Introduction. Internal quality control and safety of medical activity (further - internal control) is the form of quality control of medical activity, which is the most discussed in scientific and practical literature among existing in modern Russian health care. The article is an attempt to assess, summarize and analyze the regulatory legal framework, methodological base, as well as the experience accumulated in scientific publications on the organization and implementation of internal quality control. The aim: Based on the analysis of data from modern scientific literature and regulatory legal acts, describe the process of development of internal control as a mandatory element of the management of a medical organization. Results. The analysis of regulatory legal acts and scientific publications on the problem made it possible to form an author's periodization in the development of an internal quality control system in the healthcare of the Russian Federation, as well as to highlight basic approaches to the design and construction of an internal control system in medical organizations. Discussion. The absence of our own well-formed regulatory legal framework at the early stages of the development of internal control led to the possibility of variable design and construction of internal control in medical organizations, and also led to a significant “gap” in understanding the problems of internal control between large medical centers (private, federal, republican and regional) and other medical organizations of our country, as well as by departments and subjects of the Russian Federation. The presence of significant differences in the development of internal control in medical organizations necessitated the introduction of uniform federal requirements for its organization and implementation. Conclusions: 1) The process of forming approaches to internal control is determined by the understanding of this activity in different time periods at various levels of Russian healthcare management. 2) Four stages of the internal control development in the Russian healthcare have been identified (1996 - 2006; 2007 - 2011; 2012 - 2018; 2019 - up to the present time). 3) Three approaches are identified: "routine", "legal" and "industrial", as basic to the design and construction of internal activities control system. 4) Unified approaches to the organization internal control formation, based on federal regulatory legal documents and recommendations, will unify the requirements for the control system, provide a comparative assessment for medical organizations and use the results of control in making management decisions.