Legal risks and liability issues in medical practice serve as a primary catalyst for the current collapse of essential healthcare services in Korea. Currently, medical disputes in Korea are disproportionately focused on criminal prosecutions and high-damages civil litigation. This punitive approach fosters a culture of concealment, encourages defensive medicine, and accelerates the exodus of medical professionals from essential fields. Ultimately, this cycle deprives the system of opportunities for improvement and poses a significant threat to patient safety. In contrast, many advanced nations have adopted principles of “Just Culture” and “Safe Space,” prioritizing non-punitive reporting and systemic root-cause analysis over individual retribution. To address these issues, this paper proposes four key strategies: First, the establishment of an independent “Patient Safety Investigation Agency” to objectively investigate incidents and identify systemic flaws. Second, a transition from criminal punishment to licensing board-led management, focusing on re-education and counseling to maintain quality of care. Third, the enactment of “Apology Laws” to ensure that expressions of regret or apologies cannot be used as legal evidence of liability, thereby fostering trust and psychological recovery. Finally, the creation of a “Patient Safety Fund” to provide prompt and sufficient public compensation to victims regardless of proven negligence. In conclusion, it is imperative to shift the paradigm by defining medical accidents as “system failures” rather than individual faults. Strengthening the social safety net will encourage medical professionals to return to essential care and build a sustainable healthcare environment centered on patient safety.

The South Korean healthcare system has achieved rapid quantitative growth; however, it continues to face critical challenges in ensuring the fundamental right to health of its citizens. From the perspective of healthcare consumers and civil society, this article identifies structural problems such as imbalances in medical accessibility, instability in essential and emergency care, and the limited participation of consumers in healthcare policy-making. Although the constitution stipulates the state’s responsibility to protect public health, current healthcare policies often prioritize administrative efficiency and provider-centered interests over patient experiences and health outcomes. In particular, this article argues that these challenges are closely related to the inadequate functioning of an accountable healthcare management framework. Structural failures in essential care, workforce shortages, and regional disparities are insufficiently monitored and addressed at the system level, resulting in responsibilities being blurred or shifted to individual healthcare providers. Consequently, the risks and burdens arising from systemic weaknesses are ultimately borne by citizens. To address these issues, this article emphasizes two major shifts. First, meaningful consumer participation must be institutionalized within healthcare governance to strengthen accountability, transparency, and responsiveness. Second, family medicine and primary care should be reinforced as the cornerstone of a sustainable, community-based healthcare system that ensures continuity of care, prevention, and chronic disease management. Re-establishing the healthcare system based on the right to health is not merely a technical adjustment, but a structural transformation toward a responsible and accountable system in which the state clearly assumes responsibility for monitoring, learning, and corrective action.

The South Korean resident training system is currently at a critical turning point, facing structural crises characterized by excessive labor-intensive environments and deteriorating quality of education. Since the medical standoff in 2024, the limitations of relying on junior doctors’ labor for hospital operations have become increasingly apparent. This review examines the current status and problems of the resident training system, including long working hours exceeding Organisation for Economic Co-operation and Development (OECD) standards, lack of systematic competency-based education, and worsening regional and essential medical imbalances. By analyzing international cases from the United States, United Kingdom, Japan, and Australia, this article proposes four core strategies for reform: (1) establishing a sustainable working and educational environment through the expansion of hospitalist systems and legalizing physician assistant roles; (2) innovating the curriculum and evaluation systems based on entrustable professional activities and milestones; (3) implementing a network-based training model to bridge the gap between metropolitan and regional healthcare; and (4) securing stable financial support and strengthening governance through the establishment of an independent evaluation body (e.g., K-ACGME). Ultimately, reforming the training system is essential not only for the rights and professional growth of residents but also for ensuring patient safety and the long-term sustainability of the national healthcare system.

Recurrent difficulty securing emergency department (ED) acceptance and delayed interfacility transfer, often resulting in multiple sequential transfer attempts (“round-robin” hospital seeking), in the Republic of Korea reflect a patient safety failure across the emergency care continuum, spanning Emergency Medical Services from emergency calls and prehospital care to ED stabilization, definitive treatment, and secondary transfer. We argue that the governance split between the National Fire Agency–led prehospital response and the Ministry of Health and Welfare–led emergency medical system fragments accountability and data, undermining sustainable quality management. We describe a “double bind” in which clinicians face medico-legal risk regardless of acceptance decisions, distorting transfer behavior. We propose an outcome-linked Quality Improvement system—integrated metrics, interoperable data linkage, operational medical control, and routine feedback—to strengthen Continuity of Patient Care. This requires functional integration of the dual command structure; transferring ambulance service functions to the Ministry of Health and Welfare, or an equivalently strong joint-governance model, should be evaluated. Regionally, responsibility-based systems should be implemented through councils that set transfer principles and resource allocation, supported by stable financing and performance review, with the regional emergency medical situation room providing medical control and real-time coordination. For mass-casualty incidents, preparedness should align standardized triage, integrated command and communication, training, and after-action review. Legal reform is a necessary starting point, but trust and sustained patient safety depend more on cultivating a learning-oriented safety culture grounded in patient experience and public deliberation throughout policy design and implementation.

South Korea’s current healthcare system stands at a critical crossroads that will determine whether it can progress in a better direction over the next decade. Behind the relatively stable level of population health that has been maintained until now, it has become clear that the deterioration of patient experiences, the risk of collapse in critical emergency medical services, the burnout of healthcare providers, and the crisis in the sustainability of healthcare finances have all accumulated simultaneously. This crisis can no longer be overcome by partial fixes or short-term measures alone. The answer to what needs to change first must begin with a reaffirmation of what the healthcare system should aim for. Ultimately, what needs to be changed now is not an individual policy, but the criteria and priorities through which we view healthcare. The focus must shift from what to provide more of, to questioning what holds greater social value. If such a shift does not begin now, in ten years we won’t face a better healthcare system, but care enmeshed in a deeper crisis. Now is precisely the time to fundamentally define the direction of the healthcare system.

Purpose: The purpose of this study was to identify factors influencing the performance of safe injection practices among nurses at general hospitals, in order to provide foundational data for developing strategies to improve the quality of injection practices in the future. Methods: This descriptive study was conducted with 153 nurses who were involved in injection practices. The data were collected from August to September 2024. Results: The most frequently performed type of injection by the participants was intravenous, and all types of injection practices were performed an average of 26.8±19.07 times per working day. The variable that most significantly influenced the performance of safe injection practices was knowledge of safe injection practices (β=.56, p<.001), which explained 36.7% of the variance. Experience with injection practice-related education (β=.27, p<.001) explained an additional 10.7% of variance, and organizational culture for infection control (β=.21, p<.001) explained 3.7% more. The total explanatory power of these variables on the performance of safe injection practices was 50.3% (F=52.35, p<.001). Conclusion Since both personal aspects, such as knowledge of safe injection practices and experience with injection practice-related education, and organizational aspects, such as organizational culture for infection control, simultaneously influenced the performance of safe injection practices among nurses at general hospitals, it is strongly recommended to develop and implement an integrated program for improvement. This program should combine strategies to enhance individual knowledge and positively transform the organizational culture for infection control, aiming for higher-quality execution of nursing duties, including injection practices.

Objective: To establish and evaluate the validity of the recently developed Korean version of the Oxford Cognitive Screen (K-OCS), this study verified its reliability, validity, and diagnostic accuracy. Methods: Between November 2021 and December 2023, we recruited 72 patients with stroke from our hospital who agreed to participate in the study. The patients were repeatedly tested using K-OCS by the same or different assessors to estimate inter- and intra-rater reliability. To demonstrate the validity and usability of K-OCS, the test results of screening tools currently used in clinical practice, including the Korean-Mini Mental State Examination and the Korean version of the Montreal Cognitive Assessment, were used in comparison analyses. Results: The subtests of K-OCS demonstrated excellent inter-rater reliability (intra-class correlation coefficient [ICC]=0.914–0.998) and test–retest reliability (ICC=0.913–0.994). We found moderate-to-strong correlations for convergent validity for the subsets (r=0.378– 0.979, p<0.01), and low-to-moderate discriminant validity correlations. The optimal cut-offs estimated for the subtests of the K-OCS showed a good-to-high range of specificity (94.8%– 100%). The positive predictive value was 58.2%–100% and negative predictive value was 65.6%–98.4%. Sensitivity was estimated at 25.6%–86.9%. Conclusion The results of this study indicate that K-OCS is a reliable and valid tool for screening cognitive impairment in patients post-stroke.

Purpose: The purpose of this study was to identify factors influencing the performance of safe injection practices among nurses at general hospitals, in order to provide foundational data for developing strategies to improve the quality of injection practices in the future. Methods: This descriptive study was conducted with 153 nurses who were involved in injection practices. The data were collected from August to September 2024. Results: The most frequently performed type of injection by the participants was intravenous, and all types of injection practices were performed an average of 26.8±19.07 times per working day. The variable that most significantly influenced the performance of safe injection practices was knowledge of safe injection practices (β=.56, p<.001), which explained 36.7% of the variance. Experience with injection practice-related education (β=.27, p<.001) explained an additional 10.7% of variance, and organizational culture for infection control (β=.21, p<.001) explained 3.7% more. The total explanatory power of these variables on the performance of safe injection practices was 50.3% (F=52.35, p<.001). Conclusion Since both personal aspects, such as knowledge of safe injection practices and experience with injection practice-related education, and organizational aspects, such as organizational culture for infection control, simultaneously influenced the performance of safe injection practices among nurses at general hospitals, it is strongly recommended to develop and implement an integrated program for improvement. This program should combine strategies to enhance individual knowledge and positively transform the organizational culture for infection control, aiming for higher-quality execution of nursing duties, including injection practices.

Objective: To establish and evaluate the validity of the recently developed Korean version of the Oxford Cognitive Screen (K-OCS), this study verified its reliability, validity, and diagnostic accuracy. Methods: Between November 2021 and December 2023, we recruited 72 patients with stroke from our hospital who agreed to participate in the study. The patients were repeatedly tested using K-OCS by the same or different assessors to estimate inter- and intra-rater reliability. To demonstrate the validity and usability of K-OCS, the test results of screening tools currently used in clinical practice, including the Korean-Mini Mental State Examination and the Korean version of the Montreal Cognitive Assessment, were used in comparison analyses. Results: The subtests of K-OCS demonstrated excellent inter-rater reliability (intra-class correlation coefficient [ICC]=0.914–0.998) and test–retest reliability (ICC=0.913–0.994). We found moderate-to-strong correlations for convergent validity for the subsets (r=0.378– 0.979, p<0.01), and low-to-moderate discriminant validity correlations. The optimal cut-offs estimated for the subtests of the K-OCS showed a good-to-high range of specificity (94.8%– 100%). The positive predictive value was 58.2%–100% and negative predictive value was 65.6%–98.4%. Sensitivity was estimated at 25.6%–86.9%. Conclusion The results of this study indicate that K-OCS is a reliable and valid tool for screening cognitive impairment in patients post-stroke.

Purpose: The purpose of this study was to identify factors influencing the performance of safe injection practices among nurses at general hospitals, in order to provide foundational data for developing strategies to improve the quality of injection practices in the future. Methods: This descriptive study was conducted with 153 nurses who were involved in injection practices. The data were collected from August to September 2024. Results: The most frequently performed type of injection by the participants was intravenous, and all types of injection practices were performed an average of 26.8±19.07 times per working day. The variable that most significantly influenced the performance of safe injection practices was knowledge of safe injection practices (β=.56, p<.001), which explained 36.7% of the variance. Experience with injection practice-related education (β=.27, p<.001) explained an additional 10.7% of variance, and organizational culture for infection control (β=.21, p<.001) explained 3.7% more. The total explanatory power of these variables on the performance of safe injection practices was 50.3% (F=52.35, p<.001). Conclusion Since both personal aspects, such as knowledge of safe injection practices and experience with injection practice-related education, and organizational aspects, such as organizational culture for infection control, simultaneously influenced the performance of safe injection practices among nurses at general hospitals, it is strongly recommended to develop and implement an integrated program for improvement. This program should combine strategies to enhance individual knowledge and positively transform the organizational culture for infection control, aiming for higher-quality execution of nursing duties, including injection practices.