• 한국콘텐츠학회논문지
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• 제18권10호
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• pp.568-574
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• 2018

이 연구는 충청지역 국 공립종합병원과 민간종합병원 근로자를 대상으로 감정노동의 인식정도를 살펴보고, 아울러 국 공립과 민간종합병원 근로자의 인식차이를 살펴보고자 하였다. 또한 국 공립종합병원 근로자와 민간종합병원 근로자들을 구분하여 감정노동이 조직몰입에 미치는 영향을 분석해 보고자 하였다. 이를 통해 향후 병원 근로자의 감정노동을 완화시키기 위한 이론적 기초자료를 제공하고자 하였다. 분석결과는 첫째, 국 공립종합병원 근로자들로 한정하여, 병원 근로자들의 감정노동이 병원 근로자들의 조직몰입에 미치는 영향관계는 감정표현 빈도의 경우에는 많아질수록 조직몰입이 높아졌으나, 감정표현 주의정도, 감정부조화는 깊어질수록 병원 근로자들의 조직몰입 정도는 낮아진다는 것을 알 수 있었다. 한편, 민간종합병원 근로자들로 한정하여, 병원 근로자들의 감정노동이 병원 근로자들의 조직몰입에 미치는 영향관계는 감정표현에 주의를 더 기울일수록 조직몰입이 오히려 잘되는 것으로 확인되었으나, 감정부조화의 경우에는 감정부조화가 더 깊어질수록 민간종합병원 근로자들의 조직몰입이 감소하는 것을 알 수 있다. 둘째, 병원 근무형태에 따라 감정노동에 대한 병원 근로자의 인식 차이에서 감정표현의 빈도는 민간종합병원 근로자들에 비해 국 공립종합병원 근로자들이 감정표현의 빈도가 더 많은 것으로 확인되었으나, 감정표현의 다양성에서는 국 공립병원 근로자들에 비해 민간종합병원 근로자들이 더 감정표현을 다양하게 구사하는 것으로 확인되었다. 또한, 병원 근무형태에 따른 병원 근로자들의 조직몰입 인식 차이는 민간종합병원 근로자들에 비해 국 공립종합병원 근로자들이 조직몰입이 더 높은 것으로 확인되었다.

• Annals of Coloproctology
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• 제34권6호
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• pp.317-321
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• 2018

Purpose: We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). Methods: Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. Results: Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was $66.91{\pm}11.15years$, and the median body mass index was $24kg/m^2$ (range, $20-35kg/m^2$). The median tumor distance from the anal verge was 8 cm (range, 4-12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. Conclusion: These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.

• 한국식품조리과학회지
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• 제19권4호
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• pp.477-492
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• 2003

The purposes of the study were to establish HACCP-based standards and guidelines for conducting a plan review to build, or renovate, hospital food service establishments, and ensure the safety of foodservice and reduce the risk of food borne illness. The scope of the study included suggestion for the planning of hospital foodservice facilities: layout, design, equipment and modeling. The results of this study can be summarized as follows: 1) The development of a foodservice facility plan based on the results of a survey, literature reviews and the results of interviews with foodservice managers from 9 general hospitals. This was composed of operational policies in foodservices, layout characteristics, space allocation, selection, design, specification standards for equipment and the construction principles of foodservice facilities. 2) Two foodservice facility models were developed, one for general hospitals with 900 beds (2,000 patients and 2,500 employee meals per day) and the other for general hospitals with 300 beds (600 patients and 650 employees meals per day). 3) The suggested kitchen space requirements for the foodservice facility models were 341.2 ㎡ (W 17,100mm x L 23,700mm) and 998.8㎡ (W 35,600mm x L 32,800mm) for the 300 and 900 beds hospitals, respectively, with both designs being rectangular. The space requirements for the equipment, in relation to the total operational area, in terms of ratios were 1:3.5 and 1:3.8 for the 300 and 900 beds hospitals, respectively. The recommended space allowances per bed for the developed foodservice facility models were 1.15 ㎡ and 1.11 ㎡ for the 300 and 900 beds hospitals, respectively, which were increased by more than 30% compared to those suggested in the precedent study, and considered appropriate for the implementation of the HACCP system. 4) The hospital foodservice facilities plans and models were developed based on the general sanitation standards, guidelines and the HACCP system, and included foodservice facility layout, product flow, physical separation between contaminated and sanitary areas, foodservice facility specifications with a 1/300 scale for a 300 bed, and a 1/400 scale for a 900 beds blueprint. 5) The main features of the developed foodservice facility plans and models were; physical separation between contaminated and sanitary areas to prevent cross contamination, product flow in one direction from the arrival of the raw material to the finished product, and separation of different work areas and the process of receiving & preparation of products, refrigeration & storage, cooking, assembly, cleaning & disinfection, employee areas and janitorial facilities. The proposed models from this study were presented as examples for those wanting to build, or renovate, their facility for the production of foods.

• 한국병원경영학회지
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• 제13권4호
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• pp.1-26
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• 2008

This study examines the statistical relationship between medical specialists and managerial performance, using regression analysis with the number of medical specialists per 100 beds as the independent variable and the managerial performance index as the dependent variable. Managerial performance index incorporated the number of out-patients per specialist, the number of in-patients per specialist, the volume of revenue per specialist, the number of beds per specialist, and the average length of stay. To compare different groups of hospitals, dummy variable was applied to five groups of hospitals according to size: 100-299 beds, 300-599 beds, 600-899 beds, 900-1199 beds, and more than 1200 beds. The data consisted of 181 general hospitals with more than 100 beds, which included 28 public hospitals, 73 corporate hospitals, 64 university hospitals and 16 private hospitals. Of those, 87 hospitals were located in big cities and 94 hospitals in medium to small cities. This study used hospitals from the Korean Hospital Association, and data published in 2004. The collected data sample was analyzed using the SPSSWIN 12.0 version, and the study hypothesis was tested using regression analysis. The findings of this study are summarized as follows: Hypothesis 1 predicting a negative effect of the number of medical specialists on the number of out-patients per specialist was supported with statistical significance. The analysis of dummy variable showed causality in all the hospital groups larger than the group of 100-299 beds. Hypothesis 2 predicting a negative effect of the number of medical specialists on the number of in-patients per specialist was supported with statistical significance. The analysis of dummy variable showed causality in the hospital group of 300-599 beds when compared to the group of 100-299 beds. Hypothesis 3 predicting a negative effect of the number of medical specialists on the volume of revenue per specialist was not supported. However, the analysis of dummy variable showed that the volume of revenue per specialist increased in the hospital groups of 600-899 beds, 900-1199 beds, and over 1200 beds, when compared to the group of 100-299 beds. Hypothesis 4 predicting a negative effect of the number of medical specialists on the average length of stay was supported with statistical significance. The analysis of dummy variable showed causality in the hospital group of 300-599 beds, when compared to the group of 100-299 beds. Results of this study show that the number of the medical specialists per 100 beds is an important factor in hospital managerial performance. Most hospitals have tried to retain as many medical specialists as possible to keep the number of patients stable, to ensure adequate revenue, and to maintain efficient managerial performance. Especially, the big hospitals with greater number of beds and medical specialists have shown greater revenue per medical specialist despite the smaller number of patients per medical specialist. Findings of this study explains why hospitals in Korea are getting bigger.

• 한국치위생학회지
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• 제3권1호
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• pp.59-72
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• 2003

The purpose of this study was to examine what the role of denial hygienist was. The subjects were 751 dental hygienists from dental clinics, dental hospitals, general hospitals, public dental clinics and their branches throughout the nation. After a survey was conducted, the collected data were analyzed with SPSS WIN 10.0, and variance analysis and post-analysis were implemented. And Forgarty's 8th integrated model, out of 10 ones, was selected to delve into the practical role of dental hygienist in detail. The findings of this study were as follows: 1. The three age groups had a significantly different opinion on the significance of individual subjects. The dental hygienists of thirty six and over found the basic and preventive public dental care courses most important, and the 31~35 age group placed most stock in education and research. Overall, the post-analysis results showed that prevention and clinical courses were considered most vital, followed by education and fundamental courses. 2. There was a significant gap between four groups from the different work places in their view of the weight of the individual subjects. According to the post-analysis, the dental hygienists from the general hospitals, public dental clinics and their branches gave more weight to fundamental, education and research areas. Those who were with the dental clinics, dental hospitals and general hospitals put higher value on clinical course than the dental hygienists from the public dental clinics and their branches. 3. Two groups with a different career also had a different outlook on the importance of the individual subjects. The post-analysis results illustrated that the dental hygienists who had worked for three years or more put higher stress on the fundamental course than those with a less career, and the dental hygienists with a five-year or higher career attached more importance to the education and research field than those with a smaller career. 4. There was a significant difference between the three age groups in their clinical role. The post-analysis results indicated thai the younger dental hygienists were more of assistants than of professionals, as they chiefly took X-ray photograph, handled treatment materials or performed treatment-related works. Overall, handling treatment materials was most common. 5. The three groups from the different work places significantly varied in their clinical role. According to the post-analysis, those from the dental clinics and dental hospitals took more x-ray photographs, handled more treatment materials and performed more relevant works, compared to those from the general hospitals, public dental clinics and their branches. 6. The two groups with a different career differed significantly in their clinical role. The post-analysis results suggested that the dental hygienists with a less career played an assistant role more, which handled treatment materials or carried out other relevant works. 7. The fundamental courses (I) and (II), preventive class (I) and (II) and its practice course were regarded as integrated subjects that they should take 10 offer preventive treatment, which was one of the dental hygienist missions. What's needed to act as dental-care educators was the basic courses (I) and (II), dental hygiene education and its practice. Finally, integrated clinical courses (I) and (II) and clinical practice were viewed as necessary for their role performance as dental treatment collaborators.

• 한국콘텐츠학회논문지
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• 제17권4호
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• pp.585-595
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• 2017

본 연구는 의료급여와 건강보험환자의 의료이용량의 차이를 분석하여 의료급여환자의 도덕적 해이로 인한 진료비 증가문제를 평가하고 합리적 의료급여 정책결정의 근거를 제시하기 위한 것이다. 이를 위하여 서울시민대상 건강보험과 의료급여 급여자료를 성별 연령별 의료기관 종별로 비교 분석하였다. 분석결과는 다음과 같다. 첫째, 상급종합병원의 입원 외래이용 모두 의료급여환자가 건강보험환자에 비해서 적어서 도덕적 해이가 존재하지 않았다. 오히려 의료급여환자들이 고비용 의료서비스를 이용하고 못하고 있었다. 둘째, 종합병원의 입원이용은 건강보험환자가 많은 반면 외래이용은 의료급여환자가 많아서 의료급여환자들이 본인부담이 적은 외래서비스 이용을 많이 이용하고 있었다. 셋째, 병원 의원은 의료급여환자의 이용이 입원과 외래이용 모두 건강보험환자에 비해서 많았다. 따라서 의료급여환자들은 병원 의원의 입원과 외래이용, 종합병원의 외래이용시 적은 본인부담으로 인해 불필요한 의료이용을 할 가능성이 있는 반면에 상급 종합병원 입원과 외래이용, 종합병원의 입원이용시 비급여 의료비 등 과도한 의료비 부담으로 인해 필요한 의료서비스 이용을 하지 못할 가능성도 있었다. 따라서 중증질환을 가진 의료급여환자들의 의료비 부담을 경감시키기 위한 정책은 지속하고, 의원 병원을 이용하는 의료급여환자들이 불필요한 의료서비스를 이용하지 않도록 관리해야 할 것이다.

• 보건의료산업학회지
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• 제11권3호
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• pp.1-11
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• 2017

Objectives : The purpose of this study was to analyze factors affecting the performance of public hospitals in South Korea. Methods : We collected management performance data from 2013 to 2015 from income statements, balance sheets, and annual reports from 32 local public hospitals. The dependent variable used was profitability, which included operating margin, return on assets and net profit to gross revenues. The independent variables were general characteristics, liquidity, stability, and activity. Results : Patient revenues, total assets, and total capital had increased steadily but patient expenses had increased to a greater extent. Operating profit, and net profit were consistently in deficits and the management status of local public hospitals had recently been in difficulty. The debt ratio, quick ratio, ratio of fixed liability and fixed assets turnover rate have a significant positive(+) effect on performance in the years 2013-2015. Conclusions : We suggest management strategies for these hospitals based on the results analyzed.

• Journal of Preventive Medicine and Public Health
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• 제21권1호
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• pp.10-20
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• 1988

각 의료기관에서 분만하는 산모와 신생아의 특성을 비교분석하고 의료기관별 산모와 신생아의 위험수준을 조사하여 특정 의료기관에서 관찰한 연구결과를 해석하는데 참고 자료를 제공하기 위하여 대구시내 3개 대학병원, 2개 종합병원,2개 개인의원, 1개 조산소, 그리고 1개 모자보건센터에서 1987년 4월 1일 부터 4월 30일 까지 1개월간(1개 대학병원은 2개월간) 분만한 산모 1,410명을 대상으로 산모의 연령, 교육수준, 의료비 지불방법, 산과력 및 특정의료기관을 선택한 이유를 면담 조사하고 병원기록지에서 신생아의 출생시 체중의 조사하였다. 대학병원과 종합병원을 이용한 산모의 평균 연령은 각각 27.5세, 26.7세로 조산소(25.4세)와 모자보건센터(26.1세)를 이용한 산모보다 많았고, 교육수준은 대학병원(평균 12.7년)과 종합병원(평균 12.2년) 산모가 조산소(평균 9.2년) 및 모자보건센터(평균 9.3년) 산모보다 월등히 높았다. 그리고 의료보험 대상자도 대학병원(78.1%)과 종합병원(82.9%) 산모가 개인의원(44.3%), 조산소(29.1%)나 모자보건센터(5.4%) 보다 많았다. 모자보건센터는 2번째 출산이 47.3%로 가장 많았으나 다른 의료기관은 모두 초산부가 $56.0{\sim}61.7%$로 제일 많았다. 산모의 산과력 비교에서는 대학병원 산모가 자연유산 경험율이 상대적으로 다른 의료기관 산모보다 높았고 사산 경험자도 소수였으나 조산소와 모자보건센터에서 분만한 산모는 사산 경험자가 1명도 없었다. 대학병원 산모의 경우 37주 이하의 조산아 출생율(11.4%)과 2,499gm이하의 저체중아 출생율($5.8{\sim}13.0%$)은 타 의료기관 보다 현저히 높았다. 이에 따라 제왕절개술에 의한 분만율은 의료기관간에 차이가 많았다. 결국 대구시내 대학병원과 종합병원에서 분만하는 산모들은 사회경제적으로 중, 상류층과 소득고하를 막론하고 고위험산모들이 많고 조산소와 모자보건센터는 저소득충의 산모 가운데 산과적으로 저위험군들이 많이 이용하고 있다. 따라서 특정 의료기관을 대상으로 조사한 자료를 해석하는데 많은 제한성이 있으며 전체 산모의 특성으로 일반화하는 것은 불가능한 것으로 생각된다.

• 가정간호학회지
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• 제5권
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• pp.84-99
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• 1998

The objectives of this study are to identify the actual educational contents of management for head nurse and to propose the educational subjects according to identity the needs of head, charge, and staff nurses. The subjects were investigated the actual Management Development Programs and educational needs of head nurses and prospective nurse manager(charge nurse, staff nurse with a lot of clinical experiences) in general hospitals. The tools were composed of two questionnaires: One was developed from the literature review for making items to measure actual situation. The other was revised Katz's model for measurement of educational needs. The first respondents of actual situation were 27 general hospitals with over 400 beds in Seoul and the second respondents were 89 head nurses, 67 charge nurses and 136 nurses at 3 hospitals by convenient sampling out of 27 general hospitals. Data were collected by telephone interview, mail questionnaire and visiting from 7th of October through 30th of November in 1997. In data analysis, general characteristics of the respondents and actual status of Management Development Programs were analyzed by frequency and percentage. Educational needs according to general characteristics were analyzed by ANOVA The results were as follows: 1. Actual situation of Management Development Program 1) Seven hospitals(26%) had Management Development Program for prospective managers and 14 hospitals (52%) for head nurses. 2) Education Department existed in 14 hospitals (52%). 3) One hospital(4%) had top level managers took part in the Management Development. 4) Two hospitals selected head nurse, who had finished courses of Management Development. Eight hospitals(30%) assessed educational needs. The assessment tools consisted of making a question via questionnaire(75%), determining at department meeting(12%) and interview(13%). 5) Educational programs had 3 types: 10 lecture type, 7 discussion type and 4 role play type programs. 6) One hospital evaluated the change of learner's attitude. 7) Four hospitals scored educational point, but that was measured only by attending. 8) Actual Management Development Programs were as follows. parenthesis indicates the number of hospitals. (1) Management Development Programs for Prospective manager. Role perception of Middle level Manager (1) . Role reconstruction of Nurse Manager (1). Workshop for Charge Nurse (1). Nursing Delivery System and Nursing Process (1). Communication (1). Motivation (1) (2) Management Development Programs for Head nurse.. Head nurse's Role (5). Administrative Work (7). Service Education (4). Prevention and Countermeasure of Nursing Incidence (3). Appraisal (3) 2. The results of needs on Management Development subject 1) The educational needs of all respondents on 3 skill domains showed positive agreement to strongly positive agreement. 2) High priority(more than 4.5) items were 12 of 24 Human skill items(50%), 1 of 6 Technical skill items(16%), and 2 of 13 Conceptual skill items (15%). 3) Out of high priority items, 8 items were instituted. 4) All respondents showed high needs on 3 skill domains regardless of 3 positions (head nurse, charge nurse, and nurse). Educational needs of Human skill domain, according to position were 108. S, 108.7, 106.8 (mean score = 72) , needs of Technical skill domain were 26.5, 26.6, 26.I(mean score=18), and needs of Conceptual skill domains were 56.9,56.7, 55.1(mean score=39). 5) Needs of 3 skill domains according to clinical career showed significant difference. Out of respondents, nurses with career of over 16years showed lowest degree of needs in Human skill domains(F=4.47, P=.004) and Conceptual skill domain(F=2.93, P=.034). 6) Educational needs according to educational background were not significant difference. But out of respondents, nurses educated at 3-year junior college relatively showed lowest needs in all of the 3 skill domains. With the above-mentioned findings, further study is necessary for generalization of this study at hospitals with different bed size and location. Also it is needed to study about management skill of nurse and charge nurse, and effective educational method.

• 간호행정학회지
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• 제6권2호
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• pp.227-243
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• 2000

The purpose of this study was to identify the relationship between nursing organizational climate and job satisfaction of nurses in general hospitals and also the factors which had influences in the nursing organizational climate and job satisfaction of nurses. Data were collected from 200 nursing managers and 800 nurses with structured questionnaires at 11 general hospitals in Taegu and Kyungbuk-area, from June 1 to June 30, 1999. Data were analyed with SPSS 7.5 using program such as t-test, ANOVA and stepwise multiple regression. The results were as follows: 1) In the nursing organizational climate there were significant differences by age(F=9.246, p=.000), religion(f=5.658, p=.001), educational level(F=4.660, p=.010), position(F=27.016, p=.000), and the total length of service(F=7.274, p=.000). Also there were significant differences by subsidiary school(F=11.224, p=.000), the number of beds(F=9.893, p=.000), the number of nurses(F=6.365, p=.000), and kind of medical agency(F=5.251, p=.000) in the hospitals. 2) In the nurses' job satisfaction there were significant differences by age(f=11.528, p=.000), religion(F=3.003, p=.000), position(F=22.485, p=.000), career the department of the present service(F=5.157, p=.000), total career of service(F=9.243, p=.000), and salary(F=5.507, p=.000). Also there were significant differences by religious background(F=4.779, p=.009), subsidiary school(F=7.039, p=.000), the number of beds(F=7.039, p=.000), and kind of medical agency(F=2.778, p=.006) in the hospitals 3) There was significant correlation between nursing organizational climate and job satisfaction of nurses(r=.686). 4) The nursing organizational climate was explained 21.8% by salary 9.5%, position 7.4%, religious background of hospital 4.1%, and subsidiary school of hospital 0.8%. 5) The nurses' job satisfaction was explained 70.9% by nursing organizational climate 46.7%, salary 21.9%, kind of medical agency 1.4%, position 0.3%, religious background of hospital 0.3%, religion 0.3%.