병원 2세경영의 리더십 변화가 내부환경 및 조직유효성에 미치는 영향

김훈철 ( Hun Chul Kim ),김영훈 ( Young Hoon Kim ),김한성 ( Han Sung Kim ) 한국병원경영학회 2015 병원경영학회지 Vol.20 No.1

This study aims to examine the effect of a change of leadership on internal environment and organization effectiveness and suggest measures on effective organizational management by analyzing a change of leadership before and after 2nd generation management. There was analysis of a difference of leadership type, organizational structure, organizational culture, management resources, job satisfaction, and organizational commitment between the period of the founders and the period of 2nd generation successors by collecting data from employees of 6 hospitals in Seoul. Also there was analysis of the effect of a change of leadership on internal environment and organizational effectiveness. According to the analysis, it was demonstrated that the factor affecting job satisfaction during the period of the founder was complexity of organizational structure, and there were no factors affecting organizational commitment. In contrast, during the period of the 2nd generation successors, it was revealed that transformational leadership, centralism of organizational structure, and human resources of management resources affect job satisfaction, and transformational leadership, complexity of organizational structure, hierarchical culture of organizational culture, and human resources of management resources affect organizational commitment. Further, after the succession from the founders to 2nd generation successors, as transformational leadership increased, job satisfaction rose, and as developmental culture was reinforced and human resources increased, organizational commitment was heightened. Furthermore, as transformational leadership increased and developmental culture was reinforced, organizational commitment was heightened. Namely, as transformational leadership was reinforced resulting from the succession to 2nd generation, employees`` job satisfaction and organizational commitment increased, with circumstances aiming for the actual change.

병원 아웃소싱 근로자의 QWL과 이직의도에 관한 분석 - 이중몰입의 조절효과를 중심으로 -

김훈철 ( Hun Chul Kim ),김영훈 ( Young Hoon Kim ),김한성 ( Han-sung Kim ),우정식 ( Jung Sic Woo ) 한국병원경영학회 2017 병원경영학회지 Vol.22 No.4

[purpose] This study was conducted to identify how a hospital's outsourcing workers' QWL influences Turnover Intention and to determine Dual Commitment cause any discrepancies in regards to the link between QWL and Turnover Intention. [Methodology/Approach] The study is based on 254 survey sheets answered by outsourcing employees working at general hospitals with more than 300 beds in Seoul and the methods of analysis used are as follows: reliability analysis, correlation analysis, multiple regression analysis, and hierarchical regressions analysis. [Findings] The study results First, analyzing how different types of QWL (individual, organizational, managemental) influence Turnover Intention, R2 turned out to be 30.7% and organizational factors and managemental factors show a statistically significant difference. In addition, organizational and managemental factors have negative effects on Turnover Intention while that of organization factors has a bigger influence. Second, verifying regulation effects of Dual Commitment in regards to the link between QWL and Turnover Intention, it is learned that Dual Commitment (hiring firm) has no regulation effects on the link. However, it does have a regulation effect on the link between QWL (managemental) and Turnover Intention. Moreover, after verifying regulation effects of Dual Commitment (client's firm), it is learned that it has regulation effect on the link between QWL (organizational and managemental) and Trunover Intention. [Practical Implications] In conclusion, lower Turnover Intention, it is necessary to impose tasks that suit the employees' competence and to encourage efficiency throughout clear communications and accurate directions.

토모테라피를 이용한 3차원 입체 조형 치료의 임상적 적용 분석

조강철(Kang-Chul Cho),김주호(Joo-Ho Kim),김훈겸(Hun-Kyum Kim),안승권(Seung-Kwon Ahn),이상규(Sang-Kyoo Lee),윤종원(Jong-Won Yoon),조정희(Jeong-Hee Cho),이종석(Jong-Seok Lee),유병규(Beong-Gyu Yoo) 대한방사선과학회(구 대한방사선기술학회) 2013 방사선기술과학 Vol.36 No.4

토모테라피를 이용한 3D-CRT의 임상적 적용 사례를 Helical mode와 Direct mode로 구분하여 치료목적에 따라 주 치료목적 및 보조적 치료 목적으로 적용된 사례에 대해 선량학적 평가를 시행하였고 기존의 라이낙을 이용한 기법과 종양의 발생 부위별 선량학적 분포의 차이를 비교, 분석하였다. 선량 분석은 육종, 뇌척수조사, 유방, 뇌, 췌장, 척추 전이, 상대정맥 증후군, 식도에 토모테라피를 이용한 3차원 입체조형 방사선치료로 치료받는 환자 8명을 대상으로 Helical mode와 Direct mode, 라이낙 기반 치료기법 사이의 치료 계획 간 비교하였으며, 선량분석은 선량 체적 히스토그램과 등선량 곡선을 이용했다. Direct mode로 치료한 육종, 뇌척수 조사 환자의 경우 체적 길이에 대한 영향을 받지 않아 Junction effect 없는 선량적 결과를 보여주었고, 유방 환자는 D 99%와 D 95%의 선량에서 49.2±0.4 Gy와 49.9±0.4 Gy, V 105%와 V 110%에서 0%로 나타났다. Helical mode로 치료한 뇌, 췌장, 척추 전이 환자에서 dosimetric block을 이용해 정상조직의 선량을 효과적으로 줄일 수 있었고, 상대정맥 증후군 환자는 선량 제한(dose limitation)을 통해 방사선 치료를 재 실시해도 척수선량을 38 Gy이하로 효과적으로 제한할 수 있었다. 식도 환자에서는 기존에 다른 기법과 함께 추가조사 목적으로 사용하여 총 척수선량을 45 Gy 이하로 하고 폐의 V 20%을 20% 이하로 제한할 수 있었다. 토모테라피를 이용한 3차원 입체조형치료는 기존 선형가속기를 이용한 3차원 입체조형 방사선치료에 비해 선량적으로 제한되는 부분을 개선해주고 임상적으로 적절한 선량분포를 구현하는데 효과적인 방법 중의 하나라고 사료된다. This study investigates the case of clinical application for TomoDirect 3D-CRT(TD-3D) and TomoHelical 3D-CRT(TH-3D) with evaluating dose distribution for clinical application in each case. Treatment plans were created for 8 patients who had 3 dimensional conformal radiation therapy using TD-3D and TH-3D mode. Each patients were treated for sarcoma, CSI(craniospinal irradiaion), breast, brain, pancreas, spine metastasis, SVC syndrome and esophagus. DVH(dose volume histogram) and isodose curve were used for comparison of each treatment modality. TD-3D shows better dose distribution over the irradiation field without junction effect because TD-3D was not influenced by target length for sarcoma and CSI case. In breast case, dosimetric results of CTV, the average value of D 99%, D 95% were 49.2±0.4 Gy, 49.9±0.4 Gy and V 105%, V 110% were 0%, respectively. TH-3D with the dosimetric block decreased dose of normal organ in brain, pancreas, spine metastasis case. SCV syndrome also effectively decreased dose of normal organ by using dose block to the critical organs(spinal cord <38 Gy). TH-3D combined with other treatment modalities was possible to boost irradiation and was total dose was reduced to spinal cord in esophagus case(spinal cord <45 Gy, lung V 20 <20%). 3D-CRT using Tomotherapy could overcomes some dosimetric limitations, when we faced Conventional Linac based CRT and shows clinically proper dose distribution. In conclusion, 3D-CRT using Tomotherapy will be one of the effective 3D-CRT techniques.

도심형 아웃렛쇼핑몰의 공간구성요인이 소비자의 재방문의도에 미치는 영향

김신일(Kim, Shin-Il),김훈철(Kim, Hun-Chul),박태원(Park, Tae-Won) 한국도시행정학회 2018 도시 행정 학보 Vol.31 No.2

시대의 흐름 속에서 공간은 사람들의 라이프스타일의 변화를 대응하며, 이에 따라 상업공간 및 상업공간의 형태도 소비수준에 맞추어 진화한다. 한국에 산업단지가 발전하기 시작한 1970년대 후반 섬유 및 의류산업 중심지였던 금천 패션타운은 시대 흐름에 따른 소비자 욕구에 대응하기 위하여 아웃렛 형태로 발전하기 시작하였다. 아웃렛쇼핑몰은 브랜드 제품을 합리적으로 구매 가능하여 소비자들의 브랜드 소비욕구와 합리적 소비욕구를 동시에 충족시키며, 지속적이고 다양한 형태로 개발되며 진화하고 있다. 이에 본 연구는 마리오아웃렛의 공간구성요소에 대하여 탐색적으로 분석하고 각 요인이 아웃렛쇼핑몰 재방문의도에 미치는 영향에 대하여 실증분석 하고자 한다. 탐색적 요인분석 결과 5개의 요인이 도출되었으며, 각각 목적다양성요인, 인지식별성요인, 접근편의성요인, 가치소비성요인 및 편의지원성요인으로 명명하였다. 실증분석 결과, 인지식별성요인을 제외한 모든 요인이 통계적으로 유의미한 양(+)의 영향을 미치는 것으로 나타났다. 인지식별성요인이 재방문의도에 영향을 미치지 않는 것은 사례대상지의 특성에 기인한 것으로 추론된다. 이러한 연구결과를 바탕으로 실무적 관점에서 아웃렛쇼핑몰 기획 시 도움이 되는 시사점이 될 것으로 기대된다. The lifestyle of people changes in the flow of time, and the commercial facilities of social product also evolve according to the change of consumers. As the desires of consumers are being diversified, the forms of commercial spaces are also being diversified. In the late 1970s when the industrial complexes began to be developed in Korea, the Guro Industrial Complex was developed to cultivate the export industry, and the Geumcheon Fashion Town that was once the center of textile & clothing industry evolved into a street outlet from a factory outlet to respond to the desires of the consumers according to the flow of time. Outlet shopping malls enable the consumers to purchase famous brands in affordable price, and satisfy both the brand consumption desire and the desire for rational consumption to be developed continuously. As a result of the exploratory factor analysis, the attraction factors of Mario Outlet were shown to be 5 factors: diversity of purpose, identifiability of cognition, convenience of approach, rational consumption, and affordability of convenience. Among these factors, the diversity of purpose, convenience of approach, rational consumption, and affordability of convenience showed to have a significant positive effect on consumer intention of revisit, and the identifiability of cognition showed to have no significant effect on the consumer intention of revisit.

유방 부분 절제술 후 방사선 치료 시 TOMO Direct를 이용한 접선 조사의 선량적 유용성에 관한 고찰

김미정,김주호,김훈겸,조강철,전병철,조정희,Kim, Mi-Jung,Kim, Joo-Ho,Kim, Hun-Kyum,Cho, Kang-Chul,Chun, Byeong-Chul,Cho, Jeong-Hee 대한방사선치료학회 2011 대한방사선치료학회지 Vol.23 No.1

Purpose: Investigation of the clinical use of tangential fields technique using TOMO direct in comparison to conventional LINAC based radiation therapy after breast partial mastectomy. Materials and Methods: Treatment plans were created for 3 left-sided breast cancer patients who had radiation therapy after breast partial mastectomy by using wedged tangential fields technique, field in field technique (FIF), TOMO Direct, TOMO Direct intensity modulated radiation therapy (IMRT) under the normalized prescription condition ($D_{90%}$: 50.4 Gy/28 fx within CTV). Dose volume histogram (DVH) and isodose curve were used to evaluate the dose to the clinical target volume (CTV), organ at risk (OAR). We compared and analyzed dosimetric parameters of CTV and OAR. Dosimetric parameters of CTV are $D_{99}$, $D_{95}$, Dose homogeneity index (DHI: $D_{10}/D_{90}$) and $V_{105}$, $V_{110}$. And dosimetric parameters of OAR are $V_{10}$, $V_{20}$, $V_{30}$, $V_{40}$ of the heart and $V_{10}$, $V_{20}$, $V_{30}$ of left lung. Results: Dosimetric results of CTV, the average value of $D_{99}$, $D_{95}$ were $47.7{\pm}1.1Gy$, $49.4{\pm}0.1Gy$ from wedged tangential fields technique (W) and FIF (F) were $47.1{\pm}0.6Gy$, $49.2{\pm}0.4Gy$. And it was $49.2{\pm}0.4$ vs. $48.6{\pm}0.8Gy$, $49.9{\pm}0.4$ vs. $49.5{\pm}0.3Gy$ Gy for the TOMO Direct (D) and TOMO Direct IMRT (I). The average value of dose homogeneity index was W: $1.1{\pm}0.02$, F: $1.07{\pm}0.02$, D: $1.03{\pm}0.001$, I: $1.05{\pm}0.02$. When we compared the average value of $V_{105}$, $V_{110}$ using each technique, it was the highest as $34.6{\pm}9.3%$, $7.5{\pm}7.9%$ for wedged tangential fields technique and the value dropped for FIF as $16.5{\pm}14.8%$, $2.1{\pm}3.5%$, TOMO direct IMRT as $7.5{\pm}8.3%$, $0.1{\pm}0.1%$ and the TOMO direct showed the lowest values for both as 0%. Dosimetric results of OAR was no significant difference among each technique. Conclusion: TOMO direct provides improved target dose homogeneity over wedged tangential field technique. It is no increase the amount of normal tissue volumes receiving low doses, as oppose to IMRT or Helical TOMO IMRT. Also, it simply performs treatment plan procedure than FIF. TOMO Direct is a clinical useful technique for breast cancer patients after partial mastectomy.

비구 전 후주 골절에 대해서 Cerclage Passer를 이용한 환상 강선 고정술기 및 결과

박기철(Ki Chul Park),조현중(Hyun Joong Cho),김훈철(Hun Chul Kim),민경식(Kyung-Sik Min),정해원(Hae Won Jeong) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.6

목적: 양주 또는 T형 타입의 비구 골절은 정복이 매우 어려우며 불완전한 정복의 경우 추후 고관절의 외상성 관절염 등의 합병증이 발생한다. 본 저자들은 이에 대해 cerclage passer를 이용한 환상 강선 고정술을 시행하였고, 임상 및 방사선 결과를 보고하고자 한다. 대상 및 방법: 2013년 3월부터 2014년 12월까지 전위성 비구 골절로 cerclage passer를 이용해 수술한 최소 1년 이상 추시 관찰이 가능하였던 8예를 대상으로 하였다. 장골능의 전외측부에서 외전근과 골막 사이와 대 좌골 절흔까지 cerclage passer를 통과시킨 후 강선을 조이면서 골절을 정복하였다. 이후 내고정을 추가하여 고정력을 보강하였으며, 이에 대해 임상적 및 방사선적으로 분석하였다. 결과: 8예 모두 3 ㎜ 이하의 관절면의 정복을 얻었으며, 평균 골유합 기간은 11.8주(9-15주)였다. 방사선적 결과는 우수가 5예(62.5%), 양호가 3예(37.5%)였으며 임상적 결과는 7예(87.5%)에서 양호 이상의 결과를 얻었다. 결론: Cerclage passer를 이용한 환상 강선 고정술은 복잡한 형태의 비구 골절의 정복에 있어 매우 안전하고 유용한 수술 술기로 생각된다. Purpose: Both column and T-shaped acetabular fractures are frequently presented with difficulty in reduction. Incomplete reduction may cause traumatic arthritis in the hip joint, resulting in inferior clinical outcomes. The purpose of this study is to introduce our wiring technique and to report the clinical and radiological outcomes of such technique. Materials and Methods: Eight patients who underwent our proposed technique for having acetabular fracture with displaced quadrilateral plate between March 2013 and December 2014 were enrolled. All patients were followed-up more than 1 year. The wire passer was set up from an anterolateral aspect of the iliac crest to the greater sciatic notch, between the abductor muscle and the periosteum. The quadrilateral plate of acetabular fracture was reduced with wiring. Internal fixation was added to the pelvic brim. An analysis of the clinical and radiological outcomes was performed. Results: Reduction was performed within the 3 mm intra-articular step-off in all patients. The mean duration of union was 11.8 weeks (9–15 weeks). Five patients (62.5%) showed excellent results, and radiologically, three patients (37.5%) showed good results, and seven patients (87.5%) showed better than good results. Conclusion: The cerclage wiring fixation technique using a large cerclage passer instrument can be a useful and safe reduction method in some cases of acetabular fractures.

계류삭의 비선형운동특성해석에 관한 연구

이상무(Sang-moo Lee),김용철(Yong-chul Kim),김영환(Young-whan Kim),홍석원(Seok-won Hong),김훈철(Hun-chol Kim) 대한조선학회 1986 大韓造船學會誌 Vol.23 No.1