Does Hospital Volume Really Affect the Surgical and Oncological Outcomes of Gastric Cancer in Korea?

Kim, Eun Young,Song, Kyo Young,Lee, Junhyun The Korean Gastric Cancer Association 2017 Journal of gastric cancer Vol.17 No.3

Purpose: The significance of hospital volume remains inconsistent and controversial. In particular, few studies have examined whether hospital volume is associated with the outcome of gastrectomy for gastric cancer in East Asia. This study examined the effect of hospital volume on the short-term surgical and long-term oncological outcomes of patients undergoing curative gastrectomy for gastric cancer. Materials and Methods: Between 2009 and 2011, 1,561 patients underwent curative gastrectomy for gastric cancer at Seoul St. Mary's Hospital (n=1,322) and Bucheon St. Mary's Hospital (n=239). We defined Seoul St. Mary's Hospital as a high-volume center and Bucheon St. Mary's Hospital as a low-volume center. Results: The extent of resection, rate of combined resection, tumor stage, operating time, and hospital stay did not differ significantly between the 2 hospitals. In addition, the hospital volume was not significantly associated with the 30-day morbidity and mortality. When the overall and disease-free survival rates of the patients were stratified according to stage, hospital volume was not significantly associated with prognosis at any stage. Conclusions: Hospital volume might not be a decisive factor with respect to the surgical and oncological outcomes of patients if well-trained surgeons perform gastrectomy for gastric cancer.

병원 전문화가 건당 재원일수와 건당 의료비에 미치는 영향

김재현 ( Jae-hyun Kim ),박은철 ( Eun-cheol Park ),김태현 ( Tae Hyun Kim ),이광수 ( Kwang Soo Lee ),김영훈 ( Young Hoon Kim ),이상규 ( Sang Gyu Lee ) 한국보건행정학회 2016 보건행정학회지 Vol.26 No.2

Background: Over the last few decades, because hospitals in South Korea also have undergone dramatic changes, Korean hospitals traditionally have provided specialized health care services in the health care market. Inner Herfindahl-Hirschman Index (IHI) measures hospital caseloads based on patient proportions, independent of patient volumes. However, IHI that rely solely on patient proportions might be problematic for larger hospitals that provide a high number of diagnosis categories, as the patient proportions in each category are naturally relatively smaller in such hospitals. Therefore, recently developed novel measure, category medical specialization (CMS) is based on patient volumes as well as patient proportions. Methods: We examine the distribution of hospital specialization score by hospital size and investigate association between each hospital specialization and length of stay per case and hospital cost per case using Korean National Health Insurance Service-cohort sample data from 2002 to 2013. Results: Our results show that IHI show a decreasing trend according to the number of beds and hospital type but CMS show an increasing trend according to the number of beds and hospital type. Further, inpatients admitted at hospitals with higher IHI and CMS had a shorter length of stay per case (IHI: B=-0.104, p<0.0001; CMS: B=-0.044, p=0.001) and inpatients admitted at hospitals with higher IHI and CMS had a shorter hospital cost per case (IHI: B=-0.110, p=0.002; CMS: B=-0.118, p=<0.0001). Conclusion: This study may help hospital policymakers and hospital administrators to understand the effects of hospital specialization strategy on hospital performance under recent changes in the Korean health care environment.

지방 종합병원의 선택속성이 병원의 이미지 연구와 행동의도에 미치는 영향연구

하정복 ( Ha Jung Bok ),백상미 ( Baik Sang Mi ),이흥연 ( Lee Heung Youn ) 경희대학교 경영연구원 2016 의료경영학연구 Vol.10 No.4

This paper examined the correlation of the effect of the general hospital selection attributes on hospital image and behavior intention with the subject of potential users of general hospitals in Pyeong-taek City. The implications according to the study results are as follows. Positive hospital image-building affects very importantly on the costumers` selection of hospitals. Therefore, hospitals can hold a dominant position through marketing efforts for positive hospital image-building. It can be said that the factors that influence on positive hospital image-building are the hospital selection factors, which can also be criteria of hospital quality evaluation. Based on the previous researches, this paper composed a survey with the items that are to be standards of hospital selection factors or hospital quality evaluation. As a result of factor analysis, it can be said that the items were divided as follows: human factors(doctors` specialty and ability, kindness of medical staff and personnel); hospital and medical facilities (traffic convenience(hospital location), subsidiary facilities convenience(parking, cafe, banks, etc.), and hospital facilities and scale); tests and treatment (test fees, consultation fees, convenience with treatment procedure, hospital`s reputation and fame). Therefore, it is necessary that we should divide them into three dimensions such as human factors, hospital and facilities, and tests and treatment procedure and manage them, in order to manage the factors that influence on positive hospital image-building. It can be said that this is similar to the existing composition dimensions of hospital quality. As a result of analyzing the correlation between the factors that influence on positive hospital image-building and composition dimensions of hospital image, it was revealed that the most influential factor that was on hospital image, which are composed of specialty, public interest, integrity, and effectiveness, was human factors. Moreover, it was revealed that specialty was the most influential image factor on behavior intention which are composed of revisits, word-of-mouth spreading, and recommendation. Therefore, it is thought that local general hospitals should make marketing efforts to build the local customers` positive awareness of human factors such as especially, specialty and ability of doctors, and kindness of medical staff and personnel, in order to build an image of specialty that influences most on positive behavior intention.

병원관리자의 리더쉽 유형과 직무공헌도와의 상관관계에 관한 연구

박창식,손용만 고신대학교 보건과학연구소 2000 보건과학연구소보 Vol.10 No.-

As an intentive organization of labor and technical, a hospital aims to provide quality medical service for the patients by focusing on human life and health. It is also a public organization with the purposes of making its own profits and achieving the self-realization of its members. Henceforth, personnel management counts more than any other commercial or public organization. As the progress of the hospital depends on the quality of medical treatment and service by its members, each individual's job performance is vitally important. In other words, the members' job satisfaction is reflected on their job performance, which determines the prospects of the hospital. At present, the main type of managerial leadership in hospitals tends to be somewhat premodern and conservative. It is inappropriate to deal with various crises happening in hospital organizations and insufficient to improve the workers' job satisfaction and job performance for the development of each hospital. The leader's role to help the members do their best in their jobs is required. The cooperative type of leadership, anticipating the future and making autonomous directions, is a must. Se far, the leadership styles related with job satisfaction and job performance have been studied a lot, but very little in hospital situations. In this respect, the present research aims at analyzing the hospital members' job satisfaction and job performance in relation with the leadership patterns of hospital managers, while examining the present situations of the hospital structure and suggesting sorne directions for efficient workforce management. This research is to empirically analyze the effects of leadership styles on job satisfaction and job performance and to provide some basic data for organizational and personnel management in hospitals. For this analysis, five general hospitals with more than 400sickbeds in Pusan were chosen as the subjects. The questionnaire materials were statistically processed by way of the program called SPSS and empirically analyzed by the χ2 -test. The analytic results of this research are as follows: 1.The recognition of leadership styles has nothing to do with sex, age, educational background, post, job type, and career. 2.Job satisfaction has nothing to do with sex and educational background, but jpb satisfaction has something to do with age, post, job type, and career. 3.Job performance has nothing to do with sex, age, job type, and career, but job performance has something to do with educational background and post. 4.The recognition of leadership styles has nothing to do with the recognition of situations. 5.Job satisfaction and job performance has something to do with leadership styles. In consequence, While the most effective style is one of a patriarchal warmhearted type, most hospital managers show either democratic or dictatorial leadership style. The case of medical technologists and assistants, holding the lowest job satisfaction and regarding the leadership style as a dictatorial one, is an evident example. Therefore, the hospital managers are required to adopt a leadership style which is like an affectionate patriarch. These analytical results, I hope, will lead to even more research for the efficient management and progress of hospital organizations.

중소병원의 진료과목개설전략 : 지방공사의료원을 중심으로 With Cases of the Provincial Hospitals

정기선,정수경,류규수 한국병원경영학회 2001 병원경영학회지 Vol.6 No.1

The purpose of this study was to find out the restructuring strategy for five provincial hospitals through the business analysis and survey of the service area. Through the survey of the service area of 5 hospitals. service area was classified into three groups, such as underserved area, adequate area, and overserved area. The strategy for the restructuring the clinical departments was set up based on the result of the business analysis and characteristics of the service area. The result of the study was as follows ; 1) Whether or not a provincial hospital has specialized in specific area according to the circumstances and the needs of the community was the major factor influencing on the operating result of the hospital. 2) Provincial hospitals at the underserved area has to invest according to the changes of the occupancy rate and increasing pattern of the number of patients while maintaining the status as a general hospital. 3) Provincial hospitals at the adequate area has to lower the grade from the general hospitals down to the hospital first and has to upgrade the competency through the restructuring the clinical departments and investment in specific area. 4) Provincial hospitals at the overserved area has to lower the grade from the general hospital down to the hospital first and has to seek ways to change the hospital fundamentally into geriatric hospital, pneumoconiosis hospital or psychiatric hospital etc. Provincial hospitals incapable to compete with private hospitals and clinics has to lower the grade from the general hospital down to the hospital fist, to specialize in specific area and to restructure some clinical departments into rental base or self-operating basis. In case such methods are judged not so good solution, provincial hospitals has to find out ways such as shut-down of several departments or operating under the attending system.

병원 영양부서 평가지표에 대한 중요도-수행도 분석

이주은 ( Joo Eun Lee ) 대한영양사협회 2012 대한영양사협회 학술지 Vol.18 No.4

This study has attempted to collect actual spot`s opinions and analyze importance-performance of indicators for the evaluation of hospital nutrition department. The results of this research were as follows: first, the average score of self-estimated performance was 3.75 based on a 5-point scale. The degrees of importance of hospital foodservice and nutrition department management were in the range of 3.71∼4.85 out of 5.0 and the mean importance degree score was 4.37. Second, the average score of self-estimated performance in each category was significantly higher in the case of general special hospital compared to general hospital. Especially average performance score of nutrition management in the general special hospital was higher than that of general hospital (P<0.001). The average performance score of the hospital with more beds was significantly higher than that with less beds, Contract managed hospital`s score was significantly higher than that of self-operated hospital in two categories, "facilities management" and "nutrition management" (P<0.05, P< 0.01). In foodservice and nutrition management of task-separated hospitals, the average performance scores were significantly higher than those of not-separated hospitals (P<0.01, P<0.001). Third, according to the importance-performance analysis of recognition about indicators for the hospital nutrition department`s operations evaluation, ``foodservice facilities management`` and ``foodservice sanitation management`` were in ``doing great``, ``nutritional management`` and ``operational management`` were in ``low priority``, and ``other foodservice management`` was in ``overdone``. In conclusion, there`s a need for institutional specific standards of sanitation for Korean hospital foodservice.

구조방정식을 활용한 병원선택요인에 대한병원 및 고객 집단 간 차이 분석

이해종 ( Hae Jong Lee ),이현숙 ( Hyun Sook Lee ),윤장호 ( Jang Ho Yoon ) 한국보건정보통계학회(구 한국보건통계학회) 2014 한국보건정보통계학회지 Vol.39 No.1

Objectives: This study is to identify the difference of hospital choice factors between internal and external customers at metropolitan and non-metropolitan hospitals. Methods: The questionnaires are used to collect data from internal customers(hospital employees) and external customers (patients). That is classified with 4 latent variables- such as, physical, human, accessibility, and connection factors. Total used cases are 98 patients and 96 employees on 2 hospitals-Hospital S, located in Seoul and 116 patients and 97 employees in Hospital C, located in non-metropolitan province. Multi group analysis and mean analysis in structural equation model (SEM) is used for analysis of difference between groups. Results: The hospital choice factors are different significantly between internal and external customers of Hospital C, while there is no gaps in Hospital S. And there is a gap of choice factor between external customers of Hospital S and Hospital C, but not between internal customers of the two hospitals. The internal customers in Hospital S have more accurate information about patient’s hospital choice factors than those in Hospital C. Specially, the internal customers in Hospital C are aware of that the human factor is more important choice factor than other factors. Conclusions: There are many hospital choice gaps between customers or hospital locations. So each hospital need to make more accurate measurement about customer need/behavior for higher customer satisfaction.

H 대학병원 이미지와 마케팅 전략

김분한,임난영,김주희,전정자,정문희,유은광,이정섭,탁영란 한양대학교 의과대학 1998 한양의대 학술지 Vol.18 No.1

Nowadays many hospitals have been gradually changed from simple medical offering to various service offering. Although University hospital is not a money-making group, it has to develop marketing strategy rather than focus on only educating function as a non-profit institute. Because these positive marketing activities can be helpful to complete the aim of hospital itself. According to previous studies, results suggest that public information on hospital will be accomplished by hospital staffs and patient(internal client and external client), it is very important that marketing strategy should be collected by hospital staffs as internal client. This study was designed to analyize and preview marketing strategy for H-university hospital by analyzing the images and barrier factors of hospital. The major results of research were as follows: 1 Images on medical staffs, medical equipment, hospital convenience, medical & nursing skills, hospital reputation, hospital service, and contributions to the community were above average score of total hospital image. 2 Images on hospital environment, consultation hours and kindness of hospital staffs were below average score of total hospital image. 3 Gender affected on image of hospital convenience and contribution to community. 4 Educational status and occupation affected image of hospital environment, consultation hours and kindness of hospital staffs. 5 Image on H-University hospital of subjects who used hospital previously was worse than those who had not used hospital. Considering above results, we suggest that H-University hospital should improve image by initiating hospital marketing strategy on hospital environment, consultation hours and kindness of hospital staffs.

COVID-19 대유행 동안의 병원 회피 현상 및 연관 요인

전종욱,김세주,이수영,장진구,김찬형 대한불안의학회 2023 대한불안의학회지 Vol.19 No.2

Objective : During the coronavirus disease 2019 (COVID-19) pandemic, hospital avoidance had a significant impact on public health. We investigated the factors associated with hospital avoidance and explored practical strategies hospitals could employ to address this phenomenon. Methods : We conducted a patient experience survey in a general hospital in Korea during the COVID-19 pandemic. Between July 6, 2020, and July 20, 2020, a total of 842 patients who had previously visited hospitals before the COVID-19 outbreak participated. Self-reported hospital avoidance, factors associated with hospital avoidance, and satisfaction with the hospital’s infection control policies were the main outcomes. Binary logistic regression analysis was used to identify associated factors. Results : Data indicated that 29.9% (n=252) of the respondents avoided visiting the hospital after the COVID-19 outbreak. Satisfaction with the hospital infection control policy (odds ratio [OR]=2.297, p<0.001), female sex (OR=1.619, p<0.05), and higher educational level (OR=1.884, p<0.001) were associated with hospital avoidance. The “entrance body temperature check” was the most satisfactory policy among the hospital’s infection control policies. Conclusion : To manage hospital avoidance during an infectious disease crisis, targeted policies for at-risk groups and hospital policies to reassure and satisfy patients are needed. (Anxiety and Mood 2023;19(2):77-82)

입원환자의 병원 재이용과 서비스만족도에 관한 연구

이규은,이근연 관동대학교 의과대학 의과학연구소 2005 關東醫大學術誌 Vol.9 No.1

Purpose : This study was to identify intention of hospital revisit and hospital services satisfaction by inpatient. Method : The subjects were 257 inpatients in G city. The data were collected from August 2nd to August 31st, 2004 by structured questionnaire. The data were analyzed using descriptive statistics, x^(2)test. Results : About 86.0% of the subjects had intention of hospital revisit. Decisive factor to choose a hospital was high-tech medical equipments and facilities. Among the factors of hospital services satisfaction, service satisfaction by nurses was in the highest at average marks 3.97. Hospital services satisfaction according to decisive factors to choose a hospital, there were statistically significant differences in treatment effect(x^(2)=9.69, p<.05), kindness of doctor(x^(2)=18.60, p<.00), kindness of nurses(x^(2)=20.55, p<.00). Intention of hospital revisit according to decisive factors to choose a hospital, there were statistically significant differences in excellent medical personnel(x^(2)=4.44, p<.05), tradition and confidence of hospital(x^(2)=5.29, p<.02). Conclusion : If satisfied with hospital services, patients tend to revisit hospital. Therefore it is essentials to raise the satisfaction level with hospital services by analyzing the areas with low services satisfaction in order to increase the competition of hospital.