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.
Delivery of Health Care ; Diagnosis ; Health Care Sector ; Health Facility Size ; Hospital Administrators ; Hospital Charges* ; Hospital Costs ; Humans ; Inpatients ; Korea ; Length of Stay* ; National Health Programs

Operations research (OR) focuses on the application of analytical methods to facilitate better decision-making. Despite its usefulness and proliferation of papers in the academic literature, there are still major issues around getting OR models widely accepted and used as part of mainstream decision-making by clinicians, health managers and policy-makers. This article aims to raise the awareness of healthcare managers with regard to practical OR applications.
Decision Making ; Health Facility Administrators ; Humans ; Models, Theoretical ; Operations Research

PURPOSE: This study was done to analyze the problems and desired work conditions of nursing organizations in small-medium hospitals. METHODS: Delphi Technique was used. In the first stage, the work conditions of nurses in small-medium hospitals were identified through a literature review. In the second stage, through 3 consultations with 20 nurse advisory groups, feedback was received on the desired work conditions for nurses in small-medium hospitals. In the third stage, 415 nurses and nurse managers were selected to examine the content validity and importance of the desired work conditions identified in the second stage. RESULTS: Sixty-four items were developed along eight domains of desired work conditions for nurses in small-medium hospitals. The survey on the desired work conditions revealed the following in order of importance: ‘wages’, ‘personnel’, ‘job’, ‘work hours’, ‘welfare’, ‘education’, ‘culture’, and and ‘other incentives’. CONCLUSION: The results of this study suggest that small-medium hospitals need to recognize the desired work conditions desired by nurses and accordingly change policies through the efforts of hospitals and professional groups.
Delphi Technique ; Health Facility Environment ; Humans ; Nurse Administrators ; Nursing ; Personnel Turnover ; Referral and Consultation

PURPOSE: This study was done to build and verify a model of clinical nurses' turnover intention using organizational characteristics, job satisfaction and job embeddedness. METHODS: The study participants were 389 hospital nurses. SPSS and AMOS 22.0 program were used to analyze the data and the modeling of turnover intention. RESULTS: A total of 41% of turnover intention was explained by job satisfaction, job embeddedness and organizational characteristics. Nurses with higher job satisfaction and job embeddedness showed lower turnover intention, while organizational characteristics had an indirect effect on their turnover intention. It was found that organizational characteristics had positive effects on both job satisfaction and job embeddedness, and job embeddedness played a mediating role between organizational characteristics and turnover intention. CONCLUSION: To reduce nurses' turnover intention, hospitals' organizational characteristics should be considered. Nurse managers should strive to increase nurses' job satisfaction and job embeddedness through an understanding of the factors of organizational characteristics such as organizational fairness, nursing work environment, motivation, organizational citizenship behavior, and transformational leadership.
Health Facility Environment ; Humans ; Intention* ; Job Satisfaction* ; Leadership ; Models, Structural* ; Motivation ; Negotiating ; Nurse Administrators ; Nursing ; Organization and Administration ; Personnel Turnover

OBJECTIVES: The aim of this study was to measure the levels of adherence and to identify factors associated with adherence to option B+ prevention of mother-to-child transmission (PMTCT) among pregnant and lactating mothers in selected government health facilities of South Wollo Zone, Amhara Region, northeast Ethiopia. METHODS: An institution-based cross-sectional quantitative study design was employed from March 1, 2016 to April 14, 2016, using a standard structured data collection instrument. A sample of 191 human immunodeficiency virus (HIV)-positive pregnant and lactating mothers who were receiving PMTCT follow-up in the selected health facilities participated in the study. The data were entered using EpiData 3.1 and analyzed using SPSS version 21. Bivariate and multivariate logistic regression analyses were employed to identify factors associated with adherence. The p-values <0.05 and 95% confidence intervals (CIs) were used to identify associations between independent predictors and the outcome variable. RESULTS: The level of adherence to option B+ PMTCT drugs was 87.9%. Women who received in-hospital treatment, who lived in rural areas, and faced challenges in initiating lifelong option B+ treatment on the same-day that they were diagnosed with HIV were less likely to adhere to the treatment (adjusted odds ratios [95% CI] of 0.3 [0.11 to 0.82], 0.26 [0.1 to 0.73], and 0.08 [0.02 to 0.37], respectively). CONCLUSIONS: Collaborative efforts of zonal health departments with health facility administrators and counselors are recommended for effective and efficient interventions focusing on hospitals, rural areas, and patients who face challenges on the day of their diagnosis.
Breast Feeding ; Counseling ; Data Collection ; Diagnosis ; Ethiopia* ; Female ; Fluconazole ; Follow-Up Studies ; Health Facilities* ; Health Facility Administrators ; HIV ; Hospitals, Rural ; Humans ; Logistic Models ; Medication Adherence ; Mothers* ; Odds Ratio ; Pregnant Women

In November 2009, through Republic Act 9792, Davao Medical Center was renamed Southern Philippines Medical Center (SPMC). This act also provided for the increase in the bed capacity of the hospital from 600 to 1,200 beds.1 The set of implementing rules and regulations for the legislation subsequently specified the increase in the number of health human resources in SPMC to cope up with the hospital's growing number of clients.2 Currently, SPMC has a total of 4,737 personnel, composed of 3,329 employees with plantilla positions and 1,408 employees with non-plantilla positions, deployed to the different divisions of the hospital. Roughly a third of the total personnel are administrative staff, and two thirds are medical and allied medical staff. The Medical Center Chief (MCC) oversees the operations of the whole hospital. Five administrators directly assist the MCC in hospital management: the Chief of Medical Professional Services, the Chief Nurse, the Chief Administrative Officer, the Financial and Management Officer, and the Chief of Allied Professional Services. Due to the increasing bed occupancy rates and the pressing need to increase health human resources in SPMC, an increase in the institution’s bed capacity from 1,200 to 1,500 is presently being proposed through House Bill 7061.3 Once the bill is passed into law, it is expected that additional plantilla items will be created in order to meet the greater operational demands of a bigger hospital.
Hospital Administration ; Hospital Administrators

This paper describes a GPSS-based, multi-server queueing model that was developed to simulate the patient flow, and to analyze the effectiveness of the patient scheduling system under various conditions. Unpredictable and unacceptably long waits to receive the service at the outpatient department of a general hospital necessitated the study. Arrival and service time distribution needed for the simulation model were generated from actual arrival and service patterns observed during the peak hours. The simulation results show that a change in patient scheduling system (i.e. time interval between appointments, starting time, and the number of physicians) from a current system would significantly reduce the patient wait time. This study provides the hospital administrator with an analysis of patient scheduling system under several conditions, and will be used to plan future scheduling system and staffing. Studies such as this can demonstrate the value of simulation in providing information for use in future planning.
Appointments and Schedules ; Hospital Administrators ; Hospitals, General ; Humans ; Outpatients*

PURPOSE: This descriptive study was done to identify effects of perceived organizational support (POS) on job involvement and organizational citizenship behavior (OCB) in hospital nurses. METHODS: Data were collected from Oct. 1 to Nov. 15, 2011. Participants in this study were 324 nurses working in 6 general hospitals in S, K, and C cities. Data were analyzed using descriptive statistics, t-test, ANOVA, Scheffe test, Pearson correlation coefficients, and multiple regression. RESULTS: POS was positively correlated with job involvement, and OCB (altruism, conscientiousness, courtesy, sportsmanship and civic virtue). Factors influencing job involvement were POS and marital status, which accounted for 15.7% of the variance, marital status influenced altruism, which accounted for 4% of the variance, POS influenced conscientiousness, which accounted for 10% of the variance, religion and marital status influenced courtesy, which accounted for 6.5% of the variance, age influenced sportsmanship, which accounted for 7.9% of the variance, and POS and clinical career influenced civic virtue, which accounted for 23.1% of the variance. Job involvement mediated on the relation between perceived organizational support and organizational citizenship behavior. CONCLUSION: The results of the study indicate that hospital administrators should explore ways of improve POS for better job involvement, conscientiousness, and civic virtue.
Altruism ; Hospital Administrators ; Hospitals, General ; Humans ; Marital Status ; Virtues

OBJECTIVES: To investigate the current status of hospital-based health promotion programs in Korea and to elucidate the factors which affect to the process of implementation. METHODS: We conducted a mail survey of all 875 hospitals in Korea from March to May 2001. In reference to 12 specific kinds of health promotion programs, hospital CEOs were asked whether their hospital have such programs, whether they are fully staffed and whether the program is paid for by the patients. Contextual factors(location, hospital type, number of beds, length of operation, public/private status, economic level of the community, the level of competition) and organizational factors (the extent of market, compatibility with vision, formalization), strategic types of the CEOs (defender/analyser/prospector) were also surveyed. The relationships between each variable and the implementation of health promotion services, activation of services, and the target groups(patient/community resident) were analyzed by univariate analysis and the independent effects of these variables were examined with multiple logistic regression. RESULTS: 106 of 125 hospitals responding (84.8%) had more than one health promotion program. However, they showed fluctuations in the adoption rate of each programs, meaning that comprehensive health promotion services were not provided. Many programs were not fully staffed and few hospitals had paid programs. In factors affecting health promotion service implementation, private hospitals showed a higher rate in implementation than public hospitals. In contrast, when the competition among nearby hospitals was intense, the level of implementation of service lowered. In the strategic type of the CEOs, the prospectors were shown to have instituted more health promotion programs in their hospitals and the analysers had a greater tendency to have programs for community residents than the defenders. CONCLUSION: Considering the above results, contextual factors may contribute greatly to the introduction of health promotion services in Korean hospital, although the CEO's personal preference and organizational factors play a larger role in the activation of services. Additionally, the CEO's personal preference may be the major influencing factor in the introduction of programs for community residents.
Chief Executive Officers, Hospital ; Health Promotion* ; Hospital Administration ; Hospitals, Private ; Hospitals, Public ; Humans ; Korea* ; Logistic Models ; Organizational Innovation ; Postal Service

The propose of this study is to give a theoretical basis for better home health service by looking at the subjective structure the collaboration between the home health nurse and doctor and at how collaboration can be improved. There are at least three types of recognition that can help the collaboration. The first type is to put more weight on the relationship between doctors and home health care nurses. This means that doctors and home health care nurses should make an effort to improve, their collaboration. The second type is to put more weight on the reward for doctors' participation. Reward will help collaboration. The third type is to put more weight on organization support. Organization support will bring about trust between doctors and home health care nurses The following conclusion were reached: 1) Trust should exist between doctors and home health care nurses. 2)Doctors should maintain an equal relationship with home health care nurses and accept them as professionals. 3) Appropriate reward should be given to doctors for their participation. 4)Home health care nurses should reinforce their skills through education, training, and professionalization. 5) Home health care nurses should cooperate with doctors by building a system that centers on patients. 6) Collaboration between doctors and home health care nurses is important because it is useful to recognize patients and their families in a broader light. 7) Doctors and home health care nurses need to be more concerned about patients. 8)More active support of hospital administrators and systems is needed to enhance collaboration between doctors and home health care nurses. 9) The present legal system for collaboration between doctors and home health care nurses can be a factor. The nine nursing strategies above will help doctors and home health care nurses build more positive relations and get closer to their patient, more effective home healthcare will get closer to people who want quality medical service.
Cooperative Behavior* ; Delivery of Health Care ; Education ; Health Services* ; Hospital Administrators ; Humans ; Nurses, Community Health ; Nursing ; Reward