Service diversification is recognized as an important strategy against turbulent environmental change. This study is designed to find out the trend of service diversification in Korean health care organizations and also to identify factors associated with the degree of service diversification. Data were collected from 69 hospitals out of 71 hospitals with over 300 beds. Important findings are summarized below. 1. Types of diversification are closely related to hospital size. Large hospitals have a tendency to provide sophisticated service requiring specialized skills and equipment, while small hospital have concentrated their efforts on health screening programs. 2. The more competitive and bigger hospitals are, the greater number of services that provide. Also, hospitals operating rational management information systems provide more services. Contrary to the expectation, hospitals with a low performance during last 3 years showed more service diversification. 3. A trend of more diversification was observed in hospitals whose chief executive officer used a prospector strategy. 4. A multiple regression analysis revealed that bed size, competitive environment, degree of rational management, and the growth pattern were significantly associated with teh service diversification.
Delivery of Health Care ; Health Facility Size ; Hospital Bed Capacity ; Management Information Systems ; Mass Screening

PURPOSE: The purpose of this study was to identify the relationship among cognitive style, creative action, and challenging work and then determine whether challenging work has a mediating effect between cognitive style and creative action. METHODS: Data were collected from a convenience sample of 275 clinical nurses who graduated from 3-year nursing schools and worked in hospitals in Seoul or Kyungki Province. The questionnaire included measurements of cognitive style, creative action and challenging work. Data were analyzed using descriptive statistics, correlation, T-test, ANOVA, Duncan test, and hierarchical multiple regression. RESULTS: Mean scores for cognitive style, creative style, and challenging work were 3.28+/-0.42, 3.22+/-0.57, 3.40+/-0.63, respectively. Significant correlations were found between cognitive style and challenging work, cognitive style and creative action, and challenging work and creative action. Cognitive style was significantly different according to years in clinical career, and in hospital size. Challenging work was significantly different according to age and position. Creative action was significantly different according to years in clinical career. Finally challenging work had a mediating effect between cognitive style and creative action. CONCLUSION: Findings from this study provide a comprehensive understanding of challenging work for clinical nurses and indicate related factors and importance.
Health Facility Size ; Negotiating ; Surveys and Questionnaires ; Schools, Nursing

PURPOSE: The purpose of this study was to investigate the relationships among self-efficacy, collective efficacy, job satisfaction, and organizational commitment of nurses working in general hospitals. METHODS: Data were collected from 239 nurses working in five general hospitals of a local area by self-reported questionnaires. The collected data were analyzed with descriptive statistics, t-test, ANOVA, Pearson's correlation, and hierarchial multiple regression. RESULTS: Self-efficacy, collective efficacy, job satisfaction, and organizational commitment showed significantly positive correlations. Hierarchial multiple regression analysis showed that self-efficacy was the main factor of affecting job satisfaction, which explained 14.3% of the variance for the nurses' job satisfaction together with collective efficacy and weekly working time. In addition, the primary factor of affecting organization commitment was self-efficacy, which accounted for 17.2% of the variance for the nurses' organizational commitment together with hospital size and shift work. CONCLUSION: Self-efficacy and nursing working condition such as working time or hospital size contributed to the job satisfaction and organizational commitment and collective efficacy contributed to the job satisfaction. Therefore, the strategies for improving self and collective efficacy should be considered. Further study is also needed to investigate the concept of collective efficacy and its' measurement, and the relationship between collective efficacy and organizational commitment.
Health Facility Size ; Hospitals, General ; Job Satisfaction* ; Nursing ; Surveys and Questionnaires

PURPOSE: This study was conducted to investigate and compare the characteristics and relations of nursing practice environment, professionalism and job satisfaction among nurses in general hospitals according to hospital size. METHODS: The participants included 314 staff and charge nurses who were working in the general medical/surgical nursing units in one large hospital, three medium sized hospitals, and four small hospitals. Data collected through using self-report questionnaire were analyzed using the SPSS and SAS statistical programs. RESULTS: Nursing practice environment and job satisfaction had significant differences according to hospital size. Both of these scales were highest for medium hospitals and lowest for small hospitals. For all hospital sizes there were positive correlations between each of the variables. Multiple regression analysis showed that both nursing practice environment and job satisfaction were affected by hospital size, but professionalism was not. CONCLUSION: The results of this study indicate that nursing practice environment and job satisfaction vary with the size of the hospital. Therefore, further study is necessary to identify the work environment variables of nurses for performance management and to implement appropriate policies.
Health Facility Environment ; Health Facility Size ; Hospitals, General ; Job Satisfaction ; Nursing, Supervisory ; Phenothiazines ; Professional Competence ; Surveys and Questionnaires ; Weights and Measures

PURPOSE: This study was done to identify determinants of registered nurse (RN) skill mix and staffing level focused on hospital characteristics. METHODS: Data were obtained from health insurance claims data and hospital reporting system in the Health Insurance Review and Assessment Service (HIRA) for the year 2010. Data from 2,998 hospitals were analysed using t-test, ANOVA, Pearson correlation, and regression analysis. RESULTS: The RN skill mix and staffing level were positively related to hospital size and the percentage of inpatients to total patients. RN skill mix and staffing level were statistically different across regions. Including nursing aides (NA), however, there was no difference in staffing levels across regions. Medically vulnerable regions, bed operation rate, and the number of patients per doctor were also related to RN skill mix and staffing level. CONCLUSION: The statically significant determinants of RN skill mix and staffing level included hospital size, region, bed operation rate, percentage of inpatients, doctor-patient ratio. Further study needs to be done to investigate factors including RN supply and wages.
Health Facility Size ; Humans ; Inpatients ; Insurance, Health ; Korea* ; Nursing ; Nursing Staff ; Salaries and Fringe Benefits

BACKGROUND: This study was performed to improve the working competencies of novice infection control nurses (ICNs) and thereby prevent healthcare associated infection. We developed and implemented an education program and then evaluated its effectiveness. METHODS: The education program was developed by conducting a literature review and four expert group discussions. The program was implemented twice, and included 3 days of lectures and 1 day of practice in Seoul and Pusan, for 157 ICNs with less than 3 years of experience. The knowledge of the participants before and after the educational program and overall satisfaction were measured. Data were analyzed using the SPSS WIN 18.0 program. RESULTS: The education program consisted of 12 lectures and 2 practices in total. The post-program knowledge score increased to 77.99 compared to 45.91 prior to participating in the program (P<.001). The scores for overall satisfaction, knowledge acquirement, and usefulness in field practice were 9.05, 8.97, and 9.01, respectively. The overall satisfaction was higher for the practice component (9.37) than the lectures (9.00). There were significant differences in surveillance knowledge according to age (F=3.94, P=.021), hospital career (F=3.71, P=.027), hospital type (F=5.36, P=.006), and hospital size (F=6.19, P=.003); and there were significant differences in hand hygiene knowledge according to age (F=4.14, P=.018) and hospital type (F=4.84, P=.009). However, there was no difference in overall satisfaction with the program. CONCLUSION: To enhance working competencies and professionalism, education programs considering the characteristics and needs of the ICNs must be developed. Moreover, professional training courses are needed to nurture ICNs in small hospitals.
Busan ; Cross Infection ; Education* ; Hand Hygiene ; Health Facility Size ; Infection Control* ; Lectures ; Professionalism ; Seoul

PURPOSE: Emergency medical doctors face a working environment full of various types of stresses and often must work the night shift. This research is focused on the influences between night shift work, sleep, and physical and psychiatric health. METHODS: The subjects of research in the Internet-based survey were 51 emergency medical doctors working in four university hospitals, regional emergency medical centers, and hospitals of emergency medicine located in Honam District, Gwangju, Korea. RESULTS: Of the 51 respondents, 41.2% worked two night shifts per week and 45.1% worked three night shifts per week. Comparison of specialists and resident doctors did not reveal statistical differences between the quality of sleep and the prevalence of cardiovascular and psychiatric symptoms. However, there was a significantly higher prevalence of gastrointestinal diseases among resident doctors. Comparisons based on hospital size revealed significantly higher prevalence of gastrointestinal disease in university hospitals. The number of weekly night shifts did not significantly influence outcomes. CONCLUSION: Resident doctors and emergency medical doctors working in university hospitals may be more susceptible to gastrointestinal diseases. While no significant differences were evident concerning the prevalence of cardiovascular disease, the known similar mechanisms between gastrointestinal and cardiovascular disease indicates that continued exposure to stressful situations may prelude severe diseases such as cardiovascular disease.
Cardiovascular Diseases ; Surveys and Questionnaires ; Emergencies ; Emergency Medicine ; Gastrointestinal Diseases ; Health Facility Size ; Hospitals, University ; Prevalence ; Specialization

This study relates to the problems of organizational performance in the Christian hospitals. In this study, quality of working life (QOWL), which harmonizes individual as well as organizational goals, was used as an indicator of organizational performance from the open systems view. In order to identify the behavioral factors influencing QOWL in hospitals, self-administered questionnaires were distributed to 1,926 employees who were randomly selected from fifteen Christian hospitals from August 1 to August 30, 1986. The following results were obtained: 1) All correlation coefficients between QOWL and behavioral variables were statistically significant even though their magnitude varied according to hospital size. 2) Using factor analysis, 32 variables were parsimoniously grouped into four factors: individual conflicts, group behavior, organizational characteristics and situation, and job characteristics. The proportion of variance explained by these factors ranged from 33.5% to 38.6% according to hospital size. 3) The overall effects of the four factors in the multiple logistic models ranged from 0.85 to 3.12 according to hospital size. Among three hospital models, the model for small hospitals showed the best statistical fit. 4) The most influential factor was organizational characteristics and situation with an odds ratio ranging from 1.99 to 3.02. Again, the odds ratio was the highest for small hospitals. 5) For large hospitals, the two main factor effects were statistically significant: organizational characteristics and situation, and job characteristics. For medium hospitals, all main factor effects except job characteristics were statistically significant. For small hospitals, all main factor effects except group behavior were statistically significant. However, a factor interaction effect was shown only for large hospitals where it was statistically significant. 6) To examine whether the four factors influence financial performance, the four factor scores from the two financial performance groups were compared using Mann-Whitney test. The test results showed that the organizational characteristics and situation factor score was significantly different only for small hospitals.
Health Facility Size ; Logistic Models ; Odds Ratio ; Organizational Objectives ; Surveys and Questionnaires

Information on productivity of hospital personnel is required for optimum staffing and hospital management. This study deals with the quantitative aspects of workload of medical personnel in training hospitals by their specific characteristics. Specifically this study attempted to fine relevant determinants of the productivity of medical personnel using multiple stepwise regression analysis based on data obtained from 135 training hospitals. The findings of this study were as follows: 1) Daily average number of outpatients and inpatients treated by a physician were 20.4 and 10.2, respectively. 2) Daily average number of patients cared by a nurse was 8.2. Daily average number of tests performed by pathologic technician and radiologic technician were 83.2 and 21.5, respectively. 3) Productivity of medical personnel were significantly different for the three groups of factors: hospital size (number of beds, number of medical personnel per 100 beds); institutional characteristics (medical school affiliation, training type, profit status); and environmental factors (location, number of physician and beds per 1,000 population in the region). 4) The factors affecting the productivity varied according to the types of medical profession: the number of beds, the number of physicians per 100 beds, training type, and profit status for physicians; the number of nurses per 100 beds, the number of beds, medical school affiliation for nurses; the number of physicians per 100 beds, the number of technicians per 100 beds, and ownership for pathologic technicians; the number of technicians, training type, and the number of physicians per 100 beds for radiologic technician.
Efficiency* ; Health Facility Size ; Humans ; Inpatients ; Outpatients ; Ownership ; Personnel, Hospital ; Schools, Medical

PURPOSE: This study was conducted to compare the characteristics of organizational structure and occupational satisfaction among nurses in general hospital and small to medium-sized hospital and to investigate the affecting factors on their occupational satisfaction. METHODS: The study was based on the cross-sectional descriptive survey. A self-report questionnaire was used to collect data from 343 nurses between June and July, 2010. Data were analyzed by chi2-test, t-test, ANOVA, Scheffe's test, Pearson's correlation coefficient, and multiple regression using the SPSS/WIN 14.0 program. RESULTS: Hierarchical structure was dominant in general hospital whereas relationship was highly valued in small to medium-sized hospital. Occupational satisfaction was positively correlated with work environment built on relationship, innovation and tasks. Factors significantly influencing on occupational satisfaction in general hospital included innovative work environment, nurses' income and their health status (R2=40.3%). For the small to medium-sized hospital, they included innovative work environment, satisfaction in life, tasks and professionalism (R2=40.4%). CONCLUSION: Organizational structure, especially innovative work environment and relationship-oriented attitude had a significant influence on nurses' occupational satisfaction. Therefore, nursing administrators have to develop and consider organizational structure to improve occupational satisfaction.
Administrative Personnel ; Health Facility Size ; Hospitals, General ; Humans ; Job Satisfaction ; Organizational Culture ; Surveys and Questionnaires