• 한국의료질향상학회지
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• 제8권2호
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• pp.218-231
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• 2001

Background : The purpose of this study was to investigate the understanding and the attitude of Korean hospital CEOs toward the healthcare quality improvement. Methods : A mailed questionnaire survey to the CEOs of hospitals with 400 beds or more was conducted between September 15 and October 30, 2000. Of the 108 hospitals eligible for the study, 58 participated, yielding a response rate of 54 percent. Result : The hospital CEOs have expressed that their hospital management was arduous job, and they had been pressured by increasing competitions among healthcare providers. They indicated that the low fees of health insurance made their hospital management difficult. The results also indicated that there was general consensus that the improvement of service quality was important in encouraging their organizations, but the investment of manpower and equipment ranked higher than the improvement of service quality. The majority of the CEOs have good understanding about quality improvement activities. However the facts that in general QI must be focused at the process of services and customer satisfaction, meanwhile quality improvement activities are helpful for the organizational productivity embarrassed them. The hospital CEOs responded that there were successful changes in terms of quality of care, patient satisfaction, and process efficiency after QI activities, but no increase in patient number and profit. Lack of understanding to QI activities and limited budget seem to attribute unsatisfactory outcomes. Conclusion : The majority of Korean hospital CEOs have a good understanding and attitude about QI activities. As mentioned in the result, despite of several limitations, several facts regarding the CEOs of hospital in Korean can be elucidated. (1) The general cognition of the QI project is relatively high, and it is accepted with positive concern, (2) the priority of the QI project, however, is not set higher than other projects and (3) the specific concepts of the actual QI project such as customer (patient)-focused work driving, the recognition of the work accomplishment, and the importance of rewards have not sufficiently understood.

• 보건행정학회지
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• 제22권4호
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• pp.597-627
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• 2012

As misalignments among images, identity, and legitimacy of health professionals and institutions have been on the rise, CEOs of health care organizations have been required to enhance organizational accountability. Despite the accumulation of literature on the conceptual discussions of accountability, only a few studies empirically investigated key barriers to accountability and its facilitators. To identify perception on accountability with key barriers and facilitators of organizational accountability, a semi-structured interview with 11 CEOs of Korean hospitals was conducted. A short survey was taken to get quantitative data on CEO's perception on organizational accountability. To CEOs, accountability was very complex and unfamiliar concept, but understood as physician's code of ethics by nature and basic principle of hospital management. CEOs thought accountability could be improved through ethical leadership, financial stability and learning climate of hospitals. Distrust of the government, which failed to provide economic incentives for hospitals to increase accountability activities, was emphasized as a serious barrier to hospital accountability. There was consensus among hospital CEOs as to the importance of accountability in management. However, there were concerns that, without policy instruments to motivate hospitals toward increasing community benefits as well as collective efforts among health professionals to rebuild moral climate for being accountable, greater accountability would not be achieved in hospitals.

• 한국병원경영학회지
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• 제11권1호
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• pp.110-126
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• 2006

The purpose of the study is to find the factors influencing small or middle size clinics and hospitals CEOs' expectation level on the affiliation with the large size teaching hospitals. Data for analysis was collected to use self-administrative structured questionnaire on 164 CEOs of small or middle sized clinics and hospitals affiliated with large sized teaching hospital located in Kyung Ki Province. For the study, the researchers develop the constructs for questions on the expectation on the affiliation, the attitude such as confidence, knowledge on the affiliation, previous relationship of the affiliation, and selection guideline of the affiliation with exploratory factor analysis and reliability test. Through the confirmative factor analysis using AMOS 4, the researchers develop constructs based on exact relationship between constructs and questions. CEOs' expectation level on the affiliation is influenced on attitude or confidence, gender, types of clinics and hospitals, distance to the affiliated large hospital, types of recommender, and number of affiliated hospitals. Large sized hospitals that want to affiliation with other clinics and hospitals can promote the affiliation to consider these factors from the results.

• 보건의료산업학회지
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• 제5권2호
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• pp.105-117
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• 2011

The purpose of this study is to investigate evaluation and improvement of long-term care hospitals for changing long-term care hospitals fee system. Data were collected from 104 CEOs in nationwide long-term care hospitals using structured self-administered questionnaires during August 17 to 31, 2009. Major results of the empirical analysis are as follows; first, to change fixed sum medical fee per day caused to decline the level of geriatric service in 87% of CEOs. Second, 79% of CEOs were dissatisfied with changing fixed sum medical fee per day, and 47% of them were dissatisfied with graded fee for doctor and nurse management. Finally, they suggested that to specialize and to differentiate of long-term care hospitals will drive to improve long-term care hospitals function and to measure workforce based on rate of filled vacancies will increase efficiency and productivity of doctor and nurse management.

• 보건행정학회지
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• 제16권3호
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• pp.86-106
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• 2006

The purpose of the study is 1) to explore clinic and hospital CEOs' satisfaction and expectation level on the affiliation with the larger size teaching hospitals, 2) to find the factors influencing the satisfaction and expectation level on the affiliation with the large hospitals. Data for analysis was collected to use self-administrative structured questionnaire on 335 CEOs of small or middle sized clinics and hospitals affiliated with large sized teaching hospitals located in Seoul and Kyung Ki Province. For the study, the researchers develop the constructs for questions on the satisfaction and the expectation of the affiliation, the attitude, knowledge on the affiliation, previous relationship of the affiliation, and selection guideline of the affiliation with exploratory factor analysis and reliability test. Through the confirmative factor analysis using AMOS 4, the researchers develop constructs based on exact relationship between constructs and questions. CEOs' expressive and unexpressive satisfaction level are 2.54 of 5 point(38.5 of 100) and 2.78 of 5 point(44.5 of 100), and the expressive and unexpressive expectation level are 2.77 of 5 point(44.3) and 3.16 of 5 point(54.0). These levels are relatively row for importance of affiliation. Expectation levels do not influence satisfaction levels. Attitude of affiliation influences expressive expectation and unexpressive satisfaction, reason for affiliation unexpressive satisfaction, and previous relationship to affiliated hospitals influence both of expressive and unexpressive satisfaction. The expressive expectation level and the expressive satisfaction level influence unexpressive expectation and unexpressive satisfaction, respectively. There is cognitive dissonance between expectation and satisfaction, therefore numbers of affiliation might be smaller or weaker in the future than present time. Many CEOs feel environmental press such as competition and the press of health insurance, but they might not think affiliation is best solution. Therefore, large hospitals try to give affiliated clinics and hospitals practical benefits to increase satisfaction and expectation levels, and they need to new affiliation form such as joint venture and joint ownership. The expectation and the satisfaction level was influenced by CEOs' gender, type of health service facilities, distances between the affiliated facility and the large mother hospital, and reason for affiliation.

• 간호행정학회지
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• 제13권1호
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• pp.40-52
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• 2007

Purpose: The purpose of this paper was to investigate opinions and experiences of hospital CEOs' and QI managers toward the National Hospital Evaluation Program which was implemented in 2004 and to recommend various strategies to improve the program. Methods: We conducted a mail survey with CEOs and QI　managers' of 78 hospitals with 500 beds or more that participated the 2004 National Hospital Evaluation Program. Results: About 70.8% of the participating CEOs and 64.0% of the QI　managers felt that the objectives of the evaluation program weren't fully achieved. Most respondents said that the current program required a partial or an overall change. Evaluation Criteria was the most often cited area for a change. Many respondents pointed out the importance of including clinical quality indicators in the evaluation tool. Conclusions: To upgrade hospital services with better quality, it is most important to first reach consensus on objectives and approaches of the evaluation program among various players. For a consistent planning and implementation, it is urgent to set up a more systematic organization and financing mechanism. Also, evaluation approaches, including evaluation criteria, methods, patient satisfaction assessment, as well as ways to summarize and publicize each hospital's performance should be improved.

• 한국병원경영학회지
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• 제1권1호
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• pp.108-135
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• 1996

This paper investigates the current feature of management strategy of hospitals in Korea, and examines the relationships between adoption of a particular strategic orientation and the hospitals environmental and organizational characteristics, strategic behaviors and management improvement activities, and financial performance. Data were collected from CEOs of 88 hospitals among 650 hospitals for a 13.5% response rate using the self-administered questionnaire by mail survey. The major findings that obtained are as follows: 1. Only 37.2% of response hospitals carried out strategic planning, Most of these hospitals established the first strategic planning in 1991(81.3%) and renovated strategic planning by 4 or 5 years(56.3%), and modified strategic planning with flexibility(59.4%). Most strategic plans were documented, but informalized(68.8%). And only 29.0% of these hospitals had independent planning division. 2. Hospital services that CEOs assessed rank ordered for their impact on profitability are as follows: i)diagnostic ultrasound facility, computerized tomography scanner, obstetric inpatient unit, therapeutic X-ray, and physical therapy at present. ii)diagnostic ultrasound facility, physical therapy, computerized tomography scanner, emergency department, and health screening at future. And the services rank ordered that CEOs hoped to introduce are as follows: emergency department, physical therapy, health screening, volunteer services, and computerized tomography scanner. 3. Using a typology developed by Miles and Snow(l978), the strategic orientation of response hospitals are shifting significantly from defenders in the past to analyzers in the present, and to prospectors in the future(p<.01). 4. With regard to hospital environmental and organizational characteristics such as ownership, physician training, location, bed size, and hospital management training career and specialty of CEOs, the four strategic orientation archetypes varied not significantly. But, hospitals with a analyser orientation in the present and a reactor orientation in the future perceived competition significantly higher than the other three archetypes(p<.05). 5. The four archetypes rank ordered in terms of appling strategic behaviors and management improvement activities are as follows: prospector, analyzer, reactor, and defender. 6. The four archetypes differed significantly in terms of their financial performance using revenue per bed(p<.05). Reactors and prospectors in terms of total revenue per bed, prospectors in terms of outpatient revenue per bed, and reactors and prospectors in terms of inpatient revenue per bed had the best performance.

• Journal of Preventive Medicine and Public Health
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• 제34권4호
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• pp.399-407
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• 2001

Objectives : To investigate the current status of hospital-based health promotion programs in Korea and to elucidate the factors which affect to the process of implementation. Methods : We conducted a mail survey of all 875 hospitals in Korea from March to May 2001. In reference to 12 specific kinds of health promotion programs, hospital CEOs were asked whether their hospital have such programs, whether they are fully staffed and whether the program is paid for by the patients. Contextual factors(location, hospital type, number of beds, length of operation, public/private status, economic level of the community, the level of competition) and organizational factors (the extent of market, compatibility with vision, formalization), strategic types of the CEOs (defender/analyser/prospector) were also surveyed. The relationships between each variable and the implementation of health promotion services, activation of services, and the target groups(patient/community resident) were analyzed by univariate analysis and the independent effects of these variables were examined with multiple logistic regression. Results : 100 of 125 hospitals responding (84.8%) had mere than one health promotion program. However, they showed fluctuations in the adoption rate of each programs, meaning that comprehensive health promotion services were not provided. Many programs were not fully staffed and few hospitals had paid programs. In factors affecting health promotion service implementation, private hospitals showed a higher rate in implementation than public hospitals. In contrast, when the competition among nearby hospitals was intense, the level of implementation of service lowered. In the strategic type of the CEOs, the prospectors were shown to have instituted more health promotion programs in their hospitals and the analysers had a greater tendency to have programs for community residents than the defenders. Conclusion . Considering the above results, contextual factors may contribute greatly to the introduction of health promotion services in Korean hospital, although the CEO's personal preference and organizational factors play a larger role in the activation of services. Additionally, the CEO's personal preference may be the major influencing factor in the introduction of programs for community residents.

• 한국발생생물학회지:발생과생식
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• 제12권2호
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• pp.125-132
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• 2008

멜라토닌(N-acetyl-5-methoxytryptamine)은 포유동물의 뇌의 송과선에서 분비되는 호르몬으로 수면과 생체 리듬 등을 조절하고 난소 기능과 번식에도 영향을 미친다. 또한, 강력한 scavenger로서 항산화제의 역할을 한다. 이 연구의 목적은 멜라토닌이 생쥐 난구세포-핵낭(germinal vesicle, GV) 시기 난자 복합체의 체외성숙에 미치는 영향을 알아보는 것이다. 3주령의 ICR 암컷 생쥐의 난소에서 회수된 난자-난구세포 복합체를 0, 0.1 nM, 10 nM, 1,000 nM의 멜라토닌이 첨가된 배양액에서 18시간 동안 배양하고, 제1극체의 방출 여부를 확인하여 성숙율을 확인하였다. 체외성숙 후 TUNEL assay와 성숙율이 가장 높게 나타났다. 체외성숙된 난자에서는 세포자연사가 나타나지 않았으나 난구세포에서는 관찰되었으며, 1,000 nM을 첨가하여 배양한 군의 난구세포는 유의하게 낮은 세포자연사를 나타냈다. 그리고 1,000 nM의 멜라토닌을 첨가한 군의 난구세포에서 멜라토닌 수용체의 mRNA가 대조군에 비해 낮게 발현되었다. 이상의 결과를 종합하면 체외성숙 배양액에 첨가된 멜라토닌은 난구세포의 세포자연사를 줄여줌으로써 생쥐 미성숙 난자의 체외성숙을 향상시키는 역할을 하는 것으로 사료된다.

• 한국의료질향상학회지
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• 제8권2호
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• pp.146-159
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• 2001

Background : To propose effective strategies for successful implementation of QI in health care institutions, by identifying facilitating factors and barriers to conducting QI programs. Methods : In order to examine empirical evidence on the success factors or barriers to QI implementation in hospitals, a literature study was performed on the basis of MEDLINE search. Among the identified literature. 13 provided reliable findings and basis comprehensive discussion on this issue and thus were selected for in-depth analysis. A mailed questionnaire survey was conducted for hospital CEOs and QI directors of hospitals with 400 beds or greater to investigate what attributes of their organizations they perceived as success factors or obstacles to QI implementation. Result : The analysis of selected literature and survey results presented that the primary factors considered to be most important as successful implementation of QI were: strong support from hospital CEOs, setting higher priority for QI activities, continuous and persistent efforts in QI activities, and active participation of clinical staffs. The barriers identified in this study were : the lack of orientation and understanding of QI concepts, low level of interest and participation of physician in QI programs, the lack of evaluation and rewarding system for QI activities. Conclusion : By identifying factors that affect facilitation of QI, the study results will be of great use for either institutions being in the early stage of evolving QI or those looking for better strategies to achieve more active and persistent QI implementation in their institutions.