• Title/Summary/Keyword: literature analysis

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The Risk Implication of Ownership Structure: Focused on Korean Life Insurance Companies (유배당보험상품에 대한 재무론적 분석)

  • Lee, Kun-Ho;Wee, Kyeong-Woo;Jun, Sang-Gyung
    • The Korean Journal of Financial Management
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    • v.24 no.2
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    • pp.147-181
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    • 2007
  • Our article investigates the risk implication of ownership structure in life insurance companies. We set up a model to identify the priority structure of policyholder's and shareholder's cashflow claims, and to derive its implications. Current literature on this issue has focused on the agency paradigm or the risk-sharing efficiency. Fama and Jensen(1983a, 1983b) and Mayers and Smith(1981, 1986, 1988, 1990, 1994) argue that the survival of both the corporate and the mutual form of organization is due in part to the relative efficiencies in controlling agency problems. With regard to insurance business, agency problems arise because of the three functions inherent in the organizations:manager, risk-bearer(owner), and policyholder. Stock insurers are characterized by the potentially complete separation of all three functions while mutual insurers merger the policyholder with the ownership function. Doherty and Dionne(1993) and Doherty(1991) concentrate their analysis on differences in the efficiency of risk sharing between participating and non-participating policies. They argue that when the undiversifiable risk has higher portion in business risk, combining policy and equity claims into a single package is a more efficient risk-sharing contract than a simple prepaid risk-transfer. Among various methods for assembling the policy/equity package, Doherty and Dionne(1993) and Doherty(1991) suggest that policy/equity package offered by the mutual is the most efficient risk-sharing arrangement. There has been a controversy on the property of participating policies sold by life insurance corporations in Korea. Some scholars argue that participating policyholders of Korean life insurance companies have shared the cashflow risk with shareholders. They emphasize that insurance firms have used dividend reserves to supplement for equity deficits. Thus, they argue that the economic entities of Korean life insurance companies are mutual companies though their legal entities are corporations. Our article explicitly sets up each stakeholder's cashflow claim in stock and mutual insurers, and thus identify risk differences in shareholder and policyholder. Using our model, we could derive direct implications on the controversy. Our model shows that life insurance companies would sell participating policies since policyholders would have the incentive to share the risk inherent in their primary claims with equityholders. And there exists a fundamental difference in shareholder's risk and equityholder's.

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Analysis of Telephone Counseling Service on Child Health (전화 아기건강상담을 통해 나타난 우리나라 어머니들의 육아문제 분석)

  • Song Ji-Ho;Han Kyung-Ja;Oh Ka-Sil;Cho Kyoul-Ja;Lee Ja-Hyung;Park Eun-Sook;Cho Kap-Chul;Tak Young-Nan;Ahn Young-Mee
    • Child Health Nursing Research
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    • v.7 no.2
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    • pp.245-257
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    • 2001
  • This study analyzed the services as operated by the Child Health Telephone Service Center. The Center is a toll free service operated as part of the community services of the Korean Academic Society of Child Health Nursing. The aim of the study was to describe the concerns of child caregivers regarding child health care as discussed during telephone counseling. Specific objectives were as follows: 1. To analyze the activities of the Center. 2. To describe the characteristics of caregivers who made phone calls for counseling services and also the characteristics of their children. 3. To analyze the content of the counseling sessions. 4. To analyze counseling content according to the characteristics of the caregivers and their children. Data used for the study were obtained from the counseling records for the period from Sept. to Dec. 1999, as kept by the three counselors at the Center. The total number of calls was 8,261 and that consisted of 15,150 questions. The total questions were merged into 13,236 by eliminating those questions which overlapped or were of similar content. The final 13,236 questions were used for the final analyses. Almost of the callers (98.4%) were mothers. Among them 89.6% were between 25 and 35 years of age. Geographical distribution of the callers covered the whole nation. The largest numbers who made the calls were from the Seoul metropolitan area (36%), followed by 28% from Kyung Gi Province, and 20% were from the Kyung Sang area. Among 8,261 callers, 72.8% were first users. Sex of the babies and children in question for counseling was about even for males and females and ages ranged from one month to six years. The largest group (62.5%) was the less than six month age group. The finalized 13,236 questions/problems were categorized into 11 problem areas. They were in order of frequency, physical problems, feedings and nutrient concerns, information on child rearing, growth and development, guidance on utilization of child care facilities, elimination problems, sleeping concerns, immunization related concerns, behavior problems, injury and accidents, and safety measures. The most frequent problems for counseling were physical signs and symptoms (27.3%), followed by feeding and nutrients, information on child rearing, and growth and development. Of physical problems, abnormal gastrointestinal signs and symptoms were the most frequent concern and skin problems were next at 25% and 23.3% respectively. Loose bowels, vomiting and constipation were the most frequent gastrointestinal problems. Atopic dermatitis had the highest frequency at 53.3% with diaper rash being the second highest among the skin problems. About 80% of the growth and developmental category were physical development concerns related to physiological, body growth, and motor and sensory development. This study constitutes the activity report for the first year of the Center. The findings correspond with literature reports on child health problems and parents educational needs. One recommendation from this study is that since the services of the Center are carried out only by telephone, the psychology of the counselees and the counselor relationship must be considered for better services.

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A Study on University Students' Business Planning and Starting up a Business in Korea (우리나라 대학생들의 창업 및 사업계획에 대한 연구)

  • Koh, In-Kon
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.7 no.2
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    • pp.1-8
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    • 2012
  • Recently the youth starting up a business has become a buzzword. Business plan is a fundamentals in starting up a business. Therefore, in this study, I investigated the business planning behavior of university students in Korea. Especially, I investigated whether university students in Korea dealt with business plan inside and outside or not, and examined university students' thought whether corporate performance is related to business plan or not, and if any, how closely they are. Meanwhile, existing studies and books are arguing that there is a high correlation between business plan and corporate performance, however, there are not many domestic and/or foreign studies that analyzed it empirically. In order to find an answer to this problem, this study was approached empirically. First, the components of business plan were selected through an extensive literature review including existing researches and through factor analysis, I classified them into the five factors of product management, product development, management support system building, organizational management and macro planning. Also, I classified corporate performance into quantitative and qualitative performance, and investigated the influences of business plan factors on those performances. As a result, I found belows. First, university students in Korea thought that the business plan components affected the quantitative and qualitative performances of corporate positively. Second, Korean students had high interests in starting up a business and wanted to run a service business but had almost no experience of business planning. Whilst, Foreign students had relatively high interests in starting up a business and experiences of business planning. They wanted starting up in various industry also. Meanwhile, I did't find the gender differences in those aspects. In this study, I empirically investigated the relation between business plan components and corporate performances in the university students' view, not that of company. So I believe that this study can shed lights on the direction of effective starting up education for increasing the success rate of youth starting up a business.

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An Empirical Study on the Factors Affecting RFID Adoption Stage with Organizational Resources (조직의 자원을 고려한 RFID 도입단계별 영향요인에 관한 실증연구)

  • Jang, Sung-Hee;Lee, Dong-Man
    • Asia pacific journal of information systems
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    • v.19 no.3
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    • pp.125-150
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    • 2009
  • RFID(Radio Frequency IDentification) is a wireless frequency of recognition technology that can be used to recognize, trace, and identify people, things, and animals using radio frequency(RF). RFID will bring about many changes in manufacturing and distributions, among other areas. In accordance with the increasing importance of RFID techniques, great advancement has been made in RFID studies. Initially, the RFID research started as a research literature or case study. Recently, empirical research has floated on the surface for announcement. But most of the existing researches on RFID adoption have been restricted to a dichotomous measure of 'adoption vs. non-adoption' or adoption intention. In short, RFID research is still at an initial stage, mainly focusing on the research of the RFID performance, integration, and its usage has been considered dismissive. The purpose of this study is to investigate which factors are important for the RFID adoption and implementation with organizational resources. In this study, the organizational resources are classified into either finance resources or IT knowledge resources. A research model and four hypotheses are set up to identify the relationships among these variables based on the investigations of such theories as technological innovations, adoption stage, and organizational resources. In order to conduct this study, a survey was carried out from September 27, 2008 until October 23, 2008. The questionnaire was completed by 143 managers and workers from physical distribution and manufacturing companies related to the RFID in South Korea. 37 out of 180 surveys, which turned out unfit for the study, were discarded and the remaining 143(adoption stage 89, implementation stage 54) were used for the empirical study. The statistics were analyzed using Excel 2003 and SPSS 12.0. The results of the analysis are as follows. First, the adoption stage shows that perceived benefits, standardization, perceived cost savings, environmental uncertainty, and pressures from rival firms have significant effects on the intent of the RFID adoption. Further, the implementation stage shows that perceived benefits, standardization, environmental uncertainty, pressures from rival firms, inter-organizational cooperation, and inter-organizational trust have significant effects on the extent of the RFID use. In contrast, inter-organizational cooperation and inter-organizational trust did not show much impact on the intent of RFID adoption while perceived cost savings did not significantly affect the extent of RFID use. Second, in the adoption stage, financial issues had adverse effect on both inter-organizational cooperation and the intent against the RFID adoption. IT knowledge resources also had a deterring effect on both perceived cost savings and the extent of the RFID adoption. Third, in the implementation stage, finance resources had a moderate effect on environmental uncertainty and extent of RFID use while IT knowledge resources had also a moderate effect on perceived cost savings and the extent of the RFID use. Limitations and future research issues can be summarized as follows. First, it is difficult to say that the sample is large enough to be representative of the population. Second, because the sample of this study was conducted among manufacturers only, it may be limited in analyzing fully the effect on the industry as a whole. Third, in consideration of the fact that the organizational resources in the RFID study require a great deal of researches, this research may deem insufficient to fulfill the purpose that it initially set out to achieve. Future studies using performance research are, therefore, needed to help better understand the organizational level of the RFID adoption and implementation.

The Effects of Global Entrepreneurship and Social Capital Within Supply Chain on the Export Performance (글로벌 기업가정신과 공급사슬 내 사회적 자본이 수출성과에 미치는 영향)

  • Yoon, Heon-Deok;Kwak, Ki-Young;Seo, Ri-Bin
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.7 no.3
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    • pp.1-16
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    • 2012
  • Under the international business circumstance, global supply chain management is considered a vital strategic challenge to small and medium-sized enterprises(SMEs) suffering from deficient resources and capabilities to exploit overseas markets comparing with large corporations. That is because they can expand their business domains into overseas markets by establishing strategic alliances with global supply chain partners. Although a wide range of previous researches have emphasized the cooperative networks in the chain, most are ignoring the importance of developing relational characteristics such as trust and reciprocity with the partners. Besides, verifying the relational factors influencing firms' export performances, some studies proposed different and inconsistent factors. According to the social capital theory, which is the social quality and networks facilitating close cooperation of inter-individual and inter-organization, provides the integrated view to identify the relational characteristics in the aspects of network, trust and reciprocal norm. Meanwhile, a number of researchers shows that global entrepreneurship is the internal and intangible resource necessary to promote SMEs' internationalization. Upon closer examination, however, they cannot explain clearly its influencing mechanism in the inter-firm cooperative relationships. This study is to verify the effect of social capital accumulated within global supply chain on SMEs' qualitative and quantitative export performance. In addition, we shed new light on global entrepreneurship expected to be concerned with the formation of social capital and the enhancement of export performances. For this purpose, the questionnaires, developed through literature review, were collected from 192 Korean SMEs affiliated in Korean Medium Industries Association and Global Chief Executive Officer's Club focusing on their memberships' international business. As a result of multi-regression analysis, the social capital - network, trust and reciprocal norm shared with global supply chain partner - as well as global entrepreneurship - innovativeness, proactiveness and risk-taking - have positive effect on SMEs' export performances. Also global entrepreneurship affects positively social capital which has mediating effect partially in the relationship between global entrepreneurship and performances. These results means that there is a structural process - global entrepreneurship(input), social capital(output), and export performances(outcome). In other words, a firm should consistently invest in and develop the social capital with global supply chain partners in order to achieve common goals, establish strategic collaborations and obtain long-term export performances. Furthermore, it is required to foster the global entrepreneurship in an organization so as to build up the social capital. More detailed practical issues and discussion are made in the conclusion.

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An Empirical Study on Successful Factor of Local Mobile App One-Person Creating Company : The Moderating Effects of Social Capital (지역 모바일 앱 1인 창조기업의 성공요인에 관한 실증분석 : 사회적 자본의 조절효과를 중심으로)

  • Cheon, Phyeong Uk;Chung, Dong Seop;Ock, Young Seok
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.9 no.2
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    • pp.201-219
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    • 2014
  • The Republic of Korea in the real economy to a knowledge economy, and a center of creativity and imagination in the creative economy is changing the paradigm. As the core of creating economic, creative industries with the technology and information play an important role in the industry individuals. In order to solve the problem of the polarization of the economy and high youth unemployment rate of Korea, to recognize the role of the creative industries, as objection part, dimensions pan-national and one creative companies in industries of Mobile Apps various policies that support has been promoted. Support these policies to be able to contribute to the establishment of the success of mobile apps one-person creating company, we performed this study targeting one-person company that creates mobile apps area, we conducted a demonstration study of success factors, and thus more effective and efficient in an attempt to seek out support measures. In this study, we derive a research 4 hypothesis about the success factors of one creative enterprise through literature discussion, a study was made on the basis of empirical data of one-person company that creates mobile apps. The results of the analysis, first, if the development rate of the mobile application technology is fast and a new competition associated product is appeared, it was possible to find a tendency to be higher at the performance quantitative companies. Second, if the founder is a founding for the benefit and rewarding work and come to terms with the risk, it was possible to discover tends to be higher achievement quantitative. Third, if one-person company select a target market with capture intensively, it was possible to find a tendency for higher qualitative results. Fourth, it could be found that the reliability of the contact frequency of the network related performance business environment these characteristics enterprise management strategy and act as a significant modulatory effect. Provision of information relating to management and entrepreneurship education to be one creative enterprise is required, these results suggest that there is a provision continuing need for the opportunity to be able to meet and network and reliable variety have. In this study, to take advantage to promote the elimination measures that can increase the likelihood of success of the company of institutions to support one company that creates knowledge-based, such as in the field of mobile application.

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Development of Korean Green Business/IT Strategies Based on Priority Analysis (한국의 그린 비즈니스/IT 실태분석을 통한 추진전략 우선순위 도출에 관한 연구)

  • Kim, Jae-Kyeong;Choi, Ju-Choel;Choi, Il-Young
    • Asia pacific journal of information systems
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    • v.20 no.3
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    • pp.191-204
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    • 2010
  • Recently, the CO2 emission and energy consumption have become critical global issues to decide the future of nations. Especially, the spread of IT products and the increased use of internet and web applications result in the energy consumption and CO2 emission of IT industry though information technologies drive global economic growth. EU, the United States, Japan and other developed countries are using IT related environmental regulations such as WEEE(Waste Electrical and Electronic Equipment), RoHS(Restriction of the use of Certain Hazardous Substance), REACH(Registration, Evaluation, Authorization and Restriction of CHemicals) and EuP(Energy using Product), and have established systematic green business/IT strategies to enhance the competitiveness of IT industry. For example, the Japan government proposed the "Green IT initiative" for being compatible with economic growth and environmental protection. Not only energy saving technologies but energy saving systems have been developed for accomplishing sustainable development. Korea's CO2 emission and energy consumption continuously have grown at comparatively high rates. They are related to its industrial structure depending on high energy-consuming industries such as iron and steel Industry, automotive industry, shipbuilding industry, semiconductor industry, and so on. In particular, export proportion of IT manufacturing is quite high in Korea. For example, the global market share of the semiconductor such as DRAM was about 80% in 2008. Accordingly, Korea needs to establish a systematic strategy to respond to the global environmental regulations and to maintain competitiveness in the IT industry. However, green competitiveness of Korea ranked 11th among 15 major countries and R&D budget for green technology is not large enough to develop energy-saving technologies for infrastructure and value chain of low-carbon society though that grows at high rates. Moreover, there are no concrete action plans in Korea. This research aims to deduce the priorities of the Korean green business/IT strategies to use multi attribute weighted average method. We selected a panel of 19 experts who work at the green business related firms such as HP, IBM, Fujitsu and so on, and selected six assessment indices such as the urgency of the technology development, the technology gap between Korea and the developed countries, the effect of import substitution, the spillover effect of technology, the market growth, and the export potential of the package or stand-alone products by existing literature review. We submitted questionnaires at approximately weekly intervals to them for priorities of the green business/IT strategies. The strategies broadly classify as follows. The first strategy which consists of the green business/IT policy and standardization, process and performance management and IT industry and legislative alignment relates to government's role in the green economy. The second strategy relates to IT to support environment sustainability such as the travel and ways of working management, printer output and recycling, intelligent building, printer rationalization and collaboration and connectivity. The last strategy relates to green IT systems, services and usage such as the data center consolidation and energy management, hardware recycle decommission, server and storage virtualization, device power management, and service supplier management. All the questionnaires were assessed via a five-point Likert scale ranging from "very little" to "very large." Our findings show that the IT to support environment sustainability is prior to the other strategies. In detail, the green business /IT policy and standardization is the most important in the government's role. The strategies of intelligent building and the travel and ways of working management are prior to the others for supporting environment sustainability. Finally, the strategies for the data center consolidation and energy management and server and storage virtualization have the huge influence for green IT systems, services and usage This research results the following implications. The amount of energy consumption and CO2 emissions of IT equipment including electrical business equipment will need to be clearly indicated in order to manage the effect of green business/IT strategy. And it is necessary to develop tools that measure the performance of green business/IT by each step. Additionally, intelligent building could grow up in energy-saving, growth of low carbon and related industries together. It is necessary to expand the affect of virtualization though adjusting and controlling the relationship between the management teams.

Quality Dimensions Affecting the Effectiveness of a Semantic-Web Search Engine (검색 효과성에 영향을 미치는 시맨틱웹 검색시스템 품질요인에 관한 연구)

  • Han, Dong-Il;Hong, Il-Yoo
    • Asia pacific journal of information systems
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    • v.19 no.1
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    • pp.1-31
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    • 2009
  • This paper empirically examines factors that potentially influence the success of a Web-based semantic search engine. A research model has been proposed that shows the impact of quality-related factors upon the effectiveness of a semantic search engine, based on DeLone and McLean's(2003) information systems success model. An empirical study has been conducted to test hypotheses formulated around the research model, and statistical methods were applied to analyze gathered data and draw conclusions. Implications for academics and practitioners are offered based on the findings of the study. The proposed model includes three quality dimensions of a Web-based semantic search engine-namely, information quality, system quality and service quality. These three dimensions each have measures designed to collectively assess the respective dimension. The model is intended to examine the relationship between measures of these quality dimensions and measures of two dependent constructs, including individuals' net benefit and user satisfaction. Individuals' net benefit was measured by the extent to which the user's information needs were adequately met, whereas user satisfaction was measured by a combination of the perceived satisfaction with search results and the perceived satisfaction with the overall system. A total of 23 hypotheses have been formulated around the model, and a questionnaire survey has been conducted using a functional semantic search website created by KT and Hakia, so as to collect data to validate the model. Copies of a questionnaire form were handed out in person to 160 research associates and employees working in the area of designing and developing semantic search engines. Those who received the form, 148 respondents returned valid responses. The survey form asked respondents to use the given website to answer questions concerning the system. The results of the empirical study have indicated that, of the three quality dimensions, information quality was found to have the strongest association with the effectiveness of a Web-based semantic search engine. This finding is consistent with the observation in the literature that the aspects of the information quality should serve as a basis for evaluating the search outcomes from a semantic search engine. Measures under the information quality dimension that have a positive effect on informational gratification and user satisfaction were found to be recall and currency. Under the system quality dimension, response time and interactivity, were positively related to informational gratification. On the other hand, only one measure under the service quality dimension, reliability was found to have a positive relationship with user satisfaction. The results were based on the seven hypotheses that have been accepted. One may wonder why 15 out of the 23 hypotheses have been rejected and question the theoretical soundness of the model. However, the correlations between independent variables and dependent variables came out to be fairly high. This suggests that the structural equation model yielded results inconsistent with those of coefficient analysis, because the structural equation model intends to examine the relationship among independent variables as well as the relationship between independent variables and dependent variables. The findings offer some useful implications for owners of a semantic search engine, as far as the design and maintenance of the website is concerned. First, the system should be designed to respond to the user's query as fast as possible. Also it should be designed to support the search process by recommending, revising, and choosing a search query, so as to maximize users' interactions with the system. Second, the system should present search results with maximum recall and currency to effectively meet the users' expectations. Third, it should be capable of providing online services in a reliable and trustworthy manner. Finally, effective increase in user satisfaction requires the improvement of quality factors associated with a semantic search engine, which would in turn help increase the informational gratification for users. The proposed model can serve as a useful framework for measuring the success of a Web-based semantic search engine. Applying the search engine success framework to the measurement of search engine effectiveness has the potential to provide an outline of what areas of a semantic search engine needs improvement, in order to better meet information needs of users. Further research will be needed to make this idea a reality.

Midwives' Perceptions of the Importance of Teaching the Lamaze Method of Childbirth Preparation, Their Practice of it and Inhibiting Factors. (조산사의 라마즈 산전교육에 대한 중요성 인식과 수행정도 및 저해요인에 관한 연구)

  • Yoon, Gui-Nam;Cho, Mi-Young
    • 모자간호학회지
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    • v.2 no.1
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    • pp.21-33
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    • 1992
  • This study was done to investigate how importantly midwives thought of Lamaze Method of Childbirth, how satisfactorily they performed their Lamaze Method of Childbirth and what inhibited their activities from being performed if not done satisfactorily. The subjects of this study were 76midwives at midwifery in Pusan, Deagu, Kyungnam and Kyungbok. Data were collected by using questionaire from Sep. 1 to Sep.30, 1991. The measurement tools was maded by the researcher based on Kim's scale for prenatal nursing activities. The statistical analysis was done with based statistical values likes frequencies, means, standard deviations and advanced methods such as Pearson's correlation coefficient, 1-test, F-test, F-test by using SPSS package program. The results of this study can be summarized as follows ; 1. The results of Investigating perception according to importance degree and performance degree of Lamaze Method of Childbring showed that midwives were slightly below both perception according to importance(2.17) and performance(2.16) of Lamaze Method of Childbirth 2. Inhibiting factors of Lamaze Method of Childbirth were abscence of husband(3.08), lack of teaching room(2.71), and lack of books or literature of Lamaze Method (2.58). 3. There appears to be a positive relation between perception according to importance degree and performance degree of Lamaze Method of Childbirth (r=0.69, P<0.01). There appears to be a negative relation between perception according to importance degree and inhibit factors of performance (r=-0.38, P<0.01). There appears to be a negative relation between performance and inhibit factors of performance (r=-0.22. P<0.01). 4. The item of highest perception defree in prenatal education is 1st, Consultation about sexual life (2.53), End, illustration of the importance of a bath and perinal cleanliness and Avoidance of excessive respiration method and also its comfortable application during uterine contractility(2.45). The item of lowest perception degree is about pregnant symptom sign and predicted date of birth (E.D.C.). On the other hand, The item of highest performance degree is education about nurtrition during pregnacy. 2nd, Illustration of the Importance of a bath and perineal cleanness(2.45). The lowest one is leaching the pregnant woman and her family about the role of husband and her family and also teaching the couple to learn exercise and respiration method (1.84). Though importance perception degree and performance degree is low. Midwives who wert subject in this research shoves that they perform general items concerning prenatal education well. 5. In the relationship between perception according to importance degree of Lamaze Method of Childbirth and the general characteristics of subjects, the differences in mean number of visiting pregnacies for 1 month. 6. In the relationship between performance degree of Lamaze Method of Childbirth and the general characteristics of subjects, the differences in age, marriage, and mean number of visiting pregnancies for 1 month. With the above information we see the importance of midwife prenatal care education and high correlation between performance degree and perception degree. When Lamaze prenatal education is well performed the number of pregnant woman who have follow-up, check-ups increase. Therefore in this research we can validity that there is a relation between Lamaze prenatal education and patient follow-up. This research showes in a situation where if one does not maximally perform a prenatal education there is a possibility that the popular use of midwife activities may encounter obstacles so the education to save new knowledge and training for prenatal education is needed as a function of Lamaze prenatal education, when a special Lamaze education is well performed for the pregnant woman, who follows-up at amidwife clinic. With the above conclusion we can suggest : 1. Continued research which minimized obstacles to Lamaze prenatal education is needed. 2. The official method of midwives is necessary.

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Critical Pathway Development for the Hysterectomy Patients and its applied Effect (자궁적출술 환자를 위한 critical pathway 개발과 적용효과)

  • Noh, Gi-Ok;Park, Kyung-Sook
    • Women's Health Nursing
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    • v.6 no.2
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    • pp.234-257
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    • 2000
  • At present in the medical care, the study and effort for producing health service to consider efficiency, effectiveness, and quality are urgently called for because of the difficulty in the keen competition according to the inter- nationalization and opening, the operation in the medical institution service testing system, the change in the medical policy of KDRGs, and the lack of the health care cost increasing rate. As an alternative, the case management for the new management system is introduced in the U.S., and the Critical Pathway that is the method designing the contents of activity and its result has been developed and applied in order to anticipate and manage the patient-outcome for the realization of the cost-effective case-management. Thus, this study intended to analyze the effectiveness to obtain by developing the Critical Pathway presented as the method to improve the quality-betterment and cost effectiveness through the continuous and consistent patient management for the hysterectomy patient and applying it to the real practice. As a study method, this author formed a conceptual framework through considering five Critical Pathway used in the current U.S. and three Critical Pathway presented in the literature to develop the Critical Pathway for the hysterectomy patient, and made out the preliminary Critical Pathway through reviewing the old chart. This author made the verified the validity of the expert group about the developed Critical Pathway, and to confirm the possibility of practice application, completed and settled the final Critical Pathway after using the Critical Pathway to the hysterectomy patient from March 1st to 15th, 1997. Finally, to analyze the application-effect of the developed Critical Pathway, this author offered health care service applying the Critical Pathway to the hysterectomy patient from April 15th to August 31th, 1997. The guide for the Critical Pathway was carried out in advance by outpatient setting nurse for outpatient setting visit before the operation, and after hospitalization the primary nurse monitored the execution degree on the every duty. After discharge this author surveyed the complication through phone visiting, and one month after discharge surveyed the patient's reaction about the offered service when outpatient setting visit and analyzed the result. The source for health care cost was obtained by the statistics about the hospital charge which was offered by the General Business Department. The results were as follows. 1. It was decided that the vertical line of the Critical Pathway was made up of eight items such as monitoring/assessment, treatment, line/drains, activity, medication, lab test, diet, patient teaching, and the horizontal line of the Critical Pathway was made up of from hospitalization to discharge. 2. After the analysis of service contents through reviewing the old chart, it was decided that the horizontal line of the preliminary Critical Pathway was made up of from hopitalization to fourth postoperative day, and the vertical line of it was divided into eight items which were the contents to occur with the time frame of the horizontal line. 3. After the verifying the validity of the expert group about the preliminary Critical Pathway, the horizontal line was amended from hopitalization to third postoperative day, and taking their consensus, some contents of the horizontal line was amended and deleted. 4. From March 1st to 15th, 1997, to confirm the clinical suitability, this author offered eight hysterectomy patients the medical service through the Critical Pathway. The result was that three of them could be discharged at the expected discharge day, and the others later than that day. Supplementing the preliminary Critical Pathway through analyzing the cause of that delay- case, this author developed the final Critical Pathway. 5. There were no significant differences between the experimental and the control group in the incidence of complication(P > 0.05). 6. The 92.4% of experimental group was satisfied with the Critical Pathway service. 7. The length of hospital stay of the experimental group offered with the Critical Pathway service was 4.6 days and there was a significant difference that it was 1.3 days shorter than that of the control group(t=-29.514, P=0.000). 8. There wsa a significant difference that the mean medical charge per one patient of the experimental group offered the Critical Pathway service was cheaper \124,150 than that of the control group(t=-9.826, P=0.000). 9. The result that the author assumed and analyzed hospital income with the rate of turning bed was assumed that the increase of hospital income was \63,245,072 for that study, and the income increase was expected with \68,704,864 for a year. The result that this author applied the Critical Pathway to the hysterectomy patient have no differences in the incidence of complication, high satisfaction with that service, and the length of hospital stay decreased in the experimental group, and the mean hospital charge per one patient decreased, but hospital income increased. Suggestions for further study and nursing practice are as follows. 1. The study to apply the Critical Pathway for a year, verify the validity, and measure the effect repeatedly is needed. 2. To apply and manage the Critical Pathway effectively, the study to computerize it is needed. 3. The study to develop hospital-based Critical Pathway about other diseases or procedure, and measure the effect is needed.

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