Modernization of the organizational mechanism of functioning of institutions of the secondary and tertiary levels of healthcare
Authors: Melnyk Alla , Bogach Yuriy 
Published: February 2021

Introduction. The second stage of the reform in the domestic health care system, which concerns its secondary and tertiary levels, began in Ukraine on April 1, 2020 after fulfilment of some tasks of reforming medicine. The issues of modern peculiarities of the work of institutions of these levels are currently insufficiently worked out both on the theoretical and empirical level, which often leads to the lack of algorithms for solving problems that arise in this area. This requires research in the context of modernizing the organizational mechanism of operation of these health care facilities in today’s complex environment.The purpose of the study is to develop theoretical and methodological foundations  of the enterprise’s organizational mechanism, its empirical assessment of the health care institution of the secondary (tertiary) level of medical care in the course of its transformation, and develop proposals for its modernization.Methods. The study used epistemological, comparative and systematic methodological approaches to study the object and subject of research, research methods: dialectical, linguistic, PEST analysis, ABC analysis, SWOT analysis, expert evaluations, program- target.Results. The author’s position on the interpretation of the content of the enterprise’s organizational mechanism and its main components is presented. The factors are determined and the objective necessity of modernization of the organizational mechanism of the health care institution is substantiated.The structural component-by-component analysis of the current organizational mechanism of functioning of the health care institution of the secondary (tertiary) level of medical care is carried out. “Bottlenecks” have been identified, and the most influential among them, such as unsatisfactory coordination of the working processes and problems of resource provision, have been distinguished.The expediency of developing a strategy for the development and operation of a medical institution for the future is substantiated. Strategic priorities in the formation of a modernized model of development and functioning of a medical institution are highlighted. Clear structuring and content of strategic and operational goals; strategy development    in optimistic and pessimistic variants; development of additional strategies - image and resources have been proposed.Finally, the following steps have been proposed: a) improved organizational structure of management, through the addition of units of the current linear-functional structure and the creation of an additional adaptive structure as a temporary; b) the author’s solution of the problem of organizational design of the content of works, which is based on a differentiated approach to the typical work related to the treatment process and work (technology, types of services); c) organizational design of personnel activities.Prospects for further research concern the study of modernization of organizational design of medical staff and the problem of introducing innovative technologies in the organization of functional activities of hospitals.