General and medical director at medical institutions
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What powers will be assigned to a General director of medical institution and a Medical Director? What requirements should meet a Director of medical institution and a Medical Director?
What will happen to the chief doctors, who are currently working in medical institutions?
Are these innovations applied to private medical institutions?
Normative-legal regulation
ConclusionIn order to bring your healthcare facility in compliance with the requirements of the law, our lawyers will conduct an audit and offer the best cost- and time-effective solution, to make your facility fully operational and compliant with all requirements of the Ministry of Health of Ukraine (MoH).
The functions of the CEO and MeD will be differentiated from January 1, 2019, when the Order No. 1977 of the Ministry of Health of Ukraine of 31.10.2018 comes into force.
The Ministry of Health notes that such steps are necessary to relieve the burden on chief physicians, who, in addition to their direct responsibilities as physicians, are also entrusted with administrative functions that creates a heavy workload.
It is expected that the Order will allow to make the management of healthcare facilities much more effective and efficient. Since the changes provided for by this Order of the Ministry of Health are primarily aimed at splitting the functions of the head of the healthcare facility, who will deal with purely administrative and economic activities of the healthcare facility - these tasks will be assigned to the Healthcare Chief Executive Officer (hereinafter referred to as the CEO of the healthcare facility).
The Medical Director will handle the issues related to the effective delivery and quality of medical services. Since the distribution of the posts of the CEO and Medical Director may place additional human and cost loading on the healthcare facility, our lawyers tried to answer the question whether one person can hold both positions. HOW TO BECOME A CEO AND A MEDICAL DIRECTOR OF A HEALTHCARE FACILITY AT THE SAME TIME? CAN ONE PERSON HOLD TWO POSITIONS?
More about the powers and requirements for the CEO and MeD of a Healthcare facility
Roles and responsibilities of the CEO:
- He/She shall be responsible for the business and financial activities, as well as for the results of such activities;
- He/She shall ensure the fulfillment of all financial obligations to the state, clients and creditors, as well as monitore the enforcement of employment and commercial agreements;
- He/She shall ensure interaction between all organisation departments;
- He/She shall ensure recruitment of workers;
- He/She shall delegate deputies to deal with issues related to financial and economic activities within the powers;
- He/She shall represent the healthcare facility at all state agencies and media.
Qualification requirements for the CEO:
- Until January 1, 2022 - higher education (master’s degree) in Law, Economics, Management or Medicine.
- From January 1, 2022, management education is a must, except for the CEOs of primary healthcare facilities.
Employment history requirements for the CEO:
Total years of management experience
- All-Ukrainian institutions - ≥10 years;
- Regional institutions - 7 years;
- Community institutions - 5 years.
To become a CEO of the primary healthcare facility, a person shall have ≥ three (3) years of experience in major or one (1) year of experience in managerial positions.
Roles and responsibilities of the MeD:
- He/She shall deal with the medical issues (except for pharmacies) within the framework determined by the CEO of the facility, and may also perform the duties of the CEO in case of his/her absence;
- He/She shall monitor the quality of medical services;
- He/She shall hold responsibility for the professional development of medical staff;
- He/She shall ensure efficient external and internal coordination of the facility’s units.
Qualification requirements for the MeD:
Second level higher education (master's degree), specialization in healthcare, followed by specialization in Healthcare Organization and Management.
Employment history requirements for the MeD:
Managerial positions:
- All-Ukrainian facilities - ≥ 5 years,
- Regional facilities - ≥ 3 years.
- Community facilities - 5 years as a physician.
To become a MeD of the primary healthcare facility, a person shall have ≥ three (3) years of experience in major or one (1) year of experience in managerial positions.
If you want to learn how these positions are presented in medical license documents, please check our video.
What will happen to those Chief Physicians who are currently working in healthcare facilities, if their employment agreements are not terminated after 01.01.2019?
The good news is that Chief Physicians who have already concluded or intend to conclude an employment agreement prior to the date, when the Order comes into force (January 1, 2019), will follow the existing proceedings - i.e. they will be in charge of both administrative and medical processes - up to the date stipulated by the agreement.
Thus, the authorized executive body may appoint a Chief Physician for a period of 3 to 5 years (in accordance with para. 9 of Article 16 of the Law of Ukraine on the Fundamentals of Legislation of Ukraine on Healthcare) until 31.12.2018, without having obligation to hire another director - a Medical Director of the healthcare facility.
Once the employment agreement expires, the Chief Physician may be appointed as a CEO or a MeD on a competitive basis.
After January 1, 2019, no one can be appointed as a Chief Physician of the healthcare facility, including regional, central city, community healthcare facility, etc., as this post will be removed from the Handbook of qualification characteristics of professions. Edition 78 “Healthcare”.
The employees, that have been working as a Deputy Chief Nursing Officer before the Order No. 1977 of the Ministry of Health of Ukraine of 31.10.2018 comes into force, shall continue to perform their duties.
It should be noted that at present (November 2018) the Handbook of qualification characteristics of professions 003: 2010 does not contain the Medical Director occupational title, as well as exclude the possibility of creating such a title. Therefore, the Dictionary of Occupational Titles is reasonably expected to be amended and supplemented with the Medical Director occupational title since 01.01.2019. The healthcare reform mostly affect public healthcare facilities run by either the state or the municipality. You can learn more about the challenges to be faced by healthcare facilities at the first stages of reorganization and licensing from the general practice of our company up to 2018. ACTED AS LEGAL ADVISORS FOR A NUMBER OF MUNICIPAL MEDICAL INSTITUTION ON THE MATTERS OF LICENSING IN UKRAINE.
Are these developments set forth in the Order No. 1977 of the Ministry of Health of 31.10.2018 applicable to private healthcare facilities?
In terms of the current legislation:
Healthcare facility is a legal entity of any form of ownership and legal form or its separate subdivision providing medical services to the population on the basis of an appropriate license and professional activities of medical (pharmaceutical) workers.
The definition of a healthcare facility clearly shows that the legislator recognizes private healthcare institutions as fully-fledged entities that provide healthcare services to the population and at the same time have the appropriate license and staff to deliver such services.
The key difference between private and public healthcare facilities lies in who owns the facility and who appoints the facility staff.
In accordance with para. 7-9 of Article 16 of the Law of Ukraine on the Fundamentals of the Legislation of Ukraine on Healthcare, the head of the healthcare facility of any form of ownership may be only a person who meets the unified qualification requirements established by the Ministry of Health of Ukraine.
The head of a healthcare facility shall be appointed and dismissed in accordance with the legislation.
Heads of state and municipal healthcare facilities shall be appointed by the executive body authorized by the owner of the healthcare facility on the basis of competitive selection. The employment agreement shall be concluded for a period of 3-5 years.
Accordingly, the heads of state and municipal healthcare facilities shall be appointed by the authorized body of the healthcare facility exclusively on a competitive basis and for a period of three to a maximum of five years.
With regard to the heads of private healthcare facilities (let’s take the example of an LLC), it is the CEO of the healthcare facility that shall be appointed by the supreme corporate body of the Company, and the Medical Director may be appointed either by the supreme corporate body of the Company, or by the CEO of the healthcare facility, since the CEO of the healthcare facility is a person that is responsible for hiring qualified employees, who selects and appoints staff for the present needs of the Company.
Proceeding from the position that Chief Physicians whose employment agreement doesn’t expire before 01.01.2019 will continue to work in the same manner as at present, a private healthcare facility may sign an employment agreement with its
Chief Physician until 31.12.2019, for example, for five years, without having to search for and recruit another manager, a Medical Director, until the employment agreement with the current director expires.
In any case, the practice of applying these developments will provide an accurate answer to the question on the application of legislative developments. Distribution of administrative positions in healthcare facilities is not the only novation of the medical reform in Ukraine. Much larger changes have affected the primary healthcare. You can learn more about the conclusion of agreements with family physicians, compensation for such services etc. in the material prepared by our lawyer. СONCLUSION OF THE AGREEMENT FROM THE SIDE OF FAMILY PHYSICIAN: DETAILED EXAMINATION FROM LAWYERS
Legal and Regulatory Framework
Reconstruction of the management structure of healthcare facilities was approved by the Order No. 1977 of the Ministry of Health of Ukraine of 31.10.2018 on Amendments to the Handbook of qualification characteristics of professions. Edition 78 “Healthcare”, which was approved by the MoH to improve the management of healthcare facilities.
Conclusion
This division of powers, where one of the managers is responsible only for the management and administration of the healthcare facility, while the other is responsible for the quality and efficiency of the healthcare services provided by the healthcare facility, is expected to have a positive impact on the management of the healthcare facility and on the quality and efficiency of the healthcare services provided to the population of our country.
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