• Title/Summary/Keyword: intermediary organization

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A Preliminary Study for Evaluating on Demonstration Project of Community-based Home Health Care Nursing Services by the Seoul Nurses Association (지역사회중심 가정간호 시범사업 성과평가를 위한 기초연구- 서울시 간호사회 주관 -)

  • 유호신;이소우;문희자;황나미;박성애;박정숙;최행지;정기순;한상애
    • Journal of Korean Academy of Nursing
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    • v.30 no.6
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    • pp.1488-1502
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    • 2000
  • This study, based on current home nursing services, aims at promoting measures for establishing a community-based home nursing system derived from the pilot home nursing demonstration project conducted by the Seoul Nurses Association. The study was based on an analysis of home nursing records from march 1993 to December 1999. The following is a summary analysis, based on individual characteristics of the patients, the organization, which recommended the service for their patients and personnel services. 1. The service has been used by many elderly people 60years of age or older(66.4%). and married people(60.9%). The average number of visits by service personnel for patients of city government was 23.5. This is 2.5 times as many visits by general patients. General patients(20.2%) had only one visit from service personnel, while 65.5% of patients of city government had 10 or more visits. Particularly, for government recommended patients, 72.7% of the patients were recommended by nurses, while only 21.9% where referred to the services by doctors. The main focus of a home nursing service was to maintain present health status (53.4%), and hospice(11.6%). Also to increase hospital-based home nursing services focused on recovery(55.9%) and maintain present health conditions (19.0%). 2. For general patients, 42.0% of patients were suffering from problems related to CVA, 11.3% from high blood pressure, and for patients referred from city, 21.2% from skeletal muscular disease. Results of home nursing services 29.4% of patients were able to recover or maintain their health status, but 48.9% of the patients died. Another main point of community-based home nursing services is medication(6.7%), other basic nursing services(6.1%), special treatment, instructions on how to use medical devices(5.9%), change of physical posture(4.6%), and training on changing physical positions(4.7%). As mentioned above there were some differences between the characteristics of patients who used the pilot home nursing service conducted by the Seoul Nurses Association and those hospital-based service users. The results are believed to be useful to support a community-based home nursing service model. Particularly, patients under medical supervision and patients recommended by government-run health clinics show a higher frequency and longer use of home nursing services compared to general patients or hospital-based home nursing service users. According to the study, nurses accounted for a large number of recommendations for home nursing services. Many patients with CVA, high blood pressure, skeletal muscular disease and bedsores used community-based home nursing services, while others used the service for minor treatments or maintaining their current health status. Based on the study, the researchers make several suggestions to establish a community- based home nursing service system. First, different ways of setting up a community-based home nursing system have to be mapped out based on the evaluation of the pilot home nursing service conducted by the Seoul Nurses Association. Secondly, a new, community-based, home health care nursing service model, and reimbursement payment system have to be developed. This is based on the outcome of the analysis, and implemented policy. Accordingly, efforts are needed to develop a community- based home nursing system with an intermediary role to promote the visiting nursing services of government-run health centers.

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Flexible Specialization: A New Paradigm for Modern Industrial Society ? (柔軟的 專門化(Flexible Specialization) : 현대 産業社會의 새로운 패러다임 ?)

  • Lee, Deog-An
    • Journal of the Korean Geographical Society
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    • v.28 no.2
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    • pp.148-162
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    • 1993
  • There is much speculation that modern capi-talist society is undergoing fundamental and qualitative chnge towards flexible specialization. The purpose of this study is to examine this hypothesis. This paper focusses on: the idea of flexible specialization; the significance of this transition; industrial district; and the implicati-ons of this new production system for Korean industrial space. Main arguments of this study are as follows: First, as all different groups of researchers apply the idea of flexible specialization according to their own specifications, the current debate on this topic is not much fruitful. Not surpri-singly, the concept of flexible specialization has overlapped with subocontracting. This intergration of subcontracting into flexible specialization systems, however, is inappropriate because the two concepts have different historical contexts. The other cause of this controversy is its inherent weekness, conceptual ambiguity. Thus, today's flexibility becomes tomorrow's rigidity. Secondly, transition towards flexible speciali-zation has only been partially achieved even in advanced capitalist countries. The application of dualistic explanatory framework, such as rigidity versus flexibiity, mass production versus small-lot multi-product production, and de-skilling versus re-skilling, has resulted in great exaggeration of the transformation, from Fordism to post-Fordism. There is no intermediary part between two places. Considering that the workers allocated to the Fordist mass production assembly line are not as large as one might imagine, the shift from mass to flexible production has only limited implications for the transformation of capitalist economy. Thirdly, 'industrial district' contorversy has contributed to highlighting the importance of small firms and areas as production space. The agglomeration of small firms in specific areas is common in Korea, but it is quite different from the industrial district based on flexible specialization. The Korean phenomenon stems from close interactions with its major parent firm rather than interactions between flexible, specialized, autonomous and technology-intensive smll firms. Most Korean subcontractors are still low-skilled, labour-intensive, and heavily dependent on their mojor parent firms. Thus, the assertion that the Seoul Metropolitan Area adopts flexible specialization has no base. Fourthly, the main concern of flexible speciali zation is small firms. However, the corporate organization that needs product diversification and technological specialization is oligopolistic large corporations typified by multinational corporations. It is because of this that most of these organizations are adoptiong Fordist mass production methods. The problem of product diversification will be resolved naturally if economic internationalization progresses further. What is more important for business success is the quality and price competitiveness of firms rather than product diversification. Lastly, in order to dispel further misunderst-anding on this issue, it is imparative that the conceptual ambiguity is resolved most urgently. This study recommends adoption of more speci-fied and direct terminology (such as, factory automation, computer design, out-sourcing, the exploitation of part-time labor, job redesign) rather than that of ideological ones (such as, Taylorism, Fordism, neo-Taylorism, neo-Fordism, post-fordism, flexible specialization, peripheral post-Fordism). As the debates on this topic just started, we still have long way to go until consensus is reached.

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