• 한국산학기술학회논문지
• /
• 제17권4호
• /
• pp.340-350
• /
• 2016

의료법에서는 의원은 외래환자를, 상급종합병원은 중증의 입원환자를 전문적으로 치료하는 의료기관으로 규정하고 있다. 그러나 일차의료를 제공하는 의원의 외래환자수는 위축되는 반면 상급종합병원의 외래진료비 비중은 지속적으로 증가하고 있다. 이 연구에서는 우리나라 의료전달체계를 정상화하기 위한 보다 근원적인 방안으로 두 가지 정책안을 제시하고 이 정책을 정착시키고 성공시키기 위한 보건의료정책 거버넌스에 관한 제안을 담고 있다. 상급종합병원의 중증 환자 진료기능을 강화하기 위하여 현행 종별가산율을 외래와 입원 종별가산율로 분리하고 외래진료비 목표관리제 도입이라는 두 가지 방안을 제시하였다. 그리고 이들 정책안을 큰 부작용없이 성공시키기 위한 보건의료 정책 거버넌스를 제안하였다. 보건의료 정책 거버넌스는 의료공급자, 환자의 참여와 동기부여가 전제되어야 하며 장기적인 관점에서는 향후 의료 질을 반영할 수 있도록 설계되어야 한다.

• 한국병원경영학회지
• /
• 제7권3호
• /
• pp.1-24
• /
• 2002

The purpose of this study was to find the factors affecting the bum out syndrome and its degree in terms of personal, organizational and clients characteristics, and then to find the ways to reduce or eliminate those factors. The 228 doctors and the nurses who worked at the emergency departments in 6 general hospitals with more than 700 beds in Seoul were surveyed from April 15, 2002 for 15 days. A structured self-recording questionnaire was used; the t-test and ANOVA was used to analyse the median difference between the occupation, and multiple regression was employed to find the factors affecting the bum-out syndrome. The summary of this research analysis is as follows : First, of several variables, the highest frequency of the burn-out was the emotional burn-out followed by lack in personal touch toward the patients, decrease in sense of personal achievement. These results indicate that the doctors and nurses in emergency departments experience higher degree of burn-out than the social workers and the nurses who work at other departments in heath care environment as other studies revealed. Second, the analysis of the total burn-out factors showed the lower self respect, younger age, heavier work load, higher dissatisfaction rate toward remuneration and not-so-smooth relationship with the patients and their relatives the higher burn out rate. These variables explained 54% of the total variables. Third, the nurses experienced more burn-out syndrome than the doctors. The degree of self-respect, work pattern, relationship with the clients, age and remuneration were the causes of the burn-out. The doctors recorded lack in personal touch toward the patients more, while the nurses more to emotional exhaustion. The limitations of this research are the subjective answers of the respondents to certain questions and differences in sample numbers of each hospital in which some reservation can be exercised in explaining statistical significance of the data, and generalizing the conclusion. Despite of its limitation, this research has its own merit as an unpreceded research in this field, and provision of the basic materials to prevent and find causes of the burn-out syndrome among the doctors and nurses in the emergency departments.

• 임상간호연구
• /
• 제15권1호
• /
• pp.149-165
• /
• 2009

Purpose: This study was done to identify the causes of turnover in nursing staff in small and medium‐size hospitals and prepare measures to decrease turnover. Nurses in these hospitals were surveyed focusing on their nursing activities, reasons for turnover, and content of their work. Method: A mail survey of hospitals with 300 beds or less was conducted using a questionnaire including items on the current state of nursing, performance of nursing tasks, turnover of nurses, working conditions, and supports and policies related to insufficient number of nurses. Results: The average number of nurses per 100 beds was 37.5, 3.3 less than the prescribed level of 40.8. The turnover rate was higher when the level of remuneration for nursing care was low, and the most frequent reason for nurses leaving was 'move to another hospital', showing that there is a continuous chain of moves for nurses. Other frequent reasons were situations related to working conditions such as childbirth, child care, irregular working hours, night work, and low wages. Conclusion: To guarantee adequate nursing coverage in these hospitals, working conditions for nurses should be improved, including higher wages, a more flexible work system, and installation and operation of 24-hour child care facilities.