• Health Policy and Management
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• v.17 no.2
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• pp.68-90
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• 2007

Nurse staffing level is an important factor that influences the quality of health service and patient outcomes. This study was carried out to examine the current state of acute hospital nurse staffing and find out factors that affect the nurse staffing level. Nurse staffing of individual hospitals was measured using the number of registered nurses per 100 beds. Descriptive and multiple regression analyses were conducted using 592 acute care hospitals' data. Regression model included structure factors such as referral level, ownership, medical and general staffing, and financial outcome factors such as occupancy rate, inpatient and outpatient revenues. Market characteristics included strength of competition, supply of nurses, and income and health status level of consumers. The average number of nurses per 100 beds was 28 and showed a great variation according to the referral level. Regression model explained this variation as much as 76.87%. Hospital structure variables which affecting the hospital nurse staffing level positively were ICU bed ratio, the staffing level of specialist, training doctor and employees except doctor and nursing personnel, while the negative factor was nurse aid staffing level. General hospitals employed more nurses than hospitals. Among outcome characteristics, occupancy rate and the amount of health insurance inpatient revenue affected positively on the hospital nurse staffing level. The more supply of the new nurse and the higher consumer income and health status in the medical service markets, the more nurses were employed by the medical institutes. According to the study result, hospitals employed more nurses when they had more financial incentive by increasing nurses. This means appropriate hospital incentive policy and regulation policy, which hospital violate nurse staffing level have to pay penality, should be needed. Clarifying job description between nurses and nurse aids and the reentry program for unemployed experienced nurses will be helpful to increase nurse staffing level.

• Health Policy and Management
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• v.18 no.1
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• pp.1-20
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• 2008

How health care providers compete and how competition among them affects their behavior are crucial questions in theory and health policy. In ordinary markets, competition improves social welfare, However in health care markets facing uncertainty and information asymmetry, competition can take the form of wasteful quality competition and result in cost increase. The purpose of this study is to examine the characteristics of hospital service markets and examine the impact of hospital competition on hospital behavior, more specifically hospital cost and the size of personnel. Based on patient discharge data of 2002 by the Ministry of Health and Welfare and Korea Institute for Health and Social Affairs, and health insurance EDI claims data of 2002, this study measures the degree of competition in the inpatient service market of hospitals, using variable radius method and Herfindahl index. The result of the study shows that the hospital service market consists of on average 3.13 government administrative units(shi, gun, or gu). Compared with hospitals, general or general specialized hospitals cover larger markets and operate in more competitive markets. Nearly 60% of patients use hospitals, which are not located in their government administrative units, meaning that market definition based on variable radius is better than the conventional method of market definition based on government administrative units. The results of multivariate analysis show that competition is not associated with high cost index of hospitals. But hospitals in more competitive markets employ larger(more intensive) input of personnel per 100 beds, implying that hospital competition in Korea can have the form of quality and cost-increasing competition.

• Journal of East-West Nursing Research
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• v.9 no.1
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• pp.46-56
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• 2004

Purpose: The purposes of this study are to examine and to compare factors causing stress and coping methods between nephrology nurses working in the Hospitals of University and the Hemodialysis Clinics. Method: Data were collected by a direct survey method using a questionnaire from August 13 to August 31, 2001. The sample of 137 nephrology nurses in the twenty-one Hospitals of University and 168 nephrology nurses in the twenty-six Hemodialysis Clinics were selected for a total sample of 305 nurses. Result: Stress according to general characteristics showed a significant difference in religion and in the level of satisfaction for their work. Stress score was the highest in the nurses whose religion was Buddhism(F=4.846, P=0.008) and in the group with 'dissatisfied' for the work in the Hemodialysis unit(F=3.193, P=0.014). The results analyzed coping method according to the general characteristics had a significant difference only in religion(F=16.237, P=0.000). The score for the coping method was the highest in Buddism. The score compared the satisfaction level for their work according to the hospital type, were 3.55 in the Hospital of University group and 3.35 in the Hemodialysis clinic group and these two values were significant different(p<0.05). The mean score of the stress nephrology nurses in the Hospitals of University is 2.79 and that of the stress nephrology nurses in the Hemodialysis clinics is 2.78 of 4 point scale. Among the factors causing stress, items related nursing work and conflict in nurse-patient relationship significantly caused more stress to the nephrology nurses in the Hospitals of University than to those in the Hemodialysis clinics(p<0.05). Conclusion: This study suggests that there were some differences in the stress and coping methods between nephrology nurses in the hospitals of University and the Hemodialysis clinics. Further study related to stress management program is needed to decrease stress and use effective coping methods.

• Journal of Korean Academy of Nursing
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• v.28 no.1
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• pp.26-36
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• 1998

This primary study was done to develop an ethical guideline for organ transplantation, a life-saving treatment which helps improve the quality of life. This study tried to identify the current situation in Korea, in terms of ethical considerations in organ transplantations. This study collected basic data in organ transplantations, in the hope that procedure of organ transplantations could be developed that would be fair to both organ donors and recipients. The immediate goals of this study were : 1)to identify staff in charge of organ transplantations and their jobs in the hospital, 2)to survey whether there exists a Hospital Ethics Committee(HEC), 3)to research what consideration are formally taken in selecting recipients, and 4)to accumulate data on how consent from donors are currently obtained. The study used a survey questionnaire and received responses from 31 hospitals out of 45 hospitals where organ transplantation are being done. Organ transplantation coordinators were found in 16 hospitals, but the job description varied among hospitals. The survey showed that all 16 hospitals with an HEC that health care personnel unnecessarily dominate the committee. The study notes that HECs should be vitalized by recruiting, as members, ethicists, theologians, patients, guardians, as well as the general public outside of the hospital. The study revealed that in selecting recipients the hospital take into account ABO blood type, histocompatibility, age, waiting time. and level of patient compliance. Finally, it was shown that in the cases of living donors the transplanting hospitals seek a formal consent, whereas there are no common consenting practice established for cadaveric donors. The study concludes with three proposals. First, a nationwide institution responsible exclusively for procurement and distribution of cadaveric organs for transplantation should be established. Second. we should rebuild the national health insurance system so that have costly organ transplantation expenses are substantially covered. Last, but certainly not least. there is a need to emphasize the HEC's committment to prepare a proper ethical guideline for organ transplantation in general.

• Journal of the Korean Dietetic Association
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• v.2 no.1
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• pp.10-19
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• 1996

The purpose of this study were to improve in foodservice system, and to evaluate the satisfaction of patient meal. Two General Hospitals (A & B) in Ewha Womans University college of Medicine were selected for this study. The survey questionnaire consisted of general backgrounds and foodservice evaluation. We chosed factors which may influence meal satisfaction such as meal time, amount, optimal temperature, taste, quality, sanitary condition, and employee' s kindness. One-way ANOVA and Pearson' s correlation were used as statistical methods. The results can be summarized as follows 1. In meal time, for the A&B hospitals were 3.46$\pm$0.93 3.63$\pm$0.76 respectively. 2. In cold foods for the A&B hospitals were 3.23$\pm$0.89 3.52$\pm$0.78 respectively while in hot foods 3.29$\pm$1.02 3.27$\pm$0.90 respectively for A&B hospitals. 3. In taste for the A&B hospitals were 2.81$\pm$0.96 3.01$\pm$0.95 respectively. 4. In quality were 2.93$\pm$0.92 3.25$\pm$0.91 respectivly. 5. In amount were 3.38$\pm$0.95 3.36$\pm$0.98 respectively. 6. In sanitary condition for the A&B hospitals were 3.55$\pm$0.88 3.12$\pm$0.97 respectively. 7. In kindness were 3.11$\pm$0.87 3.32$\pm$0.76 respectively. 8. Quality, taste, meal time, kindness, sanitary condition, temperature, amount, age, duration, and room grade were significantly correlated to the satisfaction of patient meal in order.

• Journal of Preventive Medicine and Public Health
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• v.56 no.2
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• pp.180-189
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• 2023

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to a global shortage of medical resources; therefore, we investigated whether COVID-19 impacted the quality of non-COVID-19 hospital care in Korea by comparing hospital standardized mortality rates (HSMRs) before and during the pandemic. Methods: This retrospective cohort study analyzed Korean National Health Insurance discharge claim data obtained from January to June in 2017, 2018, 2019, and 2020. Patients' in-hospital deaths were classified according to the most responsible diagnosis categories. The HSMR is calculated as the ratio of expected deaths to actual deaths. The time trend in the overall HSMR was analyzed by region and hospital type. Results: The final analysis included 2 252 824 patients. In 2020, the HSMR increased nationwide (HSMR, 99.3; 95% confidence interval [CI], 97.7 to 101.0) in comparison to 2019 (HSMR, 97.3; 95% CI, 95.8 to 98.8). In the COVID-19 pandemic zone, the HSMR increased significantly in 2020 (HSMR, 112.7; 95% CI, 107.0 to 118.7) compared to 2019 (HSMR, 101.7; 95% CI, 96.9 to 106.6). The HSMR in all general hospitals increased significantly in 2020 (HSMR, 106.4; 95% CI, 104.3 to 108.5) compared to 2019 (HSMR, 100.3; 95% CI, 98.4 to 102.2). Hospitals participating in the COVID-19 response had a lower HSMR (HSMR, 95.6; 95% CI, 93.9 to 97.4) than hospitals not participating in the COVID-19 response (HSMR, 124.3; 95% CI, 119.3 to 129.4). Conclusions: This study suggests that the COVID-19 pandemic may have negatively impacted the quality of care in hospitals, especially general hospitals with relatively few beds. In light of the COVID-19 pandemic, it is necessary to prevent excessive workloads in hospitals and to properly employ and coordinate the workforce.

• Korea Journal of Hospital Management
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• v.6 no.1
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• pp.120-146
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• 2001

This study was carried out to provide the essential information in improving the graduate medical education in Korea. For the study, a survey targeting the directors of GME of nationwide teaching hospitals was performed with a questionnaire asking the questions such as the director's perception on the quality of GME, trainees' salary level, trainees' specialty selection tendency, training system and its duration. The collected data were analyzed using t-test, ANOVA, and $x^2$-test. The results were as follows: 1. The survey were executed on 240 teaching hospitals in Korea and the response rate was 66.2% (159 hospitals replied). 2. The bigger a hospitals is the better in Quality of education. Larger hospitals tend to have better status in all items including medical specialists' experience, contents of medical curriculum, general environment for medical education and medical trainees's salary level. The result supported the general perception on the positive relationship between hospital size and Quality of GMA. 3. Providing convenience for medical trainees who prepares for the medical specialist Qualifying examination didn't affect the results of the examination. 4. The directions of GME have a perception that the trainees give positive impact on financial performance of their hospitals. This seems to be one of the reasons that hospitals try to retain as many trainees as possible. 5. The directors of GME considered medical trainees as an educate, and most of them responded positively on the need of governmental supports for the education cost and the trainee's salary. Considering above results, it seems that GME would get more social attention and the trainees' impact on hospitals operation would be increased more than before. In response to these trends, hospitals would find out the ways to lower dependency on trainees, and this change of attitude of hospitals on the GME would cause problems in operation of hospitals and GME itself. In order to prevent these problems the policy on GME should be directed in following ways. 1. The contents of Qualifying examination for specialist should be improved. 2. The curriculum of GME should be strictly followed. 3. The status of trainee in a hospital has to be defined as eductee. 4. Government has to support a half of the education cost and salary of trainee. 5. The distribution of the trainee among the hospital group have to be based on total available. 6. The financial support and welfare of trainee should be improved gradually and systematically.

• Korea Journal of Hospital Management
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• v.11 no.4
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• pp.82-103
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• 2006

The purpose of this study is to analyse statistically the relation between medical service quality and managerial performance. And then the way of analysis is the regression analysis that independent variable is service quality, dependent variable is the volume of revenue, the number of patients and the rate of beds utility, and dummy variable is the number of beds, ownership and region. The sample hospitals were the 113 hospitals on general hospitals more than 300beds which were consisted of 20 public hospitals, 41 corporate hospitals and 52 college hospitals, and also distributed 67 hospitals on big city and 46 hospitals other city. The sample hospitals were selected from the Korean Hospital Association and the data of the year 2003 and 2004. The collected data was analyzed using the SPSSWIN 10.0 version, and the study hypothesis was tested using regression analysis. The findings of this study are summarized as follows. First, as a result of analysing hypothesis 1. In the study of the relationship between the service quality and the revenue, it was verified that the more service quality in last year became the more revenue in the year. But the dummy variable, ownership and region, rarely related to hospital revenue. Therefore it means that the more service quality is connected to the more revenue on the large number of beds hospitals. Second, as a result of analysing hypothesis 2 & 3. In the study of the relationship between the service quality and the number of patients, it was verified that the more service quality in last year became the more outpatients in the year. But there was no verified to inpatients. It seems to be the reason why a hospital has operated the fixed number of beds approved by the public office. So there are no free to expand beds according to the number of inpatients as much as inpatients are increasing. Third, as a result of analysing hypothesis 4 & 5. In the study of the relationship between the service quality and the rate of beds utility, it was verified that the more service quality in last year became the shorter of average stay of length in the year. Especially it has influenced much more on a hospital which was the large number of beds, the corporate and the college, but the region. But it was denied that the more service quality became the more the beds turnover. As a result of this study, it shows that the service quality in the last year has importantly influenced on a hospital managerial performance in the year. Estimating the service quality of each hospital, most patients have selected the hospital they want. And the hospital need to keep the number of patients for the proper management. So this result of the study means that a hospital must improve the service quality for keeping efficient management.

• Journal of Korean Academy of Nursing Administration
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• v.19 no.2
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• pp.196-206
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• 2013

Purpose: This descriptive correlation study was done to identify the hardiness, coping behavior, and organizational commitment of general hospital employees and show how these variables affect increases in role performance and problem solving ability to have a positive influence on organizational harmony. Methods: A quantitative, descriptive research design was used with a sample of 368 employees working in general hospitals in M and C cities. A survey was used to collect the data. Results: The score for perception of hardiness of general hospital employees was 2.85, and coping behavior was 2.40, both out of a possible 4 points, and organizational commitment, 3.03 out of a possible 5 points. There were statistically significant positive correlations between hardiness and coping behavior (r=.33, p<.001), also between hardiness and organizational commitment (r=.51, p<.001), and also between coping behavior and organizational commitment (r=.22, p<.001). Conclusion: The results of the study indicate that hardiness, coping behavior, and organizational commitment in general hospital employees have positive correlations, and thus hospital administrators should explore ways of increase individual employee hardiness and coping behavior, and make efforts to harmonize their organizations by enhancing organizational commitment.

• Korea Journal of Hospital Management
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• v.7 no.2
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• pp.52-79
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• 2002

The hospital is characterized by it's remarkable labor industry and human resources input by unit. Recently, the administrative personnel are recognized as an important staff to provide a hospital guidance to consumer and also easiness for consumer's visit to hospital. The purpose of this study is to find the organizational effectiveness of the administrative personnel in hospitals. The survey data involved in the study was derived from 229 personnels working in 3 medium and small sized hospitals and 1 university hospital in Inchon area. The major finding are as follows; 1. The organizational efficiency in accordance with the general characteristics of subjects in order of over 31 years of age, university graduates, long-term tenure and high position is higher, whereas, in as much as wage and well trained personnels in are higher, general hospital's organizational efficiency is higher in comparison with those of university hospital. 2. The organizational efficiency in accordance with satisfaction and the psychological motive contributional factors is higher as much as the high satisfactory level in every hospitals in general. 3. The organizational efficiency in accordance with the factors of job characteristics is higher in as much as difficulty of the jobs is lesser, however there was not statically significance. In as much as job standard level is higher and the more job responsibility the higher organizational efficiency. It was obvious that the higher professional expertise as well as the training and application level are improving the organizational efficiency. 4. The organizational efficiency in accordance with the factors of structural characteristics was higher in as much as the intercommunication was smooth and the structural formalization level are higher, however there was not statically significance between the participation level of decision making and the organizational efficiency. 5. In as much as older age, management of organization and the job level are satisfied, the higher structural formalization level, the smooth intercommunication have affected as major influence factors of organizational efficiency. 6. In the university hospitals is satisfied in the management and job level of hospital organization as there are no difficult jobs while the level of hospital's organizational formality is high and the intercommunication is smooth, which are improving the organizational efficiency. In the general hospitals is also satisfied the management and job level of hospital organization and psychological motive contributional factors is higher, it was apparent that the organizational efficiency is higher in as much as the level of job standardization is high and the intercommunication is smooth. As a result of this study, in order for improving the organizational efficiency of administrative personnel in hospitals, the management and job level as well as personal relation are preferably satisfied, whereas formalization of organization, intercommunication and etc. should be satisfied, and, therefore, it is advisable to buildup discriminated organizational management and environment for different division on the basis above factors. Since this study is carried on four hospitals in Inchon area, there is a certain limit to generalize its result to all domestic hospitals, nevertheless the gallop poll was made by developing the questionnaires with reasonability and reliability. Especially. as the study was carried by analyzing the comparison of influence factors' difference of organizational efficiency in accordance with the divisional characteristics of the university and general hospitals.