3 | No wage arrears | Compliance/Non-compliance | |
| 4 | Unjustified receivables and payables | Absence / 1 or more | |
| 5 | Defects in monitoring the timeliness and validity of write-offs of fixed assets | Absence / 1 or more cases |
is a special form of an employment contract with a health worker, which details and similarly sets out such provisions as his work function, conditions for earning money and accruing payments that stimulate effective activity.
The procedure for drawing up a new form of an employment contract has its own characteristics, which are set out in legislative acts.
Transition to an effective contract in healthcare
Legislatively, the transition to an efficient contract is enshrined in Decree of the Government of the Russian Federation No. 2190-r dated November 26, 2012. The end date for the planned activities is 2018.
With regard to the healthcare sector, it follows from the meaning of the document that changes in the budgetary sphere are taking place to motivate medical personnel in their activities, as well as to increase the attractiveness of the medical profession for young professionals.
In the new forms of employment contracts, the medical institution should clarify and detail the content of the employee's duties, the criteria for assessing the performance of his work, the amount and conditions of incentive and incentive payments.
The legislator clarifies that the conditions that relate to the amount of remuneration must be set out in a form accessible to the employee, not to allow unambiguous wording.
Note that the concept of "effective contract" is not enshrined in the Labor Code of the Russian Federation. This means that “employment contract” is used as the main wording.
Therefore, all legal relations that, one way or another, are connected with the conclusion or change of an effective contract occur according to the same rules as before. The employer should be guided by them in the field of new rules.
The order of the Ministry of Labor of the Russian Federation No. 167n dated April 26, 2013 contains recommendatory provisions on the registration of employees of budgetary institutions with the conclusion of an effective contract under new conditions.
Let's consider the general provisions of concluding an effective contract with employees who are working and just entering the workforce, then we will move on to particular cases.
An effective contract in healthcare with a new healthcare worker
Since no new norms have been introduced in the Labor Code of the Russian Federation regarding the conclusion of an employment contract, the medical institution must conclude with its employees according to the previous rules.
However, in the conditions of transition to an effective contract, it is necessary to take into account the provisions that are provided for in the main acts:
- labor standards existing in the medical institution;
- the current system for calculating the earnings of medical workers, the procedure for establishing allowances for them and various payments, the size of official salaries, etc.;
- labor conditions based on the results of the conducted SOUT;
- the mode of work time of employees and their rest from their immediate duties;
- the staff list of the medical institution, which sets out its structure and the number of positions and rates by profession;
- specific working conditions for certain categories of workers, if they are present - for example, traveling work, mobile work, etc.
Since an effective contract provides for work with criteria and performance indicators for health workers, the employer must take into account the methodological recommendations on this issue, which are set out in the following documents:
- order of the Ministry of Health of the Russian Federation No. 421 dated June 28, 2013 (criteria and performance indicators for employees of subordinate medical institutions, managers and main categories of employees);
- order of the Ministry of Labor of the Russian Federation No. 287 dated July 1, 2013 (criteria and performance indicators for employees of social service institutions).
Each medical institution should develop and approve a standard effective contract (labor contract) according to the new rules, which is supplemented and specified for each new employee.
Transition to an effective contract for existing employees
If an employee is already working in a medical institution, and a regular employment contract was previously concluded with him, then he must be notified of changes in the employment contract in advance. According to the rules of Part 2 of Art. 74 the obligation of the employer to comply with the notice period - no later than two months before the date of the new rules.
There is no need to conclude a new contract with a health worker - an additional agreement is concluded with him, which contains all the necessary changes due to the implementation of an effective contract.
Agreements are concluded only in writing.
The document is drawn up in two copies, one of which is stored in the personnel department at the medical institution, and the second is transferred to the employee for storage.
The personnel department must ensure that a copy of the additional agreement, which remains in the personal file of the health worker, is signed by him after the conclusion.
Use the service of the Health Care Center Economics Help System: it will help transfer an employee to an effective contract and tell you what to do if the employee does not agree to the transfer
Change of conditions upon transition to an effective contract
Once again, we note the conditions that should be detailed in an effective contract, as a form of an employment contract:
- labor function of the employee;
- the amount of the salary;
- conditions for the provision and amount of compensation payments;
- conditions for granting and the amount of incentive payments.
In other words, this is still the same employment contract, but which describes in more detail what exactly the employee does in his position, what volumes of his work are provided for, and how his monetary remuneration for a job well done is calculated.
The program, approved by Government Decree No. 2190-r of November 26, 2012, also provides an exemplary form of an effective contract, which is the basis for budgetary organizations, including those in the healthcare sector.
Let's consider some practical questions which arise at heads of medical institutions.
1. Is it necessary to terminate the previous employment contract with an employee who already works in a medical institution?
- It is impossible to terminate the current employment contract with an employee, since only some of its provisions have changed. They are drawn up in the form of an additional agreement, which will be an integral part of the previous document.
2. Is it necessary to enter into an effective contract with a part-time employee, for example, with a paramedic who works at 1.75 rates?
- Any employment contract is concluded with all employees of a medical institution, and the form of an effective contract is no exception.
- If the paramedic is hired part-time, above the main rate, then two contracts are concluded with him - one for the main rate (1.0), and the second - for 0.75 of the internal part-time rate.
- Similarly, in a situation where a health worker has already been hired on a part-time basis and is undergoing the procedure for implementing an effective contract. Two additional agreements will be concluded with him - at the main place and part-time.
- The same rules apply to external part-timers.
- These requirements are quite justified, since the reform of the public sector involves specifying the labor functions of employees and indicators of their effective performance. This means that in any case, changes must be reflected in all labor contracts in force at the medical institution.
3. Is it necessary to draw up an effective contract in healthcare with specialist consultants (for example, doctors), if not labor contracts were previously concluded with them, but civil law contracts?
In this situation, the transition to an effective contract is not provided.
- This is due to the fact that the relations of such specialists are regulated by civil law, in accordance with the provisions of which contracts for the provision of services are concluded with them. As a rule, this is a one-time or episodic work, to which a specialist is temporarily involved.
- An effective contract is a kind of labor contract. It is designed to bring labor relations between a medical institution and its employees into the legal field. And these relations involve regular work, with a specific position and labor function, as well as timely remuneration by the employer.
- A civil law contract cannot regulate labor relations, and its parties are not an employee or an employer. For example, a contract for the provision of services includes a contractor and a customer.
- A complete list of types of civil contracts is reflected in the second part of the Civil Code of the Russian Federation. For example, this is the same contract for the provision of medical services for a fee or a work contract.
- So if a doctor does not have a license for medical activities, since he is not an individual entrepreneur, a medical institution can draw up a civil contract with him. But within the framework of this agreement, not medical, but consulting services will be provided.
All other employees must be warned that the conditions set out earlier in the employment contract are subject to change. The warning must be received by employees two months before they come into force.
Best examples of effective contract implementation in Russia ,
The health worker refuses to switch to an effective contract
An effective contract in healthcare and its essence is not always clear to the employee, and he may refuse a new form of employment contract.
It must be understood that such a refusal always entails certain legal consequences.
If the health worker does not want to sign an additional agreement to the concluded employment contract, in which the conditions of his remuneration and labor function are set out specifically, then the head of the medical institution must offer him another job.
The proposed job may not suit the health worker, or the employer may not have vacant positions at the moment - in this case, the employment relationship with the employee is terminated.
We recommend that you initially explain in detail to the employee that the new form of the employment contract is supplemented, and it will always specify the conditions for the employee’s work and his remuneration for this work.
In the resolution of the Plenum of the Armed Forces of the Russian Federation No. 2 dated March 17, 2004, it was said that when an employer notifies an employee about a change in an employment agreement, it is his duty to indicate that the changes are due to new technological or organizational labor conditions.
Government Decree No. 2190-r states that the introduction of a new system of rationing and remuneration of employees in a medical institution can be indicated as new organizational conditions.
In accordance with Art. 77 of the Labor Code of the Russian Federation, one of the grounds for terminating an employment contract is the employee's refusal to continue his activities under the amended conditions of the employment contract.
We summarize the procedure for the refusal of a health worker to issue an effective contract:
- The medical institution warns its employees in advance that the terms of their employment contracts will change two months before them;
- If the health worker does not agree to continue working in the new conditions, then in writing the employer is obliged to offer him another available position that corresponds to the level of knowledge and qualifications of the employee. In another locality, vacancies can also be offered, but only if this is provided for by the edition of the employment contract or a local act of the medical institution;
- If there is no suitable job or the health worker refuses it, then the employment relationship with him ends. The personnel department in the order for the dismissal of such a health worker should note the absence of a suitable position, or that the employee refused the proposed options.
How to draw up an additional agreement with an employee
All those sections and clauses of the additional agreement that contain the amended terms of the employment contract should begin with the words: “Section ... of this employment contract shall be reworded: ...”.
The introductory section of the agreement with the health worker to the employment contract consists of the following information:
- details of the document, date of its compilation and registration number;
- date of conclusion of the agreement to the employment contract;
- full details of the health worker with whom the agreement is concluded (name, position);
- the name of the employer and the legal basis for the actions of the official on whose behalf the agreement is concluded (for example, on the basis of a power of attorney or a charter).
Below is an example of the design of the introductory section of an additional agreement with a health worker.
| Additional agreement |
| to the employment contract No. ___ dated ____ |
| "__" ___________ 20__ |
| ___________________________________________________________________________, |
| (name of the institution in accordance with the charter) |
| in the person of _____________________________________________________________________, |
| (position, full name) |
| acting on the basis ___________________________________________________ |
| (charter, power of attorney) |
| __________________________________________________, hereinafter referred to as |
| employer, on the one hand, and ____________________________________________, |
| (Full name.) |
| hereinafter referred to as the employee, on the other hand (hereinafter referred to as the parties) |
| have entered into this Supplementary Agreement as follows: |
Download an additional agreement with an employee, sample/blank >>
Description of the work function of a health worker
When concluding an effective contract with a specific health worker, it is necessary to indicate in its text:
1. the name of his position (for specialists, employees and managers);
2. working specialty or profession (for working personnel);
3. what kind of work is specifically assigned to the employee.
It must be remembered that if work in a particular profession or position is associated with the receipt by the employee of any preferences and benefits (preferential professions), its name must comply with the professional standard and the qualification directory.
The correct job titles are given for health workers in the nomenclature of medical specialists, which was approved by order of the Ministry of Health of the Russian Federation No. 1183n dated December 20, 2012.
To find the correct job title or profession for non-medical personnel, refer to the following sources:
- unified qualification reference book (Order of the Ministry of Health and Social Development No. 541n dated July 23, 2010);
- positions of managers and specialists (Decree of the Ministry of Labor of the Russian Federation No. 37 of 21.08.1998);
- tariff-qualification reference books of working positions;
- all-Russian classifiers approved by Rosstandart (for example, order of Rosstandart No. 2020-st of December 12, 2014, resolution of Gosstandart No. 367 of December 26, 1994);
For some positions, you additionally need to specify:
- specialty - for a specialist doctor, in the direction in which he has training and directly performs these duties (for example, an endocrinologist);
- the name of the section of medical activity - for the deputies of the chief physician (for example, the deputy chief physician for the medical part);
- the full name of the medical position according to the profile - for the head of the department of the medical institution (for example, the head of the surgical department - a surgeon);
- the name of the position with the specialty - for the doctor of the admission department (for example, the doctor of the admission department - general practitioner).
For the titles of medical workers, in accordance with the Decree of the State Standard of the Russian Federation No. 367 of December 26, 1994, the words “senior”, “district”, “leading”, “district”, “chief” can be used in addition.
For example, head midwife, district paediatrician, head nurse, head nurse, etc..
Consider a practical situation:
It is necessary to correctly indicate the position of the head of the CDL, who has no medical education.
The correct title of the position of the head of the CDL is “head of the clinical diagnostic laboratory – laboratory assistant”. A specialist who worked as a laboratory doctor before 01.10.1999 may be appointed to such a position.
As follows from the nomenclature of medical workers approved by order of the Ministry of Health of the Russian Federation No. 1183n dated December 20, 2012, the title of the head of the department of the medical institution must be assigned the name of the medical position according to the profile of activity.
The only position that a specialist without a medical education can take is a laboratory assistant. In this case, the document contains a clause that only a specialist who was hired for this position before 10/01/1999 can work as a laboratory doctor. If the relevant specialist was hired later, then he cannot take the position of head of the CDL or laboratory assistant.
Specification of the labor function in an effective contract
An effective contract in healthcare allows you to disclose in detail the labor duties of an employee during his working hours.
It is not necessary to indicate exactly how many positions an employee occupies, for example, 0.25 rates. You must enter the total number of hours worked per week.
Also, in an effective contract that specifies the working conditions of a health worker, you can also indicate that the employee combines several positions or professions.
For example, in conditions of shortage of personnel, many nurses also perform the functions of a nurse. This time is not worked out in excess of the norm, since the employee performs this work during his main working day in addition to the main duties stipulated by the employment contract.
The employee is involved in the combination by agreement with the employer, the volume, content and payment of additional work are discussed.
The consent of the employee is reflected in writing. So, you can conclude an additional agreement with the employee or take written consent from him, after which the corresponding order of the head physician is issued.
The description of the labor function should be supplemented with specific duties performed.
It can be pointed out that the labor standards of a health worker are established by the official system of labor rationing of a medical institution.
Description of job responsibilities can be taken from job descriptions, which are compiled on the basis of qualification characteristics approved by order of the Ministry of Health and Social Development No. 541n dated July 23, 2010.
If a professional standard has been developed for a specific position, the necessary wording can be taken from this document.
Below is an example of a job description for a pediatrician.
The duties of the employee is to provide medical assistance to the children's population. Including:
- Examination of the patient in order to establish his diagnosis;
- Appointment of medical and diagnostic measures for the children's population, monitoring their safety and effectiveness;
- Development and implementation of individual rehabilitation programs;
- Sanitary and educational work with children and their parents, the formation of a healthy lifestyle of the population;
- Preventive activity of the health status of children in different age groups, as well as analysis of its effectiveness;
- Monitoring the activities of subordinate middle and junior medical personnel.
It is undesirable to record in an additional agreement that the employee must perform a certain amount of work (for example, to conduct a certain number of tests, studies, appointments, medical examinations).
It is also impossible to say that a health worker provides assistance only to certain groups of the population, for example, only for paid medical services.
Indication of the specific type of work assigned to the employee
An indication of the specific duties assigned to the employee must be made if the health worker does not perform all the duties provided for the position of a doctor, but, for example, part of them.
The job responsibilities of specialists are formed based on the qualification characteristics approved by the order of the Ministry of Health and Social Development No. 541n dated July 23, 2010.
If a doctor performs only a part of the functions provided for a specific position, for example, he will conduct an appointment and consultation, conduct only a specific study - an ECG, then they should be listed in an effective contract.
Also, the specific type of work assigned is indicated when concluding a fixed-term employment contract. For example, if an employee is hired to carry out preventive vaccinations for specific indications, for example, during a flu epidemic.
An employment contract or an effective contract in healthcare must necessarily contain the name of the structural unit in which the health worker will carry out his activities.
When specifying a structural unit, it is important to check the staffing of a medical institution and the list of departments of medical institutions, which are approved by Decree of the Government of the Russian Federation No. 781 of 10/29/2002.
Mistakes by the employer will lead to negative consequences for the employee - with inaccurate wording, the employee may lose his right to receive a preferential early pension.
Salaries in an effective contract
When reflecting the official salary of a particular medical worker in the text of an effective contract, it is necessary to indicate its amount in accordance with the regulations of the constituent entity of the Russian Federation, which determine the salaries for the PCG.
PKG are reflected in the following regulations:
- Order of the Ministry of Health and Social Development of the Russian Federation No. 526 of 08/06/2007 (for pharmaceutical and medical workers);
- Order of the Ministry of Health and Social Development of the Russian Federation No. 247n dated May 29, 2008 (industry-wide job titles of specialists, managers and employees); Order of the Ministry of Health and Social Development of the Russian Federation No. 248n dated May 29, 2008 (working specialties and professions).
| In which PCG is the position of the head (chief physician) of the medical institution?
Professional qualification groups in accordance with Art. 144 of the Labor Code of the Russian Federation are dedicated groups of positions of specialists and professions of workers. They do not include the positions of heads of medical institutions, including the chief physician. In addition, the PCG of a doctor is not provided for by orders of the Ministry of Health and Social Development No. 526 and No. 247n. The remuneration of labor of heads of medical institutions is established in the manner established by Decree of the Government of the Russian Federation No. 583 of 08/05/2008, in regional acts, in documents of municipalities and in the constituent documentation of a medical institution. |
In regional medical institutions, it is possible to establish official salaries of employees not according to the PCG, if such an order is directly regulated by a regional act.
Federal medical institutions can also use non-PCG salaries, however, this is not recommended.
Consider two practical situations that are associated with the establishment of official salaries for health workers.
1. Can an employee be given an official salary below the minimum wage.
- A medical institution can set official salaries that are lower than the minimum wage, but the amount of the entire monthly salary of a medical worker cannot be lower than the minimum wage established for the region or country.
- It is necessary to take into account that the salary of medical workers consists, in addition to the salary, of other payments - stimulating and compensatory in nature. Therefore, a salary that is below the minimum wage cannot be regarded as a violation.
- However, it is important to remember that often other payments may depend on the fulfillment by the employee of certain conditions in his activity, so it is important to take this into account when determining the salary.
- In recent years, medical institutions and other public sector organizations have been striving to increase their employees precisely the guaranteed part of their wages, i.e. raise their salaries first.
2. Is it possible for a health worker to establish a reduced basic salary for the period of probation.
- This approach does not meet the requirements of the law.
- When hiring an employee for a probationary period, this condition must be spelled out in his effective contract. It also indicates the conditions for remuneration of his work, including the specific amount of the official salary.
- In accordance with the requirements of Art. 22 and 56 of the Labor Code of the Russian Federation, a medical institution, as an employer, must pay wages to its employees in full, equally evaluate the equal work of its employees, including in monetary terms.
- This is due to the fact that the probationary period in accordance with Art. 70 of the Labor Code of the Russian Federation is initially established in order to check whether the health worker corresponds to the work assigned to him.
- Official salaries are always set in terms of money, in Russian rubles.
3. Does an effective contract need to reflect the amount of the employee's official salary, taking into account personal income tax?
- An employment contract and an effective contract in healthcare assume that the salary of an employee will be set in it, taking into account the income tax of an individual. As you know, personal income tax should tax all the income of an employee, his entire salary.
- In this case, the medical institution acts as a tax agent for the employee, transferring the withheld amounts to the appropriate budget.
- Also, in a medical institution, it is permissible to use, in addition to official salaries, daily or hourly fixed wage rates, when a health worker performs certain complex work in a certain unit of time.
- This rate does not include social, incentive and compensation payments.
Efficient healthcare contract and employee compensation
In order to reflect in an effective contract the compensation payments due to the employee, it is recommended to reflect them in the form of such a table:
- in an effective contract, it is worth mentioning only those payments that form the salary of a health worker;
- do not mention the compensation associated with the processing of an employee who exceeded the monthly work rate;
- you can indicate fixed amounts of payments in rubles, or reflect them as a percentage of the salary (for example, payment for continuous work experience in healthcare - 30% of the official salary);
- if the amount of a particular payment and the conditions for its calculation are precisely determined by the legislator, you can use the following wording in the contract - "other compensation payments are made to the employee in the amount determined by the legislation of the Russian Federation."
Order of the Ministry of Health and Social Development of the Russian Federation No. 822 dated December 29, 2007 established lists of compensation payments for employees of budgetary and state-owned organizations.
The following types of such payments are established in the Labor Code of the Russian Federation:
- for work at night;
- for work in working conditions deviating from normal(harmful production factors);
- for work in irregular working hours;
- for work in special climatic conditions (Far North);
- for work on weekends and holidays.
Incentive payments for health workers in an effective contract
An effective contract in healthcare, among other things, is designed to stimulate the effective work of employees. As such, it provides detailed criteria and performance indicators for an employee to receive these benefits.
Reflect the conditions and amounts of these payments in a special table, which will include the following information:
- the name of the payment due to the employee;
- the condition of its accrual;
- criteria for evaluating the activities of an employee;
- the purpose of achieving a particular criterion (its indicator);
- terms of payments and their frequency;
- amounts or amounts of payments in relation to the official salary.
All payments specified in an effective contract must correspond to the payments and their values approved by the medical institution's remuneration system.
It is not recommended to establish payments that are not related to the performance of the employee and medical institutions, as well as immeasurable and specifically uncertain payments and their conditions, for example, incentive payment for intensive work.
On one-time bonuses and payments, an effective contract in healthcare may provide for the following wording: “on the basis of local acts of a medical institution, an employee may be given one-time incentive payments, which are provided for by the current remuneration system.”
The condition of the incentive payment is a specific requirement that a health worker must fulfill in the course of exercising his professional duties in order to accrue it.
For example, such a requirement may be the absence of comments from management or disciplinary sanctions.
The order of the Ministry of Health of the Russian Federation No. 421 dated 06/28/2013 refers to the use of the principle of scoring for the calculation of incentive payments. However, this provision is advisory in nature.
The frequency of specific payments can be different - once a month, once a year, once a quarter, based on the results of work.
We summarize the content of this article on the implementation of an effective contract in healthcare:
| Things to keep in mind when implementing an effective contract | What should be done |
| Conclusion of additional agreements with existing employees of the medical institution | All employees are warned in advance that the medical institution is introducing an employment contract in the form of an effective contract for two months.
The basis for concluding an agreement is a change in technological and organizational labor conditions |
| Labor function of a health worker | For managers and specialists of a medical institution, a specific position is indicated, for workers - a specialty or profession.
An effective contract must indicate the department or subdivision of the medical institution in which it is accepted. |
| Official salaries | The amount of the official salary of a health worker is indicated in rubles. The amount of the salary corresponds to the regional acts, according to a certain PKG, to which the position of the employee belongs. |
| Compensatory payments | An effective contract lists all payments, indicates the basis for their payment |
| Incentive payments |
Payments must not only be listed, but also indicate what indicators the employee must achieve in order to receive them, in what period they are paid. |
The use of an effective contract for health workers is designed to bring the quality of services to a new level and increase the interest of workers in achieving high performance. For this purpose, special criteria for an effective contract (in health care) are established for health workers. In fact, the introduction of an effective contract allows you to establish a direct relationship between the quantity and quality of work performed by an employee and the amount of remuneration of a particular employee.
The basic task for health care is to improve the quality of services for the population in the coming years. To achieve the goal, it was decided to move from estimated financing to a more advanced system of remuneration - an effective contract in healthcare. The amount of incentive payments, salary, labor assessment criteria - these indicators will affect the level of income of medical personnel. Officials are confident that the transition to effective contracts in healthcare will improve working conditions for staff, improve the quality of services for the population and stop the outflow of qualified personnel.
Tasks and criteria for an effective contract in healthcare
The concept of an effective contract has been present in the legislation for quite a short time. It was introduced by order of the Government of Russia dated November 26, 2012 No. 2190-r. This normative act approved a special program, in accordance with which a gradual improvement in the procedure for remuneration of employees of budgetary institutions will be carried out.
In order to increase the efficiency of the work of employees and motivate them to achieve maximum professional results, conditions on special incentive payments are introduced into the employment contract. At the same time, such payments are made only when the employee reaches the indicators stipulated by the contract.
In this regard, information on the list of incentive payments established in relation to each specific employee is entered into an effective contract. In addition, the indicators are clearly prescribed, upon reaching which the employee receives contractual payments.
Most often, to introduce performance indicators, the current labor contract with the employee is supplemented with special provisions, which include the criteria for an effective contract in healthcare. For this purpose, an additional agreement is concluded to the current employment contract, which lists performance indicators, incentive payments and their size.
You can download an effective contract in healthcare on our website. Here we bring to your attention an additional agreement to the employment contract, which contains information specific to an effective contract. Such an additional agreement to an employment contract (an effective contract in healthcare sample)
Sample effective contract in healthcare
An effective contract is a new type of employment agreement that clearly defines the responsibilities of each employee. An effective contract in healthcare will change the attitude of employees to their duties and improve the level of services provided to the population. The task of the reform is to analyze the work of both an individual specialist and the entire medical organization. The main goals of the state program:
- Maintain human resources.
- Ensure decent wages in every medical organization.
- Raise the prestige of the profession.
- Significantly improve the quality of services.
- Encourage employees to improve their skills.
To achieve the goals in the new employment contract, special attention is paid to the section "Payment". An effective contract in healthcare provides for several types of payments:
- Rate and salary.
- Compensatory payments - allowances for seniority, working conditions, etc.
- Incentive payments - in this paragraph, the developed system of criteria for assessing personnel is fixed.
Please note that the incentives are not permanent. In order to receive them, the employee must fulfill certain conditions, have no complaints from patients, follow the established plan, etc.
A sample of an effective contract in healthcare can be supplemented with other conditions:
- Introduction of a point system for assessing work.
- Cash reward for an overfulfilled plan (for example, conducting medical examinations, etc.).
- Specification of job responsibilities for each employee.
- Periodicity of payments.
Transition to efficient contracts in healthcare
Reforms are always scary, but an effective contract in healthcare is the same labor contract. The main difference is that all job responsibilities will be spelled out in the document. The transition to an effective contract in healthcare requires compliance with certain conditions:
Step 1. Preparation and delivery of the notice to each employee.
At least 2 months before the transition to a new remuneration system, the manager must familiarize the staff with the innovation (under signature).
Step 2. Development of an additional agreement to the current employment contract.
Here are the new working conditions. Since there will be many changes, the parties "agree" on a new version of the agreement.
Step 3. Issuance of an order (effective healthcare contract).
The document informs about the transition to a new system of remuneration.
If the employee does not agree to continue working under the new conditions, he may be dismissed under clause 7 of part 1 of Art. 77 of the Labor Code of the Russian Federation.
Further, a commission is being created, which will form the criteria for assessing personnel according to certain indicators. Local acts of the organization are being developed and amended - a collective agreement, internal labor regulations, job descriptions, regulations on remuneration.
The employer must specify a deadline for the transition of the entire organization to an effective contract in healthcare.
Prerequisites for reform - why is it necessary to switch to an efficient contract in healthcare?
An effective contract in healthcare is necessary to improve the wage system: each employee receives incentive payments by providing quality services. The most important tasks became the prerequisites for the reform:
- Implementation of the national project "Health" - additional payments to health workers.
- The regional modernization program is the introduction of high standards of services and improving the quality of medical care.
During the analysis of the existing system of remuneration in health care, it was found that it is not effective. Employees receive various allowances, salaries, payments for harm. But there are no incentive payments for the quality of services and personal achievements. An effective contract in healthcare will change the very mechanism of payroll, motivating employees to improve their skills, honing their professionalism.
The transition to effective contracts in healthcare is a complex process only in organizational terms. But such an approach will make it possible to increase the level of income of employees and introduce new quality standards for the provision of medical services.
Material prepared and checked by our experts
Hello, friends! In this article, I would like to talk about how, from the point of view of law, relations between a medical worker and an employer are being built today. If in the not so distant Soviet times the concept of an employment contract existed more in theory than in practice, today not a single enterprise or institution works without it.
Why is an employment contract necessary?
Your social security depends on how the employment contract is drawn up, what rights and obligations are included in it. The law strictly regulates such concepts as the duration of working hours, rest, minimum wage, working conditions, which is reflected in the contract. It is important for both parties.
However, today in a number of industries, ordinary employment contracts are undergoing changes. First of all, this applies to social workers, including medical workers. In recent years, such a form of contract as an effective contract in healthcare has become widespread.
Exemplary examples of such a contract can be easily found and downloaded on the Internet. However, it must be understood that these are just exemplary samples, since an effective contract in force in one institution may differ significantly from that adopted in another. Therefore, you need to figure out what kind of document it is, how it differs from a regular employment contract, and whether it is really effective.
Similarities and differences
To begin with, we note by whom and when it was regulated. In November 2012, the Russian government issued a decree, the purpose of which was to regulate the issues of remuneration for employees of social institutions, including healthcare institutions. It is this document that contains the requirement to switch to the conclusion of an effective contract in the industry by 2018.
Is it possible to say that an effective contract and an employment contract are directly opposite concepts? No, this statement is incorrect. Both comply with Labor Law. In fact, the contract is the same contract, but more detailed. It outlines what specific labor duties the employee must perform. This is an important point, because earlier in the contract they were not based on them, but on the position.
Efficient work needs to be encouraged
In addition to describing responsibilities, an effective contract details the terms of remuneration. Not the minimum wage, but all together - salary, incentive payments, compensation for work in harmful working conditions, in special weather conditions, etc. The bonus, if any, is also indicated.
The contract also includes such an indicator as efficiency. To evaluate it, criteria for evaluating the work of medical workers are being developed. This is a rather difficult moment, causing different reviews when switching to a new system. It was assumed that the work will be evaluated on a point system. However, as it turned out, a special staff is needed to calculate points, which is not always possible.
Nevertheless, each health care institution itself accepts the conditions under which incentive payments are established. Their adoption must be documented and reflected, for example, in such documents as the Regulation on remuneration or incentive payments.
These payments necessarily take into account the quality of the work of the doctor, nurse and other medical workers. For example, if an emergency occurred due to the fault of an employee, a medical error was made, patients reasonably complain about the quality of treatment, then incentive payments can hardly be discussed.
On the contrary, if the work is carried out intensively, causes good reviews, leads to results, the employee improves his qualifications, has a long work experience, then he has the right to count on incentive payments. This approach is important not in itself, but for improving the quality of services, which occurs, among other things, due to material interest.
If an employee refuses
How is the transition to a new type of contract? Firstly, it is absolutely not necessary to conclude a new employment contract with employees who are already working in the institution. It is enough to draw up an additional agreement and reflect in it all the changes that an effective contract carries. If the employee does not agree, he is offered another position. In case of refusal, the employment relationship is terminated.
It is necessary to warn employees two months before the transition to a new uniform. It is developed by responsible employees of the labor department, taking as a basis the annex to the government order mentioned above. Before the transition to new conditions, documents must be developed to determine the effectiveness.
Pitfalls of innovation
The introduction of an effective contract pursued the goal of stimulating health workers to improve the quality of service delivery. At the same time, the government is taking steps to significantly increase their wages. It is assumed that this form will increase the salary so that it will be 200% of the average in the region.
Unfortunately, in practice it does not always work out as intended. Reviews of health workers indicate that the new form has disadvantages. One of them is the insufficient financing of the industry, as a result of which there is a contract, incentive payments are prescribed, people work well, but there are no funds to implement the promised.
Not everything is simple with the definition of work efficiency - it still raises a lot of questions and dissatisfaction on the part of doctors and nurses. Although, in general, the idea of an effective contract is a positive moment in the development of healthcare and in the activities of every medical worker.
If you have already switched to a new form of contract or are just about to do it, we will be glad to hear your opinion on the topic, as well as feedback on our article. Leave comments on our site, we are interested in everyone's opinion.