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Ãëàâíàÿ arrow Àðõèâ íîìåðîâ arrow ¹6 2023 (69) arrow ÏÐÎÒÎÒÈÏÈÐÎÂÀÍÈÅ ÏÐÎÅÊÒÎÂ – ÈÍÑÒÐÓÌÅÍÒ ÏÐÎÃÍÎÇÈÐÎÂÀÍÈß È ÎÏÒÈÌÀËÜÍÎÃÎ ÐÀÇÂÈÒÈß ÎÒÐÀÑËÈ ÇÄÐÀÂÎÎÕÐÀÍÅÍÈß
ÏÐÎÒÎÒÈÏÈÐÎÂÀÍÈÅ ÏÐÎÅÊÒΠ– ÈÍÑÒÐÓÌÅÍÒ ÏÐÎÃÍÎÇÈÐÎÂÀÍÈß È ÎÏÒÈÌÀËÜÍÎÃÎ ÐÀÇÂÈÒÈß ÎÒÐÀÑËÈ ÇÄÐÀÂÎÎÕÐÀÍÅÍÈß Ïå÷àòü
24.12.2023 ã.

DOI: 10.21045/2071-5021-2023-69-6-1

1,2 Àõîõîâà À.Â., 2 Òõàáèñèìîâà È.Ê., 2 Ãàéäàø Î.Á., 2 Êàðäàíîâ Ò.Ñ., 2 Ìîêàåâ À.Ì.
1Îáùåñòâî ñ îãðàíè÷åííîé îòâåòñòâåííîñòüþ Ôèðìà «ÑÝÌ», ã. Íàëü÷èê, Ðîññèéñêàÿ Ôåäåðàöèÿ
2ÔÃÁÎÓ ÂÎ «Êàáàðäèíî-Áàëêàðñêèé ãîñóäàðñòâåííûé óíèâåðñèòåò èìåíè Õ.Ì. Áåðáåêîâà» Ìèíîáðíàóêè Ðîññèè, ã. Íàëü÷èê, Ðîññèéñêàÿ Ôåäåðàöèÿ

Ðåçþìå

Àêòóàëüíîñòü. Ïðîòîòèïèðîâàíèå â ïðîåêòíîé äåÿòåëüíîñòè — ýòî èíñòðóìåíò ôîðìèðîâàíèÿ ïðåäâàðèòåëüíîé (ðàííåé) ïàðàäèãìû ïðîåêòà, ñ öåëüþ ïðîâåäåíèÿ àïðîáèðîâàíèÿ è îöåíêè ýôôåêòèâíîñòè åãî èñïîëüçîâàíèÿ, àíàëèçà òåõíè÷åñêèõ õàðàêòåðèñòèê, ïåðåä íà÷àëîì ðåàëèçàöèè.

Àâòîðàìè âïåðâûå ïðåäïðèíÿòà ïîïûòêà îáîñíîâàòü íåîáõîäèìîñòü ñîçäàíèÿ ïðîòîòèïà â ìåäèöèíñêîé îðãàíèçàöèè, ðåàëèçóþùåé ïðîåêòû, ñ âûáîðîì óðîâíÿ äåòàëèçàöèè ïðîòîòèïèðîâàíèÿ, îðèåíòèðîâàííîãî íà ýôôåêòèâíîå èñïîëüçîâàíèå ðåñóðñîâ ñèñòåìû çäðàâîîõðàíåíèÿ â áóäóùåì, ïîòðåáíîñòåé ïàöèåíòà, áåðåæíîå îòíîøåíèå ê âðåìåííîìó ðåñóðñó êàê îñíîâíîé öåííîñòè çà ñ÷åò âûáîðà îïòèìàëüíîé ëîãèñòèêè ðåàëèçóåìûõ ïðîöåññîâ.

Îáúåêòîì èññëåäîâàíèÿ ÿâëÿþòñÿ ïðîöåññû ïðîòîòèïèðîâàíèÿ ðàçíîé ñòåïåíè äåòàëèçàöèè, çàâèñÿùèå îò ñóáúåêòîâ - ó÷àñòíèêîâ ðåàëèçàöèè ôåäåðàëüíûõ ïðîåêòîâ, èñïîëíèòåëåé íà óðîâíå ðåãèîíà, ïàöèåíòîâ.

Öåëü èññëåäîâàíèÿ: ñîçäàíèå àáñîëþòíîãî ìèíèìóìà â ìåäèöèíñêîé îðãàíèçàöèè (ïðîòîòèïà), ðåàëèçóþùåé ïðîåêòû, â êà÷åñòâå èíñòðóìåíòà äëÿ ïðîâåðêè ôóíêöèîíàëüíîñòè ýòàïîâ äî íà÷àëà èõ ôàêòè÷åñêîãî ïðåäîñòàâëåíèÿ (ðàçðàáîòêè) è ïîñëåäóþùåé îöåíêè. Äëÿ äîñòèæåíèÿ äàííîé öåëè ïðåäïðèíÿòà ïîïûòêà äîêàçàòü íåîáõîäèìîñòü ïðèìåíåíèÿ ïðîöåññîâ ïðîòîòèïèðîâàíèÿ íà ðàçíûõ óðîâíÿõ âîïëîùåíèÿ ñòðàòåãè÷åñêèõ öåëåé, ïîñòàâëåííûõ íàöèîíàëüíûìè ïðîåêòàìè ñ òî÷êè çðåíèÿ ñëåäóþùèõ õàðàêòåðèñòèê: ñêîðîñòè, ñòîèìîñòè, îáðàòíîé ñâÿçè è ðåàëèñòè÷íîñòè.

Ìàòåðèàëû è ìåòîäû. Ìàòåðèàëàìè èññëåäîâàíèÿ ÿâèëèñü ðàáîòû ðîññèéñêèõ è çàðóáåæíûõ ó÷åíûõ, ñâÿçàííûõ ñ ïðîòîòèïèðîâàíèåì â ðàçíûõ îòðàñëÿõ äåÿòåëüíîñòè.  ñôåðå çäðàâîîõðàíåíèÿ äàííàÿ ìåòîäèêà ïðåäëîæåíà âïåðâûå. Äëÿ îáîñíîâàíèÿ íåîáõîäèìîñòè èñïîëüçîâàíèÿ ïðîöåññîâ ïðîòîòèïèðîâàíèÿ ïðè ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ èñïîëüçîâàëèñü ìåòîä ñèñòåìíîãî è ñòðóêòóðíî-ôóíêöèîíàëüíîãî àíàëèçà.

Ðåçóëüòàòû.  èòîãå àâòîðîì ñôîðìóëèðîâàíû ïðàêòè÷åñêèå ðåêîìåíäàöèè, êîòîðûå ïîìîãóò ñíèçèòü ðèñêè è îïòèìèçèðîâàòü çàòðàòû íà ðåàëèçàöèþ ïðîåêòîâ, ñ ïîìîùüþ ïîòåíöèàëüíûõ âîçìîæíîñòåé ïðîòîòèïà, çàâèñÿùèõ îò óðîâíÿ åãî äåòàëèçàöèè è ïîëó÷èòü îáðàòíóþ ñâÿçü îò ïîòåíöèàëüíûõ ñòåéêõîëäåðîâ ïðîåêòà.

Çàêëþ÷åíèå. Ïðîòîòèïèðîâàíèå ÿâëÿåòñÿ íîâûì óïðàâëåí÷åñêèì èíñòðóìåíòîì â îòðàñëè çäðàâîîõðàíåíèÿ è ìîæåò ñòàòü ýôôåêòèâíûì ðåçåðâîì äëÿ äîñòèæåíèÿ ïîñòàâëåííûõ öåëåé ôåäåðàëüíîãî ïðîåêòà íàöèîíàëüíîãî ïðîåêòà «Çäðàâîîõðàíåíèå». Âûñîêèé óðîâåíü äåòàëèçàöèè ïðîòîòèïà ìàêñèìàëüíî ïðèáëèæ¸í ê êîíå÷íîìó ðåçóëüòàòó ïðîåêòà, ïîýòîìó ïðè âçàèìîäåéñòâèè ñ íèì ïîòðåáèòåëè óñëóã ïîëó÷àò ïðàêòè÷åñêèé îïûò, ìàêñèìàëüíî ïðèáëèæåííûé ê ðåàëèñòè÷íîìó.

Êëþ÷åâûå ñëîâà: óðîâíè äåòàëèçàöèè ïðîòîòèïà; ïîòåíöèàëüíûå ñòåéêõîëäåðû ïðîåêòà; ïðîòîòèï ìåäèöèíñêîé îðãàíèçàöèè; ïðîöåññû ïðîòîòèïèðîâàíèÿ, ïðîåêòû

Êîíòàêòíàÿ èíôîðìàöèÿ: Àõîõîâà Àçèñ Âëàäèìèðîâíà, åmail: Ýòîò e-mail çàùèùåí îò ñïàì-áîòîâ. Äëÿ åãî ïðîñìîòðà â âàøåì áðàóçåðå äîëæíà áûòü âêëþ÷åíà ïîääåðæêà Java-script .
Ôèíàíñèðîâàíèå. Èññëåäîâàíèå íå èìåëî ñïîíñîðñêîé ïîääåðæêè.
Êîíôëèêò èíòåðåñîâ. Àâòîðû äåêëàðèðóþò îòñóòñòâèå ÿâíûõ è ïîòåíöèàëüíûõ êîíôëèêòîâ èíòåðåñîâ â ñâÿçè ñ ïóáëèêàöèåé äàííîé ñòàòüè.
Ñîáëþäåíèå ýòè÷åñêèõ ñòàíäàðòîâ. Äàííûé âèä èññëåäîâàíèÿ íå òðåáóåò ïðîõîæäåíèÿ ýêñïåðòèçû ëîêàëüíûì ýòè÷åñêèì êîìèòåòîì.
Äëÿ öèòèðîâàíèÿ: Àõîõîâà À.Â., Òõàáèñèìîâà È.Ê., Ãàéäàø Î.Á., Êàðäàíîâ Ò.Ñ., Ìîêàåâ À.Ì. Ïðîòîòèïèðîâàíèå ïðîåêòîâ - èíñòðóìåíò ïðîãíîçèðîâàíèÿ è îïòèìàëüíîãî ðàçâèòèÿ îòðàñëè çäðàâîîõðàíåíèÿ. Ñîöèàëüíûå àñïåêòû çäîðîâüÿ íàñåëåíèÿ [ñåòåâîå èçäàíèå] 2023; 69(6):1. Ðåæèì äîñòóïà: http://vestnik.mednet.ru/content/view/1542/27/lang,ru/. DOI: 10.21045/2071-5021-2023-69-6-1

PROJECT PROTOTYPING AS A TOOL FOR PREDICTION AND OPTIMAL DEVELOPMENT OF THE HEALTHCARE INDUSTRY
1,2 Akhokhova A.V., 2 Tkhabisimova I.K., 2 Gaydash O.B., 2 Kardanov T.S., 2 Mokaev A.M.
1Limited Liability Company “SEM”, Nalchik, Russia
2Kabardino-Balkarian State University named after Kh.M. Berbekov of the Ministry of Education and Science of the Russian Federation, Nalchik, Russia

Abstract

Significance. Prototyping is a tool to develop a draft (early) project paradigm, with the aim of testing and evaluating effectiveness of its use and analyzing technical characteristics prior to implementation.

For the first time ever, the authors have attempted to substantiate the need for a prototype in a medical organization implementing projects, with a choice of the prototyping detail level, focused on efficient use of the healthcare system resources in future, patient needs, lean approach to the time budget as the main value by choosing the optimal logistics of the processes under implementation.

The object of the study is prototyping processes of different degree of detail, depending on the subjects - participants in the implementation of the federal projects, implementers at the regional level, and patients.

The purpose of the study is to create an absolute minimum in a medical organization (prototype) that implements projects, as a tool to test functionality of the stages prior to their actual implementation (development) and subsequent evaluation. To achieve this goal, an attempt has been made to substantiate application of prototyping processes at different levels of implementation of the strategic goals set by national projects in terms of the following characteristics: speed, cost, feedback and realism.

Material and methods. The research material included publications by Russian and foreign scientists related to prototyping in various fields of activity. For the first time ever, this technique was proposed to be used in healthcare. To substantiate the need to use prototyping processes in implementing national projects, the method of systemic and structural-functional analysis was used.

Results. As a result, the authors have formulated practical recommendations that will help reduce risks and optimize costs associated with project implementation, using potential capabilities of the prototype, depending on the level of its detail as well as receive feedback from potential project stakeholders.

Conclusion. Prototyping is a new management tool in healthcare and can become an effective reserve for achieving the goals of the national project “Healthcare”. A highly detailed prototype is much similar to the project final result; therefore, service consumes interacting with the prototype, will receive as realistic practical experience as possible.

Keywords: prototype detail levels; potential project stakeholders; medical organization prototype; prototyping processes; projects

Corresponding author: Azis V. Akhokhova, email: Ýòîò e-mail çàùèùåí îò ñïàì-áîòîâ. Äëÿ åãî ïðîñìîòðà â âàøåì áðàóçåðå äîëæíà áûòü âêëþ÷åíà ïîääåðæêà Java-script
Information about authors:
Akhohova À.V
. http://orcid.org/0000-0003-2370-9701
Tkhabisimova I.K. http://orcid.org/0000-0003-4065-989X
Gaydash O.B., https://orcid.org/0009-0007-4627-9587
Kardanov T.S., https://orcid.org/0009-0007-4633-4398
Mokaev A.M., https://orcid.org/0009-0001-6090-9350
Acknowledgments. The study had no sponsorship.
Competing interests. The authors declare the absence of any conflicts of interest regarding the publication of this paper.
Compliance with ethical standards. This study does not require a conclusion from the Local Ethics Committee.
For citation: Akhokhova A.V., Tkhabisimova I.K., Gaydash O.B., Kardanov T.S., Mokaev A.M. Project prototyping as a tool for prediction and optimal development of the healthcare industry. Social'nye aspekty zdorov'a naselenia [serial online] 2023; 69(6):1. Available from: http://vestnik.mednet.ru/content/view/1542/27/lang,ru/. DOI: 10.21045/2071-5021-2023-69-6-1 (In Rus).

Ââåäåíèå

Ïðîòîòèïè́ðîâàíèå — áûñòðàÿ «÷åðíîâàÿ» ðåàëèçàöèÿ áàçîâîé ôóíêöèîíàëüíîñòè áóäóùåãî ïðîäóêòà/èçäåëèÿ, äëÿ àíàëèçà ðàáîòû ñèñòåìû â öåëîì. Íà ýòàïå ïðîòîòèïèðîâàíèÿ ìàëûìè óñèëèÿìè ñîçäà¸òñÿ ðàáîòàþùàÿ ñèñòåìà. Âî âðåìÿ ïðîòîòèïèðîâàíèÿ âèäíà áîëåå äåòàëüíàÿ êàðòèíà óñòðîéñòâà ñèñòåìû [1].

Ïðîòîòèïèðîâàíèå èñïîëüçóåòñÿ â ìàøèíî-ïðèáîðîñòðîåíèè, ïðèáîðîñòðîåíèè, ïðîãðàììèðîâàíèè è âî ìíîãèõ äðóãèõ îáëàñòÿõ òåõíèêè [2]; êàê ïðàâèëî, ïðîòîòèï ñòàíîâèòñÿ ïðèëîæåíèåì ê òåõíè÷åñêîìó çàäàíèþ. Ïðè ýòîì ïðîòîòèï íå îáÿçàòåëüíî âûïîëíÿåòñÿ â ðàìêàõ òåõ æå òåõíîëîãèé, ÷òî è ðàçðàáàòûâàåìàÿ ñèñòåìà [3,4].

Ïðîòîòèïèðîâàíèå òàêæå íàøëî ñâîå ïðèìåíåíèå ïðè ðåàëèçàöèè îñíîâíûõ îáðàçîâàòåëüíûõ ìîäóëåé, êîòîðûå âàæíû ñ òî÷êè çðåíèÿ ôîðìèðîâàíèÿ çíàíèé è óìåíèé, íåîáõîäèìûõ äëÿ ñîçäàíèÿ íîâûõ òåõíîëîãèé, à òàêæå íîâûõ ïðîäóêòîâ òåõíîñôåðû. Òàê, ìîäóëü 3D-ìîäåëèðîâàíèå, ïðîòîòèïèðîâàíèå, òåõíîëîãèè öèôðîâîãî ïðîèçâîäñòâà â îáëàñòè îáðàáîòêè ìàòåðèàëîâ, àääèòèâíûå òåõíîëîãèè íàïðàâëåí íà ôîðìèðîâàíèå èíñòðóìåíòàðèÿ ñîçäàíèÿ è èññëåäîâàíèÿ ìîäåëåé [4].

Ïðîòîòèïèðîâàíèå, ïî ìíåíèþ íåêîòîðûõ ðàçðàáîò÷èêîâ, ÿâëÿåòñÿ ñàìûì âàæíûì ýòàïîì ðàçðàáîòêè [1,5]. Ïîñëå ýòàïà ïðîòîòèïèðîâàíèÿ îáÿçàòåëüíî ñëåäóþò ýòàïû ïåðåñìîòðà àðõèòåêòóðû ñèñòåìû, ðàçðàáîòêè, ðåàëèçàöèè è òåñòèðîâàíèÿ êîíå÷íîãî ïðîäóêòà [5,6].

Ðàçðàáîòêè ïðîòîòèïîâ îñóùåñòâëÿþòñÿ â ðàçíûõ îòðàñëÿõ è ñôåðàõ äåÿòåëüíîñòè ÷åëîâåêà, â ïðîèçâîäñòâåííîé ñðåäå.  ñôåðå çäðàâîîõðàíåíèÿ îñíîâíûìè íàïðàâëåíèÿìè èñïîëüçîâàíèÿ è âíåäðåíèÿ ïðîòîòèïîâ ñòàëè ñîâðåìåííûå ìåäèöèíñêèå èíôîðìàöèîííûå ñèñòåìû è òåõíîëîãèè [7]. Îäíèì èç íèõ ÿâëÿåòñÿ ìåòîä áûñòðîãî ñîçäàíèÿ ïðîòîòèïîâ ãðàôè÷åñêèõ ïðåäñòàâëåíèé äàííûõ äëÿ ìîíèòîðèíãà ðåçóëüòàòîâ äåÿòåëüíîñòè îáúåêòà óïðàâëåíèÿ â ïðîöåññå ôóíêöèîíèðîâàíèÿ ìåäèöèíñêèõ îðãàíèçàöèé [8].

Åäèíè÷íûå èññëåäîâàíèÿ ïîñâÿùåíû âíåäðåíèþ è ðàçðàáîòêå ïðîòîòèïà äëÿ webñàéòà ìåäèöèíñêîé îðãàíèçàöèè â öåëÿõ èíôîðìàöèîííîãî îáñëóæèâàíèÿ ïàöèåíòîâ ãîðîäñêîé ïîëèêëèíèêè, êîòîðûì îïðåäåëåíû òðåáîâàíèÿ ê ôóíêöèîíàëó ïðîãðàììíîãî ðåøåíèÿ, ðàçðàáîòàííîé ñòðóêòóðå è äèçàéíó [9,7].

 ïðàêòè÷åñêîé ìåäèöèíå äàííûé ìåòîä íàøåë ñâîå ïðèìåíåíèå â ïëàñòè÷åñêîé õèðóðãèè ïðè èñïîëüçîâàíèè êîìïüþòåðíîãî ïðîòîòèïèðîâàíèÿ ïîâðåæäåííûõ èëè óòðà÷åííûõ ÷àñòåé òåëà íà ýòàïå ïëàíèðîâàíèÿ îïåðàöèé. Ñîâðåìåííûå òåíäåíöèè ïëàñòè÷åñêîé õèðóðãèè çíà÷èòåëüíî ðàñøèðèëè âîçìîæíîñòè ñïåöèàëèçèðîâàííîãî ëå÷åíèÿ, âñëåäñòâèå âíåäðåíèÿ â êëèíè÷åñêóþ ïðàêòèêó òåõíîëîãèé ñîçäàíèÿ ïðîòîòèïà, ÷òî ïîçâîëÿåò äîáèâàòüñÿ ëó÷øèõ àíàòîìè÷åñêèõ è ôóíêöèîíàëüíûõ ðåçóëüòàòîâ [10,11].

Íåêîòîðûìè àâòîðàìè îïèñàíû òåîðåòè÷åñêèå îñíîâû è ïðàêòè÷åñêîå ïðèìåíåíèå òåõíîëîãèè äèçàéí-ìûøëåíèÿ â äåÿòåëüíîñòè ìåäèöèíñêîé îðãàíèçàöèè, ñ èñïîëüçîâàíèåì â êà÷åñòâå èíñòðóìåíòà ìåòîäà ïðîòîòèïèðîâàíèÿ äëÿ óïðàâëåíèÿ âçàèìîäåéñòâèåì ñ ïàöèåíòàìè â öåëÿõ óëó÷øåíèÿ îêàçàíèÿ ìåäèöèíñêîé ïîìîùè ïðè ñåðäå÷íî-ñîñóäèñòûõ çàáîëåâàíèÿõ [12,13].

Âìåñòå ñ òåì, ðàáîò, ïîñâÿùåííûõ èñïîëüçîâàíèþ ìåòîäà ïðîòîòèïèðîâàíèÿ, â êà÷åñòâå èíñòðóìåíòà íåîáõîäèìîãî äëÿ ðåàëèçàöèè ïðîåêòîâ ìåäèöèíñêèìè îðãàíèçàöèÿìè íå íàéäåíî. Àâòîðîì âïåðâûå ïðåäïðèíÿòà ïîïûòêà îáîñíîâàòü íåîáõîäèìîñòü ñîçäàíèÿ àáñîëþòíîãî ìèíèìóìà (ïðîòîòèïà) â ìåäèöèíñêîé îðãàíèçàöèè, ðåàëèçóþùåé ïðîåêòû, ñ ïîñëåäóþùèì âûáîðîì óðîâíÿ äåòàëèçàöèè ïðîòîòèïèðîâàíèÿ, îðèåíòèðîâàííîãî íà ýôôåêòèâíîå èñïîëüçîâàíèå ðåñóðñîâ ñèñòåìû çäðàâîîõðàíåíèÿ â áóäóùåì, ïîòðåáíîñòè ïàöèåíòà, áåðåæíîå îòíîøåíèå ê âðåìåííîìó ðåñóðñó êàê îñíîâíîé öåííîñòè çà ñ÷åò âûáîðà îïòèìàëüíîé ëîãèñòèêè ðåàëèçóåìûõ ïðîöåññîâ.

Öåëü èññëåäîâàíèÿ – ñîçäàíèÿ àáñîëþòíîãî ìèíèìóìà (ïðîòîòèïà) â ìåäèöèíñêîé îðãàíèçàöèè, ðåàëèçóþùåé ïðîåêòû, â êà÷åñòâå èíñòðóìåíòà äëÿ ïðîâåðêè ôóíêöèîíàëüíîñòè ýòàïîâ äî íà÷àëà èõ ôàêòè÷åñêîãî ïðåäîñòàâëåíèÿ (ðàçðàáîòêè) è ïîñëåäóþùåé îöåíêè.

Ìàòåðèàëû è ìåòîäû

Îáúåêòîì èññëåäîâàíèÿ ÿâëÿþòñÿ ïðîöåññû ïðîòîòèïèðîâàíèÿ ðàçíîé ñòåïåíè äåòàëèçàöèè, çàâèñÿùèå îò ñóáúåêòîâ - ó÷àñòíèêîâ ðåàëèçàöèè ôåäåðàëüíûõ ïðîåêòîâ, èñïîëíèòåëåé íà óðîâíå ðåãèîíà. Àâòîðàìè ïðåäïðèíÿòà ïîïûòêà îáîñíîâàòü íåîáõîäèìîñòü ïðèìåíåíèÿ ïðîöåññîâ ïðîòîòèïèðîâàíèÿ íà ðàçíûõ óðîâíÿõ âîïëîùåíèÿ ñòðàòåãè÷åñêèõ öåëåé, ïîñòàâëåííûõ íàöèîíàëüíûìè ïðîåêòàìè ñ òî÷êè çðåíèÿ ñëåäóþùèõ õàðàêòåðèñòèê: ñêîðîñòè, ñòîèìîñòè, îáðàòíîé ñâÿçè è ðåàëèñòè÷íîñòè.

Ìàòåðèàëàìè èññëåäîâàíèÿ ÿâèëèñü ðàáîòû ðîññèéñêèõ è çàðóáåæíûõ ó÷åíûõ, ñâÿçàííûõ ñ ïðîòîòèïèðîâàíèåì â ðàçíûõ îòðàñëÿõ äåÿòåëüíîñòè.  ñôåðå çäðàâîîõðàíåíèÿ äàííàÿ ìåòîäèêà ïðåäëîæåíà âïåðâûå. Ïîèñê ïóáëèêàöèé äëÿ àíàëèçà, ïîñâÿùåííûõ èçó÷àåìîé ïðîáëåìå, ïðîâîäèëñÿ â áàçàõ äàííûõ (Medline, Cochrane Controlled Trials Register è äðóãèõ). Îòáîð íàó÷íî-èññëåäîâàòåëüñêèõ ðàáîò è ñòàòåé îñóùåñòâëÿëñÿ èç ýëåêòðîííûõ áàç äàííûõ Íàó÷íàÿ ýëåêòðîííàÿ áèáëèîòåêà eLIBRARY.RU è èíôîðìàöèîííî-êîììóíèêàöèîííîé ñåòè «Èíòåðíåò» çà ïåðèîä âðåìåíè ñ 2002 ïî 2023 ãã.

 öåëÿõ èçó÷åíèÿ èññëåäîâàòåëüñêîãî âîïðîñà ïðîàíàëèçèðîâàíû áîëåå 30 èñòî÷íèêîâ ëèòåðàòóðû, íàïðÿìóþ èëè êîñâåííî çàòðàãèâàþùèå òåìû ïðàêòè÷åñêîãî ïðèìåíåíèÿ ïðîòîòèïèðîâàíèÿ ñ ó÷åòîì óðîâíÿ èõ äåòàëèçàöèè.

Ðåçóëüòàòû

Ïðîöåññ ïðîòîòèïèðîâàíèÿ — ñâîåîáðàçíûé ïðåäâàðèòåëüíûé ýêñïåðèìåíò ïåðåä âîïëîùåíèåì â æèçíü ïðîåêòà ìåäèöèíñêîé îðãàíèçàöèåé, íà÷èíàÿ îò íîðìàòèâíîé ïðàâîâîé ðåãëàìåíòàöèè ïîðÿäêà åãî ðåàëèçàöèè äî ïîëó÷åíèÿ ðåçóëüòàòîâ, óñòàíîâëåííûõ êðèòåðèÿìè äîñòèæåíèÿ ïîêàçàòåëåé â ñîîòâåòñòâèå íàöèîíàëüíûìè ïðîåêòàìè [14].

Ïî ñóòè, ïðîòîòèï - ìàêåòíûé îáðàçåö, êîòîðûé ïîçâîëèò çàèíòåðåñîâàííûì ëèöàì ïðîåêòà (äàëåå - ñòåéêõîëäåðû) îò÷åòëèâî ïðåäñòàâëÿòü êîíå÷íûå ðåçóëüòàòû, ïîëó÷åííûå ïðè ðåàëèçàöèè ðåãèîíàëüíûõ ïðîåêòîâ íà âñåõ óðîâíÿõ (ïàöèåíò, ìåäèöèíñêàÿ îðãàíèçàöèÿ, îðãàí èñïîëíèòåëüíîé âëàñòè ñóáúåêòà), íàïðàâëåííûõ íà îáåñïå÷åíèå äîñòèæåíèÿ öåëåé, ïîêàçàòåëåé è ðåçóëüòàòîâ ôåäåðàëüíûõ ïðîåêòîâ [15,14].

Ïîýòîìó ïðåäâàðèòåëüíîå òåñòèðîâàíèå ïðîòîòèïà ðåãèîíàëüíîãî ïðîåêòà íà âñåõ óðîâíÿõ åãî ðåàëèçàöèè íåîáõîäèìî â ïëîòíîì âçàèìîäåéñòâèè ñ ïîòðåáèòåëÿìè óñëóã (ïàöèåíòàìè) è ñòåéêõîëäåðàìè ïðîåêòà (ôåäåðàëüíûå ðóêîâîäèòåëè è äð.), ÷òîáû óñòðàíèòü âñå âîçìîæíûå äåôåêòû, ìèíèìèçèðîâàòü ðèñêè ïðåæäå, ÷åì îñóùåñòâëÿòü ôèíàíñèðîâàíèå, ïðîèçâîäèòü ðàñ÷åòû âðåìåííûõ è òðóäîâûõ ðåñóðñîâ è äð. Ïðè ýòîì áåçóñëîâíûì îãðàíè÷åíèåì ÿâëÿåòñÿ êâàëèôèêàöèÿ èññëåäîâàòåëÿ (ñïåöèàëèñòà), êîòîðûé äîñòîâåðíî èíòåðïðåòèðóåò äåéñòâèÿ ïîòðåáèòåëåé óñëóã, èíûõ çàèíòåðåñîâàííûõ ëèö ïðîåêòà [16,14].

Ïðîòîòèï ìîæåò ÿâëÿåòñÿ ñâîåîáðàçíûì èíñòðóìåíòîì äëÿ ïðèíÿòèÿ ðåøåíèÿ ðàñïðåäåëåíèÿ è óïðàâëåíèÿ âûäà÷åé ñóáñèäèé íà ðåàëèçàöèþ ïðîåêòà(îâ) â ðåãèîíå(àõ) [17,16], èçáàâëÿÿ îðãàíû ôåäåðàëüíîé è ðåãèîíàëüíîé èñïîëíèòåëüíîé âëàñòè îò ðóòèííîãî ðåòðîñïåêòèâíîãî àíàëèçà ðåçóëüòàòîâ å¸ îñâîåíèÿ. Äàííîå îáñòîÿòåëüñòâî ðåçåðâèðóåò âðåìÿ, è äàåò âîçìîæíîñòü îñóùåñòâëÿòü àíàëèç è ïîäâîäèòü èòîãè ïî îöåíêå ýôôåêòèâíîñòè èñïîëüçîâàíèÿ ñóáñèäèè íà óðîâíå ðåãèîíà äëÿ âûðàáîòêè óïðàâëåí÷åñêèõ ðåøåíèé íà ôåäåðàëüíîì óðîâíå.

Ïðàâèòåëüñòâîì Ðîññèè óæå ïðåäïðèíÿòû ïîïûòêè ðåàëèçàöèè ïèëîòíîãî ïðîåêòà, ãäå íà ïðàêòèêå îñóùåñòâëÿåòñÿ òåñòèðîâàíèå ôóíêöèîíàëà åäèíîé ïëîùàäêè íà ïðåäìåò âîçìîæíîñòè ïðîâåäåíèÿ âñåõ ýòàïîâ îòáîðà ïîëó÷àòåëåé áþäæåòíûõ ñðåäñòâ ïîñðåäñòâîì ïðîòîòèïà [18,19].

 íàñòîÿùåå âðåìÿ ñâåäåíèÿ î äîñòèæåíèè ðåçóëüòàòîâ èñïîëüçîâàíèÿ ñóáñèäèé àêêóìóëèðóþòñÿ è àíàëèçèðóþòñÿ âðó÷íóþ, ñîîòâåòñòâåííî ïðèíÿòèå ðåøåíèé, íàïðàâëåííûõ íà ñâîåâðåìåííîå óñòðàíåíèå íàðóøåíèé, íåâîçìîæíî, èç-çà îòñóòñòâèÿ îïåðàòèâíîñòè. Îòñóòñòâèå ìîíèòîðèíãà ðåçóëüòàòîâ ïðîìåæóòî÷íûõ èòîãîâ òàêæå íå äàåò ïîíèìàíèÿ îöåíêè óðîâíÿ ýôôåêòèâíîñòè è ñâîåâðåìåííîñòè äîñòèæåíèÿ òåõ èëè èíûå êîíòðîëüíûõ òî÷åê [18]. Äàííîå îáñòîÿòåëüñòâî â èòîãå ïðåïÿòñòâóåò: îïåðàòèâíîìó âîçäåéñòâèþ íà ïðîöåññ äîñòèæåíèÿ ðåçóëüòàòà êîíêðåòíûì ïîëó÷àòåëåì ñóáñèäèè; âûïîëíåíèþ çàïëàíèðîâàííûõ ýòàïîâ â ñðîê; ïðåäóïðåæäåíèþ ñëó÷àåâ îáðàçîâàíèÿ íåèñïîëüçîâàííûõ îñòàòêîâ ñóáñèäèé [20,14].

Íà îñíîâàíèè èçëîæåííîãî àâòîðîì ïðåäïðèíÿòà ïîïûòêà îáîñíîâàòü íåîáõîäèìîñòü èñïîëüçîâàíèå ïðîöåññîâ ïðîòîòèïèðîâàíèÿ, ñ òî÷êè çðåíèÿ ñòåïåíè èõ äåòàëèçàöèè íà ðàçíûõ óðîâíÿõ âîïëîùåíèÿ (Ìèíçäðàâ Ðîññèè, Ìèíçäðàâ ñóáúåêòà, ìåäèöèíñêàÿ îðãàíèçàöèÿ) äëÿ äîñòèæåíèÿ öåëåé, ïîñòàâëåííûõ íàöèîíàëüíûìè ïðîåêòàìè è îöåíêè ñëåäóþùèõ õàðàêòåðèñòèê: ñêîðîñòü, ñòîèìîñòü, îáðàòíàÿ ñâÿçü è ðåàëèñòè÷íîñòü.

Îáúåêòîì èññëåäîâàíèÿ ÿâëÿþòñÿ ïðîöåññû ïðîòîòèïèðîâàíèÿ ðàçíîé ñòåïåíè äåòàëèçàöèè, íàõîäÿùèåñÿ â êîððåëÿöèîííîé çàâèñèìîñòè îò õàðàêòåðèñòèê ïîêàçàòåëåé ðåàëèçàöèè ïðîòîòèïîâ íà ðàçíûõ óðîâíÿõ ñóáúåêòîâ - ó÷àñòíèêîâ ðåàëèçàöèè ôåäåðàëüíûõ ïðîåêòîâ: ðàáîòíèêîâ ôåäåðàëüíûõ îðãàíîâ èñïîëíèòåëüíîé âëàñòè; èñïîëíèòåëåé íà óðîâíå ðåãèîíà: ìåäèöèíñêèå îðãàíèçàöèè ñóáúåêòà, ðåãèîíàëüíûé îðãàí èñïîëíèòåëüíîé âëàñòè; ïàöèåíòîâ è äð. (òàáëèöà) [16,12].

Òàáëèöà

Çàâèñèìîñòü ïîêàçàòåëåé ðåàëèçàöèè ïðîòîòèïîâ îò ñòåïåíè èõ äåòàëèçàöèè íà ðàçíûõ óðîâíÿõ ðåàëèçàöèè ïðîåêòîâ

Ó÷àñòíèêè ðåàëèçàöèè
 Õàðàêòåðèñòèêè ïîêàçàòåëåé ðåàëèçàöèè ïðîåêòîâ
 ñêîðîñòü  ñòîèìîñòü îáðàòíàÿ ñâÿçü
ðåàëèñòè÷íîñòü
 Ìèíçäðàâ Ðîññèè - Ìèíçäðàâ ñóáúåêòà
íèçêàÿ ↑  íèçêàÿ ↓
 íèçêàÿ ↓  íèçêàÿ ↓
 Ìèíçäðàâ ñóáúåêòà - Ìåäèöèíñêàÿ îãðàíèçàöèÿ  ñðåäíÿÿ   ñðåäíÿÿ   ñðåäíÿÿ   ñðåäíÿÿ
 Ìåäèöèíñêàÿ îãðàíèçàöèÿ - Ïàöèåíò  âûñîêàÿ ↓
 âûñîêàÿ ↑  âûñîêàÿ ↑  âûñîêàÿ ↑
   Ñòåïåíü äåòàëèçàöèè ïðîòîòèïà - íèçêàÿ, ñðåäíÿÿ, âûñîêàÿ

Ïðè ýòîì õàðàêòåðèñòèêè ïîêàçàòåëåé ðåàëèçàöèè ïðîòîòèïîâ (ñêîðîñòü, ñòîèìîñòü, îáðàòíàÿ ñâÿçü è ðåàëèñòè÷íîñòü) îöåíèâàëèñü â ñîïîñòàâëåíèè ñ ïðîãíîçèðóåìîé ýôôåêòèâíîñòüþ ðàáîòû ó÷àñòíèêîâ (ñóáúåêòîâ) ïðîåêòîâ, êðèòåðèè êîòîðûõ çàêðåïëåíû íà çàêîíîäàòåëüíîì óðîâíå [19,17]:

1) îáåñïå÷åíèå èñïîëíåíèå íàöèîíàëüíîãî ïðîåêòà, ôåäåðàëüíîãî ïðîåêòà, âåäîìñòâåííîãî ïðîåêòà â ñîîòâåòñòâèè ñ ïàñïîðòîì ñîîòâåòñòâóþùåãî ïðîåêòà è èíûìè äîêóìåíòàìè;

2) ñâîåâðåìåííîå ïðåäñòàâëåíèå ðóêîâîäèòåëþ íàöèîíàëüíîãî ïðîåêòà èíôîðìàöèè î ðåàëèçàöèè ñîîòâåòñòâóþùåãî ïðîåêòà, â òîì ÷èñëå èíôîðìàöèè î ðèñêàõ ðåàëèçàöèè ñîîòâåòñòâóþùåãî ïðîåêòà, à òàêæå èíôîðìàöèè î ìåðàõ ðåàãèðîâàíèÿ, íàïðàâëåííûõ íà óñòðàíåíèå (ìèíèìèçàöèþ) ðèñêîâ;

3) îòâåòñòâåííîñòü çà äîñòîâåðíîñòü, àêòóàëüíîñòü è ïîëíîòó èíôîðìàöèè î ðåàëèçàöèè íàöèîíàëüíîãî ïðîåêòà, ôåäåðàëüíîãî ïðîåêòà èëè âåäîìñòâåííîãî ïðîåêòà;

4) íàïðàâëåíèå ðóêîâîäèòåëþ íàöèîíàëüíîãî ïðîåêòà ïðåäëîæåíèé ïî îáåñïå÷åíèþ ñâîåâðåìåííîãî äîñòèæåíèÿ îáùåñòâåííî çíà÷èìûõ ðåçóëüòàòîâ, âûïîëíåíèÿ çàäà÷ íàöèîíàëüíîãî ïðîåêòà, ôåäåðàëüíîãî ïðîåêòà, äîñòèæåíèÿ èõ ïîêàçàòåëåé, ìåðîïðèÿòèé (ðåçóëüòàòîâ) è êîíòðîëüíûõ òî÷åê;

5) ïðåäñòàâëåíèå ïî çàïðîñó ïðîåêòíûõ îôèñîâ èíôîðìàöèè î ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ, ôåäåðàëüíûõ ïðîåêòîâ è âåäîìñòâåííûõ ïðîåêòîâ;

6) ó÷àñòèå â óïðàâëåíèè ðèñêàìè ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ, ôåäåðàëüíûõ ïðîåêòîâ è âåäîìñòâåííûõ ïðîåêòîâ;

7) âûïîëíåíèå èíûõ ôóíêöèé, ïðåäóñìîòðåííûå Ïîëîæåíèåì îá îðãàíèçàöèè ïðîåêòíîé äåÿòåëüíîñòè è èíûìè íîðìàòèâíûìè ïðàâîâûìè àêòàìè â ñôåðå ïðîåêòíîé äåÿòåëüíîñòè [21,19].

Ñ ó÷åòîì ñòåïåíè äåòàëèçàöèè ïðîòîòèïîâ, íåîáõîäèìî âûäåëèòü ñëåäóþùèå òèïû ïðîòîòèïèðîâàíèÿ [22,2].

Ïðîòîòèïû ìîãóò áûòü ñîçäàíû ñ íèçêîé, ñðåäíåé è âûñîêîé ñòåïåíüþ äåòàëèçàöèè, ÷òî ïîäðàçóìåâàåò óðîâåíü êîíêðåòèçàöèè è ôóíêöèîíàëüíîãî íàïîëíåíèÿ ïðîòîòèïà. ×åì ïîäðîáíåå äåòàëèçàöèÿ, òåì áîëüøå óñèëèé è ðåñóðñîâ òðåáóåòñÿ äëÿ åå ñîçäàíèÿ.

Ïðîòîòèïû ñ íèçêîé äåòàëèçàöèåé — ýòî áóìàæíûå ïðîòîòèïû (ïðîåêòû íîðìàòèâíûõ àêòîâ), ñ íèçêîé âðåìåííîé ðåñóðñîåìêîñòüþ. Ïî ñóòè, îíè ïðåäñòàâëÿþò ñîáîé ïðîñòóþ íåïîëíóþ âåðñèþ ïðîåêòà ïî äîñòèæåíèþ öåëåâîãî(ûõ) ïîêàçàòåëÿ(åé) (íà óðîâíå ôåäåðàëüíîãî, ðåãèîíàëüíîãî îðãàíà èñïîëíèòåëüíîé âëàñòè, ìåäèöèíñêîé îðãàíèçàöèè) è ÿâëÿþòñÿ îòëè÷íûì ñïîñîáîì ïðîâåðèòü êîíöåïöèþ âûñîêîãî óðîâíÿ ïðåæäå, ÷åì âûäåëÿòü äîïîëíèòåëüíîå âðåìÿ è ðåñóðñû íà ðåàëèçàöèè ïðîåêòà. Êðîìå òîãî, îíè òàêæå ïîçâîëÿþò ïîëó÷àòü îáðàòíóþ ñâÿçü è òåñòèðîâàòü èäåè íà ðàííåé ñòàäèè ïðîöåññà ïðîåêòèðîâàíèÿ.

Ïðîòîòèïû ñðåäíåé äåòàëèçàöèè – ïî ñóòè ìàêåòû, âêëþ÷àþùèå ïðîåêòèðîâàíèå ïóòåé âçàèìîäåéñòâèÿ ïîòðåáèòåëåé óñëóã, ñòåéêõîëäåðîâ ïðîåêòà ñ âûñòðàèâàíèåì èíôîðìàöèîííîé àðõèòåêòóðû. Ïîñðåäñòâîì äàííîãî òèïà ìîæíî ñâîåâðåìåííî ðàññòàâèòü àêöåíòû íà âàæíûõ ôóíäàìåíòàëüíûõ àñïåêòàõ äèçàéíà ïðîåêòà.

Ïðîòîòèïû âûñîêîé äåòàëèçàöèè âîçìîæíû ïîñëå íåñêîëüêèõ öèêëîâ òåñòèðîâàíèÿ ïðîòîòèïîâ ñ íèçêîé è ñðåäíåé ñòåïåíüþ äåòàëèçàöèè, íà ïðèìåðå îïûòà, ïîëó÷åííîãî ñ ìîìåíòà ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ (2005 ã.) [23,24]. Ïðè ýòîì íåîáõîäèìî âèçóàëèçèðîâàòü äèçàéí ïðîåêòà ñ âûñîêîé ñòåïåíüþ äåòàëèçàöèè è ïî ìåðå èòåðàöèîííûõ ïðîöåññîâ äâèãàÿñü ê çàâåðøàþùåé ñòàäèè, îñóùåñòâëÿòü òåñòèðîâàíèå ïðîòîòèïîâ âûñîêîé äåòàëèçàöèè äî íà÷àëà ýòàïà ôàêòè÷åñêîãî âíåäðåíèÿ ïðîåêòà [25].

Ïðè ýòîì îõàðàêòåðèçîâàòü ïîêàçàòåëè ïðîòîòèïîâ ñ ó÷åòîì ñòåïåíè èõ äåòàëèçàöèè (âûñîêàÿ, ñðåäíÿÿ, íèçêàÿ) ïðèìåíèòåëüíî ê ñóáúåêòàì ðåàëèçàöèè ïðîåêòîâ ìîæíî ñëåäóþùèì îáðàçîì:

Ñòîèìîñòü. ×åì âûøå äåòàëèçàöèÿ ïðîòîòèïà, òåì ôèíàíñîâûå çàòðàòû íà ðåàëèçàöèþ ïðîåêòà áóäóò âûøå. Ïðè ýòîì ðàñõîä ðåñóðñîâ íå òîëüêî ôèíàíñîâûõ, íî âðåìåííûõ è ÷åëîâå÷åñêèõ äåòåðìèíèðîâàí ñî ñòåïåíüþ äàííîé êîíêðåòèçàöèè. Ïîýòîìó íåîáõîäèìî ñâîåâðåìåííî âíîñèòü èçìåíåíèÿ, «îáêàòûâàòü» ïðîòîòèïû íà ïðåäûäóùèõ ýòàïàõ ïðîåêòà, ñ ïîñëåäóþùèì íîðìàòèâíûì çàêðåïëåíèåì òðåáîâàíèé äëÿ ñóáúåêòîâ ñ ó÷åòîì ñïåöèôèêè èõ ðåàëèçàöèè, ïðåæäå ÷åì ïåðåõîäèòü íà ñòàäèþ âûñîêîé äåòàëèçàöèè [26,3].

 òàáëèöå ïîêàçàòåëü «ñòîèìîñòü» ñîîòâåòñòâóåò âûñîêîé ñòåïåíè äåòàëèçàöèè ïðîòîòèïà íà óðîâíå ñóáúåêòîâ «Ìåäèöèíñêàÿ îðãàíèçàöèÿ – Ïàöèåíò», è íèçêîé ñòåïåíè äåòàëèçàöèè íà óðîâíå «Ìèíçäðàâ Ðîññèè – Ìèíçäðàâ ñóáúåêòà». Ýòî ñâÿçàíî ñ äåòàëüíûì ïîíèìàíèåì íà óðîâíå ìåäèöèíñêèõ îðãàíèçàöèé âîçíèêàþùèõ ïîòðåáíîñòåé ïàöèåíòîâ ïðè ðåàëèçàöèè ïðîåêòîâ, ôàêòè÷åñêèõ çàòðàò, ïîíåñåííûõ ïîòåðü è ðèñêîâ [6,15]

Ñîîòâåòñòâåííî, ÷åì íèæå äåòàëèçàöèÿ, òåì ìåíüøå ñòîèìîñòü. ×åì âûøå äåòàëèçàöèÿ, òåì áîëüøåå êîëè÷åñòâî ðåñóðñîâ åé íóæíî [22,27].

Òàêèì îáðàçîì, ðåãóëÿòîðó ñëåäóåò òåñòèðîâàòü êîíöåïöèè áóäóùèõ ïðîåêòîâ íà ïðîòîòèïàõ ñ áîëåå âûñîêîé äåòàëèçàöèåé. Ýòî ïîçâîëèò ñýêîíîìèòü âðåìÿ, ôèíàíñû è óñèëèÿ íà ïðîòÿæåíèè âñåãî æèçíåííîãî öèêëà ïðîåêòèðîâàíèÿ è àäàïòàöèè íà óðîâíå ìåäèöèíñêîé îðãàíèçàöèè. Ïî-âèäèìîìó, îïûò, ïîëó÷åííûé ïî ðåçóëüòàòàì ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ è âíåäðåíèå ïðàêòèêè ïèëîòíûõ ïðîåêòîâ, ïîñëóæèò áëàãîäàòíîé ïî÷âîé äëÿ ýòîãî.

Ñêîðîñòü èëè áûñòðîòà. Ýòî õàðàêòåðèñòèêà ïîêàçàòåëÿ ïðîòîòèïà, ïîäõîäÿùåãî äëÿ êîëëåêòèâíîãî îáñóæäåíèÿ ðàçëè÷íûõ èäåé è êîíöåïöèé ðåàëèçàöèè ïðîåêòîâ. Îíà ïîçâîëÿåò áûñòðî âíîñèòü ïðàâêè è îáíîâëÿòü ïðè íåîáõîäèìîñòè òðåáîâàíèÿ íîðìàòèâíîé ïðàâîâîé áàçû, ðåãëàìåíòèðóþùåé öåëè, öåëåâûå è äîïîëíèòåëüíûå ïîêàçàòåëè íàöèîíàëüíîãî ïðîåêòà, çàäà÷è è ðåçóëüòàòû íàöèîíàëüíûõ ïðîåêòîâ äëÿ ðåãèîíîâ [28,20].

Ïðîòîòèï ñ íèçêîé äåòàëèçàöèåé íà óðîâíå «Ìèíçäðàâ Ðîññèè-Ìèíçäðàâ ñóáúåêòà» ïîìîãàåò áûñòðî ïðîâåðèòü ïîñòàâëåííûå çàäà÷è ïðîåêòàìè â êîðîòêèå ñðîêè è ñ ìèíèìàëüíûìè çàòðàòàìè òîëüêî íà íà÷àëüíûõ ýòàïàõ ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ ÷åðåç ðåãèîíàëüíûå îðãàíû âëàñòè ñóáúåêòà, ìåäèöèíñêèå îðãàíèçàöèè. Ñîîòâåòñòâåííî ïðè ñóùåñòâîâàíèè ïðîåêòà íà ïðîòÿæåíèè îïðåäåë¸ííîãî âðåìåíè ñòàíîâÿòñÿ ïîíÿòíû äåòàëè, è íåîáõîäèìîñòü âíåñåíèÿ èçìåíåíèé, êîððåêòèðîâîê [29,2].

Ñîîòâåòñòâåííî íà óðîâíå «Ìèíçäðàâ ñóáúåêòà-Ìåäèöèíñêàÿ îðãàíèçàöèÿ» ñêîðîñòü äîðàáîòêè óâåëè÷èâàåòñÿ, èçìåíèòü ïðîòîòèï ñ íèçêîãî óðîâíÿ ñòàíîâèòüñÿ ïðîùå è áûñòðåå ÷åì ïðè èñïîëüçîâàíèè âûñîêîé äåòàëèçàöèè, ïîýòîìó â òàáëèöå ñòåïåíü äåòàëèçàöèè ïðîòîòèïà íà äàííîì óðîâíå - ñðåäíÿÿ.

Íà óðîâíå ó÷àñòíèêîâ ïðîåêòà «Ìåäèöèíñêàÿ îðãàíèçàöèÿ-Ïàöèåíò» ñòåïåíü äåòàëèçàöèè ïðîòîòèïà – âûñîêàÿ, íà âûõîäå ìû ïîëó÷àåì ðåçóëüòàò ïðîåêòà, ìàêñèìàëüíî ïðèáëèæåííûé ê êîíå÷íîìó, ïîýòîìó íå óäèâèòåëüíî, ÷òî íà åãî ñîçäàíèå ïîòðåáóåòñÿ äîïîëíèòåëüíîå âðåìÿ, ñîîòâåòñòâåííî ñêîðîñòü äîðàáîòîê ìèíèìèçèðóåòñÿ ïðè âûñîêîé ñòåïåíè äåòàëèçàöèè ïðîåêòà. Ïðè ýòîì îïûò, ïîëó÷åííûé ïðè ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ íà âñåõ óðîâíÿõ [23,30], óæå ñîçäàë áëàãîïðèÿòíûå óñëîâèÿ äëÿ âíåñåíèÿ èçìåíåíèé â íîðìàòèâíóþ ïðàâîâóþ áàçó ñóáúåêòîâ, ïåðåñìîòðó ïîçèöèé ôåäåðàëüíûõ îðãàíîâ èñïîëíèòåëüíîé âëàñòè â îòíîøåíèè ðåãèîíîâ, ó÷èòûâàÿ ñïåöèôèêó ïîñëåäíèõ.

Îáðàòíàÿ ñâÿçü è ðåàëèñòè÷íîñòü. Ïðàêòè÷åñêèé îïûò ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ ïîêàçàë, ÷òî ïîòðåáèòåëè óñëóã áûëè áîëåå îáúåêòèâíû è áåñïðèñòðàñòíû â ñâîèõ îöåíêàõ ïåðñïåêòèâ ðåàëèçàöèè áóäóùèõ ïðîåêòîâ (ìàêåòà ïðîåêòà), íåæåëè ïî èñòå÷åíèè âðåìåíè [31,28]. Îäíàêî, â ïðîòîòèïå, ñ íèçêîé äåòàëèçàöèåé, èçíà÷àëüíî ñóùåñòâóþò ïðîáåëû, êîòîðûå ïîòðåáèòåëè óñëóã è ðåãóëÿòîðû ìîãóò òîëêîâàòü äèàìåòðàëüíî ïðîòèâîïîëîæíî. Ýòî â ñâîþ î÷åðåäü èñêàæàåò è óõóäøàåò îáðàòíóþ ñâÿçü è ìîæåò ïðèâåñòè ê áîëüøèì ïðîáëåìàì ïðè ðàçðàáîòêå è ðåàëèçàöèè ïðîåêòîâ, îøèáî÷íûì ðåçóëüòàòàì.

Ïðîòîòèïû ñî ñðåäíåé è âûñîêîé ñòåïåíüþ äåòàëèçàöèè áîëåå ðåàëèñòè÷íû, ÷òî äåëàåò ýòîò ìåòîä ïðîòîòèïèðîâàíèÿ áîëåå ïðèáëèæåííûì ê êîíå÷íîìó ðåçóëüòàòó. Ýòî ïîçâîëèò ïîëó÷èòü îòçûâû îò ñòåéêõîëäåðîâ ïðîåêòà, ñîîòâåòñòâóþùèå ðåàëüíûì, òàê êàê áóäóò èìåòü äåëî ñ äåòàëüíî ïðîðàáîòàííîé âåðñèåé ïðîåêòà. Ïîñêîëüêó âûñîêèé óðîâåíü äåòàëèçàöèè ïðîòîòèïà ìàêñèìàëüíî ïðèáëèæåí ê êîíå÷íîìó ðåçóëüòàòó ïðîåêòà, òî ïðè âçàèìîäåéñòâèè ñ íèì ïîòðåáèòåëè óñëóã ïîëó÷àò ïðàêòè÷åñêèé îïûò, ìàêñèìàëüíî ïðèáëèæåííûé ê ðåàëèñòè÷íîìó.

Îáñóæäåíèå

Ïðè÷èíû ñîçäàíèÿ ïðîòîòèïîâ ïðè ðåàëèçàöèè ïðîåêòîâ, â òîì ÷èñëå â îòðàñëè çäðàâîîõðàíåíèÿ ïðåñëåäóþò ìíîæåñòâî öåëåé. Ó÷èòûâàÿ îïèñàííûå õàðàêòåðèñòèêè ïîêàçàòåëåé ïðîòîòèïèðîâàíèÿ (ñêîðîñòü, ñòîèìîñòü, îáðàòíàÿ ñâÿçü è ðåàëèñòè÷íîñòü) ïðèìåíèòåëüíî ê ñòåïåíè äåòàëèçàöèè ïðîòîòèïà ìîæíî âûíåñòè ðÿä ïðàêòè÷åñêèõ âûâîäîâ.

Âî-ïåðâûõ, ïðîòîòèïû ïîçâîëÿþò ýêñïåðèìåíòèðîâàòü ñ ðàçëè÷íûìè èäåÿìè è ðåøåíèÿìè. Ðåãóëÿòîð ìîæåò ïðîáîâàòü íåñêîëüêî âîçìîæíûõ âàðèàíòîâ ðåàëèçàöèè ïðîåêòà, âíîñèòü ñâîåâðåìåííî êîððåêòèðîâêè äëÿ óëó÷øåíèÿ ýêñïëóàòàöèîííûõ õàðàêòåðèñòèê ñèñòåìû, ôóíêöèîíèðóþùåé â îïðåäåë¸ííûõ óñëîâèÿõ äëÿ äîñòèæåíèÿ óñòàíîâëåííûõ öåëåé ñ íåîáõîäèìîé ðåçóëüòàòèâíîñòüþ, ýôôåêòèâíîñòüþ è óäîâëåòâîð¸ííîñòüþ.

Âî-âòîðûõ, ïðîòîòèï íàãëÿäíî è ñõåìàòè÷íî äåìîíñòðèðóåò ïëàí äåéñòâèé â îòíîøåíèè êîíå÷íîãî ïðîäóêòà, ñïîñîáñòâóÿ ôîðìóëèðîâêå àêòóàëüíîé (äåéñòâóþùåé) òàêòèêè è âûðàáîòêå ñòðàòåãèè â öåëÿõ ïîñëåäóþùåé îïòèìèçàöèè. Äàííîå îáñòîÿòåëüñòâî òàêæå ïîâûøàåò ýôôåêòèâíîñòü âçàèìîäåéñòâèÿ ñòåéêõîëäåðîâ ïðîåêòà.

Â-òðåòüèõ, ïðîòîòèï äàåò ðåàëèñòè÷íîå ïðåäñòàâëåíèå îá óñòàíîâëåííûõ ñðîêàõ ðåàëèçàöèè ïðîåêòîâ, äëÿ äîñòèæåíèÿ öåëåâûõ ïîêàçàòåëåé, ôèíàíñîâûì è èíûì ðåñóðñàì, êîòîðûå óñòàíîâëåíû ñîãëàøåíèÿìè è èíûìè íîðìàòèâíûìè àêòàìè.

Â-÷åòâåðòûõ, â ïðîòîòèïû ãîðàçäî ïðîùå âíîñèòü èçìåíåíèÿ, ÷åì â êîíå÷íûé ðåçóëüòàò, çíà÷èò åñòü âîçìîæíîñòü ìîäåëèðîâàíèÿ ïðîòîòèïà ïðîåêòà íà ðàííèõ ñòàäèÿõ, ïðîôèëàêòèðîâàòü ðèñêè, ÷òî â ïåðñïåêòèâå ïîçâîëèò îïòèìèçèðîâàòü áþäæåò è ñðîêè åãî èñïîëíåíèÿ.

Â-ïÿòûõ, ïðîòîòèïû ìîãóò âåñòè ê íåîæèäàííûì îòêðûòèÿì è èäåÿì äëÿ ðàçâèòèÿ ïðîåêòà, ÷òî ìîæåò ïîäíÿòü êîíå÷íûé ðåçóëüòàò ïðîåêòà íà áîëåå ñîâåðøåííûé òåõíîëîãè÷åñêèé óðîâåíü. Ýòî â ñâîþ î÷åðåäü îòêðûâàåò åùå áîëüøå ïåðñïåêòèâ äëÿ ðàçâèòèÿ è íåîáõîäèìîñòè èñïîëüçîâàíèÿ òåõíîëîãèé ïðîòîòèïèðîâàíèÿ â ñôåðå çäðàâîîõðàíåíèÿ.

Òàêèì îáðàçîì, ïðîòîòèïèðîâàíèå ÿâëÿåòñÿ íîâûì óïðàâëåí÷åñêèì èíñòðóìåíòîì â îòðàñëè çäðàâîîõðàíåíèÿ è ìîæåò ñòàòü ýôôåêòèâíûì ðåçåðâîì äëÿ äîñòèæåíèÿ ïîñòàâëåííûõ öåëåé ôåäåðàëüíîãî ïðîåêòà íàöèîíàëüíîãî ïðîåêòà «Çäðàâîîõðàíåíèå». Îäíàêî, íåîáõîäèìî îòìåòèòü, ÷òî ïðîòîòèïèðîâàíèå ïîòðåáóåò äîïîëíèòåëüíûõ ôèíàíñîâûõ è âðåìåííûõ ðàñõîäîâ, è îáÿçàòåëüíîãî íîðìàòèâíîãî óðåãóëèðîâàíèÿ.

Âûâîäû

  1. Ðåãóëÿòîðó ñëåäóåò òåñòèðîâàòü êîíöåïöèè áóäóùèõ ïðîåêòîâ íà ïðîòîòèïàõ ñ áîëåå âûñîêîé äåòàëèçàöèåé. Ýòî ïîçâîëèò ñýêîíîìèòü âðåìÿ, ôèíàíñû è óñèëèÿ íà ïðîòÿæåíèè âñåãî æèçíåííîãî öèêëà ïðîåêòèðîâàíèÿ è àäàïòàöèè íà óðîâíå ìåäèöèíñêîé îðãàíèçàöèè. Ïî-âèäèìîìó, îïûò, ïîëó÷åííûé ïî ðåçóëüòàòàì ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ è âíåäðåíèå ïðàêòèêè ïèëîòíûõ ïðîåêòîâ, ïîñëóæèò áëàãîäàòíîé ïî÷âîé äëÿ ýòîãî.
  2. Îïûò, ïîëó÷åííûé ïðè ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ íà âñåõ óðîâíÿõ, óæå ñîçäàë áëàãîïðèÿòíûå óñëîâèÿ äëÿ âíåñåíèÿ èçìåíåíèé â íîðìàòèâíóþ ïðàâîâóþ áàçó ñóáúåêòîâ, ïåðåñìîòðó ïîçèöèé ôåäåðàëüíûõ îðãàíîâ èñïîëíèòåëüíîé âëàñòè â îòíîøåíèè ðåãèîíîâ, ó÷èòûâàÿ ñïåöèôèêó ïîñëåäíèõ.
  3. Âûñîêèé óðîâåíü äåòàëèçàöèè ïðîòîòèïà ìàêñèìàëüíî ïðèáëèæ¸í ê êîíå÷íîìó ðåçóëüòàòó ïðîåêòà, ïîýòîìó ïðè âçàèìîäåéñòâèè ñ íèì ïîòðåáèòåëè óñëóã ïîëó÷àò ïðàêòè÷åñêèé îïûò, ìàêñèìàëüíî ïðèáëèæåííûé ê ðåàëèñòè÷íîìó.

Áèáëèîãðàôèÿ

  1. Êîâàëåâ Ä.Ñ. Ïðîòîòèïèðîâàíèå öèôðîâîé îáðàçîâàòåëüíîé ñðåäû (îïûò ÃÁÍÎÓ "Àêàäåìèÿ öèôðîâûõ òåõíîëîãèé"). Àêàäåìè÷åñêèé âåñòíèê. Âåñòíèê Ñàíêò-Ïåòåðáóðãñêîé àêàäåìèè ïîñòäèïëîìíîãî ïåäàãîãè÷åñêîãî îáðàçîâàíèÿ 2020; (3): 38-47.
  2. Áåëîâ Â.Ô., Ãàâðþøèí Ñ.Ñ., Ìàðêîâà Þ.Í. Ìàòåìàòè÷åñêàÿ ìîäåëü ðàñïðåäåëåííîãî ïðîåêòèðîâàíèÿ ïðîòîòèïîâ â ìàøèíîñòðîåíèè. Èçâåñòèÿ âóçîâ. Ìàøèíîñòðîåíèå 2019; (9): 7-19. DOI: 10.18698/0536-1044-2019-9-7-19 Ðåæèì äîñòóïà: https://cyberleninka.ru/article/n/matematicheskaya-model-raspredelennogo-proektirovaniya-prototipov-v-mashinostroenii (Äàòà äîñòóïà: 16.09.2023).
  3. Aboulkhai N.T., Maskery I., Tuck C. The microstructure and mechanical properties of selectively laser melted AlSi10Mg: The effect of a conventional T6-like heat treatment. Materials Science & Engineering A 2016; 667: 139–146. DOI: 10.1016/J.MSEA.2016.04.092
  4. Ãóëÿåâà Í.È., Õóñåéíîâ Ð.Â. Ìîäóëüíàÿ ïðîãðàììà ïî 3D-ìîäåëèðîâàíèþ: ðàçðàáîòêà è ðåàëèçàöèÿ. Ïðîôåññèîíàëüíîå îáðàçîâàíèå è ðûíîê òðóäà 2016; (4): 34-37. Ðåæèì äîñòóïà: https://cyberleninka.ru/article/n/modulnaya-programma-po-3d-modelirovaniyu-razrabotka-i-realizatsiya (Äàòà äîñòóïà: 16.08.2023).
  5. Êðà÷òåí.Ô. Ââåäåíèå â Rational Unified Process. Ìîñêâà: ÈÄ "Âèëüÿìñ"; 2002. 240 ñ.
  6. Âàðôåë Òîää Çàêè. Ïðîòîòèïèðîâàíèå. Ïðàêòè÷åñêîå ðóêîâîäñòâî. Ìîñêâà: Èçäàòåëüñòâî «Ìàíí, Èâàíîâ è Ôåðáåð»; 2013. 240 ñ.
  7. Ãóëèåâ ß.È. Îñíîâíûå àñïåêòû ðàçðàáîòêè ìåäèöèíñêèõ èíôîðìàöèîííûõ ñèñòåì. Âðà÷ è èíôîðìàöèîííûå òåõíîëîãèè 2014; (5): 10-13. Ðåæèì äîñòóïà: https://cyberleninka.ru/article/n/osnovnye-aspekty-razrabotki-meditsinskih-informatsionnyh-sistem (Äàòà äîñòóïà: 28.09.2023).
  8. Ïîíîìàðåâ À.Á., Ïèêóëåâà Ý.À. Ìåòîäîëîãèÿ íàó÷íûõ èññëåäîâàíèé: ó÷åá. ïîñîáèå. Ïåðìü: ÈÄ «Ïåðì. íàö. èññëåä. ïîëèòåõí. óí-òà»; 2014. 186 ñ.
  9. Åâäàêîâ Â.À., Àëëåíîâ À.Ì., Àðòåìüåâà Ã.Á., Ëüâîâà Ä.Ï., Àëåõèí Ñ.Ã., Ãóùèí Ì.Â. Ñîâåðøåíñòâîâàíèå äåÿòåëüíîñòè ãîðîäñêîé ïîëèêëèíèêè íà îñíîâå áåðåæëèâûõ òåõíîëîãèé. Íàóêà ìîëîäûõ – Eruditio Juvenium 2020; (4): 481-494. Ðåæèì äîñòóïà: https://cyberleninka.ru/article/n/sovershenstvovanie-deyatelnosti-gorodskoy-polikliniki-na-osnove-berezhlivyh-tehnologiy. DOI: 10.23888/HMJ202084481-494 (Äàòà äîñòóïà: 16.08.2023).
  10. Ñâàíàäçå Ñ.Í. Î íåêîòîðûõ àñïåêòàõ ðàçâèòèÿ ïëàñòè÷åñêîé õèðóðãèè â Ðîññèéñêîé Ôåäåðàöèè. Ãëàâíûé âðà÷ 2015; (12): 76-82.
  11. Î ñîçäàíèè ñîâìåñòíîé êîìèññèè Ìèíèñòåðñòâà çäðàâîîõðàíåíèÿ Ðîññèéñêîé Ôåäåðàöèè ïî ïðèåìêå ðåçóëüòàòîâ âûïîëíåííûõ ðàáîò (ýòàïîâ ðàáîò) ïðîãðàììû Ñîþçíîãî ãîñóäàðñòâà «Ðàçðàáîòêà íîâûõ ñïèíàëüíûõ ñèñòåì ñ èñïîëüçîâàíèåì òåõíîëîãèé ïðîòîòèïèðîâàíèÿ â õèðóðãè÷åñêîì ëå÷åíèè äåòåé ñ òÿæåëûìè âðîæäåííûìè äåôîðìàöèÿìè è ïîâðåæäåíèÿìè ïîçâîíî÷íèêà»: Ïðèêàç Ìèíèñòåðñòâà çäðàâîîõðàíåíèÿ ÐÔ îò 18 èþíÿ 2021 ã. ¹ 648. Ðåæèì äîñòóïà: https://static-0.minzdrav.gov.ru/system/attachments/attaches/000/055/642/original/MZRF_2021_All_08-04-2021-Preview.pdf?1619014721. (Äàòà äîñòóïà: 16.08.2023)
  12. Ïîïñóéêî À.Í., Äàíèëü÷åíêî ß.Â., Áàöèíà Å.À., Êèëèæåêîâà Ä.Â., Êàðàñü Ä.Â., Àðòàìîíîâà Ã.Â. Âîçìîæíîñòè èñïîëüçîâàíèÿ äèçàéí-ìûøëåíèÿ äëÿ óëó÷øåíèÿ ïðîöåññà îêàçàíèÿ ìåäèöèíñêîé ïîìîùè. Íàó÷íî-ïðàêòè÷åñêèé æóðíàë ìåäèöèíû 2022; (1): 132-145 Ðåæèì äîñòóïà: https://cyberleninka.ru/article/n/vozmozhnosti-ispolzovaniya-dizayn-myshleniya-dlya-uluchsheniya-protsessa-okazaniya-meditsinskoy-pomoschi DOI: 10.17709/2410-1893-2022-9-1-12. (Äàòà äîñòóïà: 16.08.2023).
  13. Ïîïñóéêî À.Í., Äàíèëü÷åíêî ß.Â., Áàöèíà Å.À., Àðòàìîíîâà Ã.Â. Èííîâàöèîííûé ïîäõîä â óïðàâëåíèè âçàèìîäåéñòâèåì ñ ïàöèåíòàìè. Êîìïëåêñíûå ïðîáëåìû ñåðäå÷íî-ñîñóäèñòûõ çàáîëåâàíèé 2021; 10(S2): 68-72. Ðåæèì äîñòóïà: https://cyberleninka.ru/article/n/innovatsionnyy-podhod-v-upravlenii-vzaimodeystviem-s-patsientami. DOI: 10.17802/2306-1278-2021-10-2S-68-72 (Äàòà äîñòóïà: 16.08.2023).
  14. Ñòåíüêèíà Å.Í. Êóðàñîâà Å.À., Ñëåï÷åíêî Ä.Ï. Íàöèîíàëüíûå ïðîåêòû çäðàâîîõðàíåíèÿ â Ðîññèè: îïûò è ïåðñïåêòèâû ýêîíîìè÷åñêîãî ðàçâèòèÿ ïðîåêòíîãî ïîäõîäà ê óïðàâëåíèþ. Ýêîíîìèêà è ïðåäïðèíèìàòåëüñòâî 2021; 126 (1): 1008-1011. DOI 10.34925/EIP.2021.126.01.196.
  15. Ôàõðóòäèíîâà Å.Â. Òåîðèÿ è ïðàêòèêà ðåàëèçàöèè ïðèîðèòåòíûõ íàöèîíàëüíûõ ïðîåêòîâ â Ðîññèè. Âåñòíèê Àêàäåìèè ýêîíîìè÷åñêîé áåçîïàñíîñòè ÌÂÄ Ðîññèè 2009; (3): 40-44. Ðåæèì äîñòóïà: https://cyberleninka.ru/article/n/teoriya-i-praktika-realizatsii-prioritetnyh-natsionalnyh-proektov-v-rossii (Äàòà äîñòóïà: 16.08.2023).
  16. ßêîâëåâà Å.À., Òèòîâà Å.Â. Ðåãèîíàëüíûå ïðèîðèòåòû ðåàëèçàöèè íàöèîíàëüíûõ ïðîåêòîâ (íà ïðèìåðå Âîðîíåæñêîé îáëàñòè). Ðåãèîíàëüíàÿ ýêîíîìèêà è óïðàâëåíèå: ýëåêòðîííûé íàó÷íûé æóðíàë 2020; 2 (62): 180-183. Ðåæèì äîñòóïà: https://eee-region.ru/article/6210/ (Äàòà äîñòóïà: 16.08.2023).
  17. Ïðîáëåìû ñîâåðøåíñòâîâàíèÿ áþäæåòíîé ïîëèòèêè ðåãèîíîâ è ìóíèöèïàëèòåòîâ.  êí.: Òðóäû Äåñÿòîé íàó÷íî-ïðàêòè÷åñêîé êîíôåðåíöèè (28–30 ñåíòÿáðÿ 2011, Ïåòðîçàâîäñòê). Ïåòðîçàâîäñê: Èçäàòåëüñòâî ÏåòðÃÓ; 2011. 255 ñ. Ðåæèì äîñòóïà: http://openbudget.karelia.ru/conf10/docs/conf10_book.pdf. (Äàòà äîñòóïà: 16.08.2023)
  18. Ëàâðîâ À.Ì. Ïðàêòèêà èíèöèàòèâíîãî áþäæåòèðîâàíèÿ â ñóáúåêòàõ ÐÔ. Êðóãëûé ñòîë «Èíèöèàòèâíîå áþäæåòèðîâàíèå êàê âàæíûé ôàêòîð ñîöèàëüíî-ýêîíîìè÷åñêîãî ðàçâèòèÿ ñóáúåêòîâ ÐÔ» 5 äåêàáðÿ 2017 ã. Ðåæèì äîñòóïà: http://www.council.gov.ru/media/files/1h99uVOK05 ia7rkZfgAAPf5A6vATScwA.pdf (Äàòà äîñòóïà: 16.08.2023).
  19. Îá îðãàíèçàöèè ïðîåêòíîé äåÿòåëüíîñòè â Ïðàâèòåëüñòâå Ðîññèéñêîé Ôåäåðàöèè: Ïîñòàíîâëåíèå Ïðàâèòåëüñòâà ÐÔ îò 2018.10.31; N1288. Â: Ñîáðàíèå çàêîíîäàòåëüñòâà ÐÔ 2018.11.05, N45, ñò. 6947. Ðåæèì äîñòóïà: http://government.ru/docs/34523/. (Äàòà äîñòóïà: 16.08.2023)
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  31. Ãðèíôèëä Äæ., Øîðò Ê. Ôàáðèêè ðàçðàáîòêè ïðîãðàìì. Ïîòîêîâàÿ ñáîðêà òèïîâûõ ïðèëîæåíèé, ìîäåëèðîâàíèå, ñòðóêòóðû è èíñòðóìåíòû. [Ïåð. ñ àíãë]. Ìîñêâà: ÎÎÎ «È. Ä. Âèëüÿìñ»; 2007. 592 ñ.

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