• Journal of Korean Academy of Nursing Administration
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• v.1 no.1
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• pp.65-78
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• 1995

This is a quasi-experimental research to test the effect of using a nursing care scale. This study identified the effects of using a nursing care scale influencing on the nursing performance and job satisfaction. The subjects consisted of 63 staff nurses in 8 medical and surgical units of one hospital affiliated to university hospital in Seoul, and assigned to experimental and control group conveniently. The data were collected in September and December, 1992. The evaluation of the nursing performance were measured by the instrument from a nursing care scale of one univerrsity hospital and job satisfaction was measured by Stamp's Scale (1978). The data were analyzed by percentage distribution, 2-test, Mann-Whitney U Wilcoxon Rank Sum W test, ANCOVA and T-test. The summarized results were as follows : 1. The nursing performance of the experimental group showed markedly increase about 13 areas of nursing care. However no significant difference in the nursing performance between the two groups was found. 2. There was a significant difference in the nursing performance between the experimental and the control group about 7 areas of nursing records(W=22.0, P<.05). 3. After using a nursing scale, there was a significant difference in the nursing performance about nursing care and nursing records between the experimental and the control group(W=25.0, P<.05). Comparing before using a nursing scale with after, there was no significant difference in the nursing performance between two groups. 4. There was no significant difference in job satisfaction between the experimental and the control group. The main reasons for there being no defference in two groups could be the small size sample and the procedure of intervention. Further comparative study is needed using more strictly controlled procedure of intervention.

• Journal of Korean Academy of Nursing Administration
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• v.19 no.2
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• pp.254-264
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• 2013

연구목적: 본 연구는 간호사의 임상경력단계에 따른 경력개발제도에 대한 간호사의 인식을 파악하고, 경력개발제도에 대한 인식, 전문직 자아개념과 임파워먼트와의 관계를 파악하여 간호사 경력개발제도의 개선의 근거 마련하고 전문직 자아개념과 임파워먼트의 증대 방안 모색을 통한 인적자원관리에 기여하고자 시도 된 서술적 상관관계 연구이다. 연구방법: 서울시 소재 일 상급종합병원에서 근무하는 중환자실, 수술실, 응급실 간호사 162명을 대상으로 설문지를 이용하여 경력개발제도에 대한 인식, 전문직 자아개념, 임파워먼트를 측정하였다. 수집된 자료는 SPSS WIN 18.0 프로그램을 활용하여 서술적 통계, t-test, ANOVA, Pearson's Correlation Coefficient, Multiple linear Regression을 시행하였다. 연구결과: 간호사의 임상경력단계에 따른 경력개발제도에 대한 인식은 전임 2 간호사가 신입 간호사, 일반 간호사, 전임 1 간호사보다 높은 인식을 가지고 있었다. 경력개발제도에 대한 인식과 전문직 자아개념, 임파워먼트에는 통계적으로 유의한 양의 상관관계가 있었다. 다중회귀분석을 실시한 결과 경력개발제도에 대한 전반적 이해, 경력개발제도에 대한 기대효과, 최종학력, 임상경력단계가 전문직 자아개념의 42% 설명하는 것으로 나타났고, 경력개발제도에 대한 전반적 이해, 전문적 활동 참여에 대한 인식, 경력개발제도에 대한 기대효과, 임상경력단계가 임파워먼트를 42% 설명하였다. 결론: 전문직 자아개념과 임파워먼트에 영향을 미친 변수로 나타난 경력개발제도에 대한 인식을 향상시킬 수 있는 방안을 개발하여 적용을 통한 효과 검증이 요구되며, 간호 관리자들의 제도 운영과 관련된 장애요인의 파악 및 세심한 제도 개선이 필요하다.

• Journal of Korean Academy of Nursing Administration
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• v.13 no.3
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• pp.352-361
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• 2007

Purpose: The purpose of this study was to develop roles and organizational policy of advanced practice nurses (APNs) in an acute hospital setting. Method: The design of the study was to descriptive-exploratory. Sample consisted of 43 participants who included 13 nurses, 18 nurse managers and 12 physicians. Survey, interview and focus group interview were performed to obtain the data. Results: The expected roles of APNs were education and counseling, direct management patient care with advanced skills, research, and collaboration and coordination among several departments. The expected outcomes were patient satisfaction, improved access to care, decreased the rate of complications, and speedy provision of services. Based on research, a proposal of APNs roles and organizational policy in a hospital setting was developed, which included definition of APNs, qualification, roles and specific roles, specialty areas, accountability, recruitment and affiliation, privileges, and expected outcomes. Conclusion: This study gives a guideline on how to introduce and use APNs in acute care tertiary settings.

• Health Policy and Management
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• v.8 no.2
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• pp.25-57
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• 1998

In order to assess the attractiveness of the hospital industry, the competitive environment of the industry was analyzed. With the employment of Michael Porter's five forces model' the deciding factor was examined and applied to evaluate the intensity of the competitiveness in the hospital industry, and then the structure and attractiveness in hospital industry was assessed. The subject of this study was hospitals that have over 500 beds. Main findings are as follows. 1. Out of 5 factors deciding competitiveness, the pressure from newly opened hospitals and the competition between existing hospitals, were both high in intensity; this makes hospital industry less attractive. The pressure from the substitutes and the pressure from the negotiating power of consumers and suppliers were low; this makes hospital industry more attractive. 2. Overall intensity of competitive pressure pressure for existing hospital industry that have over 500 beds was rather low, consequently the attractiveness of the industry was evaluated quite high. These findings, however, were not solid enough to endorse the attractiveness of the industry. 3. It was understood that future industry would have bigger pressure/ competition so that the attractiveness for the relevant hospital industry would be decreased. This study has its limitations. As the evaluation of competitive factor was not grounded on quantitative data, its objectivity could be questioned. Also, the overall result of each factors could be distorted as it was calculated with same weight against individual factor. This study has its significance in that the specific hospital group was viewed as one industry, and its attractiveness as a potentially profitable industry in which worth investing was estimated, with all factors considered. With this key result, hospitals industustry could work out a plan to enhance the status of hospitals, allowing hospitals to get assistance in making strategic decisions such as mergers, cooperations, and new establishments.

• Health Policy and Management
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• v.6 no.1
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• pp.191-210
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• 1996

This study purported to acquire information necessary to improve the operational efficiency of general hospitals. It tried to determine major indices which represent managerial performance of general hospitals and to identify the managerial characteristics of general hospital which affect the major financial indices. 201 hospitals which were subject to standardization audit by the Korean Hospital Association were investigated and 80 hospitals were finally chosen for this study. Their financial and managerial data during the period between January 1991 and December 1991 were collected. Considering financial indices in this study were the ration of net income to total asset, income growth rate, and quick ration. The results of study are summarized as followings. First. The ration of net income to total assets and quick ration were highly related to managerial characteristics of general hospitals. Therefore, the standardization of three financial indices should be needed to systematically check the operational efficiency of general hospitals. Second, the sample hospitals can be classified as four groups on the basis of their financial indices' level. 4 of those hospitals(5.0%) showed high level of performance in terms of three financial indices and 27 of them(33.7%) showed that they are highly related to only two financial indices. 34 hospitals(42.5%) showed they have high level of relationship with only one indices and 15 hospitals(18.8%) showed very weak performance level with three indices. In addition, there is no hospitals to show mid-range level of managerial performance in relation to all three financial indices. Third, there is no significant relationship between three financial indices and the managerial characteristics of hospitals such as the number of beds, type of operation, location of hospitals, and etc. However, in the case of hospitals which have high level of managerial performance, they have more specialists and medical support personnel in comparison to low performance hospitals. They also have high level of bed occupancy rate and average length of stay(ALOS). In conclusion, the study showed the standardization of 3 financial indices are necessary to systematically evaluate the managerial performance of general hospitals and provide more accurate operational information for each hospital. To do so, it is necessary to focus on management side of hospital such as the effective human resource management and quality enhancement of medical treatment.

• Health Policy and Management
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• v.19 no.1
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• pp.81-96
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• 2009

The expansion of long-term care hospitals (LTCHs) is expected to contribute to meeting the long-term care needs of the elderly with chronic diseases in a rapidly aging society. It is also expected to increase efficiency of health resource use and decrease elderly health expenditures by transferring patients from acute care hospitals (ACHs) to LTCHs. This study aimed to empirically examine how the expansion of LTCHs had influences on the length of hospitalization of the elderly in ACHs. Panel regression analysis was employed as an analytic tool using data of the National Health Insurance and the National Statistical Office from 2002 to 2006. The expansion of LTCHs was measured as location quotient (LQ) of LTCHs, denoting the share of LTCHs in a large city or province relative to the share of LTCHs at the national level. In addition, per capita GRDP (gross regional domestic product) and the proportion of population over 65 were included as control variables. The main findings are as follows. First, it was observed that LQ of LTCHs showed a statistically significant negative association with the length of hospitalization of the elderly in ACHs. Second, the negative correlation was evident among general hospitals with over 100 beds while it was not among hospitals with less than 100 beds. Third, LQ of LTCHs had more influences among the elderly over 85. In conclusion, the expansion of LTCHs seems to contribute to decrease in the inpatient cost of the elderly in ACHs and to increase efficiency in the utilization of health resources.

• Health Policy and Management
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• v.26 no.3
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• pp.233-241
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• 2016

Background: This study purposed to analyze and understand how spatial accessibility of patients influenced the number of outpatient visits for the internal medicine of a hospital. Methods: A hospital with 100 beds in Seoul, South Korea provided data from 2013 January 1 to 2013 June 30. Euclidean distance and road ares were used to represent the spatial accessibility. Patient level data and dong level data were collected and used in spatial analysis. Dong level data was converted into grid level ($500{\times}500m$) for the multivariate analysis. Hot-spot analysis and generalized linear model were applied to the data collected. Results: Hot-spots of outpatient visits were found around the study hospital, and cold-spots were not found. Number of outpatient visits was varied by the distance between patient resident and hospitals, and about 80% of total outpatient visits was occurred in within the 5 km from study hospital, and 50% was occurred in within 1.6 km. Spatial accessibility had significant influences on the outpatient visits. Conclusion: Findings provide evidences that spatial accessibility had influences on the patients' behaviors in utilizing the outpatient care of internal medicine in a hospital. Results can provide useful information to health policy makers as well as hospital managers for their decision making.

• Health Policy and Management
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• v.26 no.3
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• pp.195-206
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• 2016

Background: Concentration of patients to large hospitals is serious problem in Korea. The purpose of this paper is to propose appropriate policy direction to relieve concentration of patients to large hospitals. It is focused on evaluation of the possibility of family doctor system as a policy alternative to relieve concentration of patients to large hospital by empirically analyzing the effect of usual source of care (USC) on large hospitals medical care use. Methods: Korea Health Panel conducted 2009, 2012, 2013 by KIHASA (Korea Institute for Health and Social Affairs) and NHIS (National Health Insurance Service) was used for analysis. For dependent variables, first, the ratio of the amount of using large hospital to total amount of using medical care, and second, the amount of using large hospital are estimated. Independent variables are having an USC and type of USC. Panel analysis was done with above variables. Results: Main results are as follows. First, having an USC increases using large hospital. Second, having a domestic clinic type USC decreases using large hospital and ratio of using large hospital. Third, the effect of domestic clinic type USC is greater in older group, less income group, worse health status group, not having private insurance group, and having chronic disease group. Conclusion: These results show that family doctor program can be a policy alternative to relieve concentration of patients to large hospital. Nonetheless, primary care system in Korea is unsatisfied. It is recommended to reinforce primary care system and family doctor system to relieve concentration of patients to large hospitals.

• Health Policy and Management
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• v.20 no.3
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• pp.123-137
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• 2010

The main purpose of this article is for deriving functions related to the prediction of the closure of the hospitals, and finding out how the discriminant functions affect the closure of the hospitals. Empirical data were collected from 3 years financial statements of 41 private hospitals closed down from 2000 till 2006 and 62 private hospitals in business till now. As a result, the functions related to the prediction of the closure of the private hospital are 4 indices: Return on Assets, Operating Margin, Normal Profit Total Assets, Interest expenses to Total borrowings and bonds payable. From these discriminant functions predicting the closure, I found that the profitability indices - Return on Assets, Operating Margin, Normal Profit Total Assets - are the significant affecting factors. The discriminant functions predicting the closure of the group of the hospitals, 3 years before the closure were Normal Profit to Gross Revenues, Total borrowings and bonds payable to total assets, Total Assets Turnover, Total borrowings and bonds payable to Revenues, Interest expenses to Total borrowings and bonds payable and among them Normal Profit to Gross Revenues, Total borrowings and bonds payable to total assets, Total Assets Turnover, Total borrowings and bonds payable to Revenues are the significant affecting factors. However 2 years before the closure, the discriminant functions predicting the closure of the hospital were Interest expenses to Total borrowings and bonds payable and it was the significant affecting factor. And, one year before the closure, the discriminant functions predicting the closure were Total Assets Turnover, Fixed Assets Turnover, Growth Rate of Total Assets, Growth Rate of Revenues, Interest expenses to Revenues, Interest expenses to Total borrowings and bonds payable. Among them, Total Assets Turnover, Growth Rate of Revenues, Interest expenses to Revenues were the significant affecting factors.

• Health Policy and Management
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• v.21 no.4
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• pp.527-540
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• 2011

Some patients tend to visit tertiary hospitals instead of non-tertiary hospitals for minor illnesses, which is a chronic problem within the Korean health care delivery system. In order to reduce the number of patients with minor severity diseases unnecessarily utilizing the tertiary medical services in Korea, the Ministry of Health and Welfare raised the outpatient co-insurance rate for the tertiary hospitals in July, 2009. Another increase in the prescription drug co-insurance rate by the general and tertiary hospitals is scheduled to take place in the second half of 2011. An increase in copayments may discourage the utilization rate of medical services among the underprivileged or patients who require complicated procedures. This study aims to analyze the diabetic patients' utilization rates of tertiary hospitals according to the Comorbidity score. Diabetic patients' data was gathered from the Health Insurance Claims Records in the Health Insurance Review & Assessment Service between 2007-2009. Comorbidity scores are measured by the Charlson Comorbidity Index and the Elixhauser Index. Chi-square and logistic regressions were performed to compare the utilization rates of both insulin-dependents (n=94,026) and non-insulin-dependents (n=1,424,736) in tertiary hospitals. The higher Comorbidity outcomes in the insulin-dependent diabetic patients who didn't visit tertiary hospitals compared to those who did, was expected. However, after adjusting the gender, age, location, first visits and complications, the groups that scored >=1 on the comorbidity scale utilized the tertiary hospitals more than the O score group. Non-insulin-diabetic patients with higher Comorbidity scores visited tertiary hospitals more than patients who received lower grades. This study found that patients suffering from severe diabetes tend to frequently visit the tertiary hospitals in Korea. This result implied that it is important for Korea to improve the quality of its primary health care as well as to consider a co-insurance rate increase.