日本医療経営学会誌
Online ISSN : 2187-8951
Print ISSN : 1883-7905
ISSN-L : 1883-7905
最新号
選択された号の論文の13件中1~13を表示しています
巻頭言
原著
  • 竹村 淳一
    2024 年 18 巻 1 号 p. 5-14
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    Using job characteristics theory and self-determination theory, which are motivation theories, I examined the work motivation of senior medical professionals. It was suggested that these two motivation theories have a high affinity because they can indicate the strength and position of work motivation by MPS of job characteristics theory and RAI of self-determination theory. The quantitative survey is verified by multivariate analysis and path analysis using 596 samples obtained from questionnaires. As a result, it was suggested that there is work motivation generated by going back and forth between two motivation theories. It was suggested that the work motivation of senior medical professionals is strongly influenced by occupational identity, and that it is an important variable that generates autonomy, desire for growth, and organizational commitment. Based on these, I will consider measures to maintain work motivation and play an active role even if medical professionals become elderly human resources.

  • ~ケアマネジャーへのアンケート調査より~
    座光寺 佑樹
    2024 年 18 巻 1 号 p. 15-25
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    <Background> In the past 20 years, profit-making corporations have entered the home-visit nursing business, but many small-scale home-visit nursing stations have been closed or suspended. Therefore, we considered the competitive strategy of them.

    <Methods> Questionnaire surveys were filled out by care managers in Japan. The date was analyzed with SPSS ver. 27 for Mac and KH Coder3.Bate.03.

    <Results> Forty-four care managers answered the questionnaire (response ratio: 27.0%). The conditions that the care managers requested for a small-scale home-visit nursing station were " Professional skills and Experience," "Ease to collaboration," "Ease to contact," and "Emergency Response."

    <Conclusions> Home-visit nurses in small-scale home-visit nursing stations need identify their strengths based on their professional skills and experience, and differentiate themselves from the others. Moreover, they need to build relationships with care managers through smooth collaboration and contact. In addition, it is important to build a system for emergency response.

  • 座光寺 佑樹
    2024 年 18 巻 1 号 p. 27-36
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    <Background> The diversification of user needs in recent years has led to the increase in the number of home-visit nursing stations that provide non-insured services. The current situation remains to be known. Therefore, we aimed to examine the needs and acceptance price for it.

    <Methods> Questionnaire surveys were filled out by people interested in regular services in Japan. We preformed the X2 test with SPSS statistics ver. 27, and PSM for the acceptance price.

    <Results> 300 people answered the questionnaire (response ratio: 16.4%). The acceptance price range for it was between 2,500 and 7,500 yen, although users were charged higher; between 3,000 and 9,500 yen. “Break” was the most common purpose, followed by “Accompany to hospital”.

    <Conclusions> It is required to establish a service system that can be used in combination with regular by setting contents and prices according to user needs.

  • ―ある地域の中規模私立医療法人のコロナ禍におけるBSCの事例を通じて―
    井上 秀一, 丹羽 修二, 松本 亮
    2024 年 18 巻 1 号 p. 37-46
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    The purpose of this paper is to clarify function factors of management accounting systems under a crisis such as the coronavirus pandemic. In this paper, a functioning management accounting system is defined as operating in the same way as under normal circumstances. Research question is as follows; What are factors that enable a management accounting system to operate in the same way as under normal circumstances in the coronavirus pandemic. This paper conducts interviews in a mid-sized private healthcare corporation. Two factors of management accounting systems are clarified.

    (1) Education and initiatives on management accounting systems under normal circumstances foster understanding and acceptance of management accounting systems among medical professionals and promote accounting communication across multiple professions.

    (2) Managers compares normal circumstances with crisis, and managers take flexible measures to operate management accounting systems so that the same activities can be made during crisis as during normal circumstances.

  • 玉置 翔平, 真野 俊樹
    2024 年 18 巻 1 号 p. 47-54
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    The purpose of this study is to clarify the elements of value for in-app purchase of smartphone healthcare application among healthy 10s to 60s who pay regularly for the application.

    The subjects were 70 healthy men and women in 10s to 60s who continuously charged for the application in the last year. Wilcoxon signed-rank sum test was used to examine 36 value elements ("Functional value", "Emotional value", "Life-changing value", "Social impact", "Healthcare-related value" and “Other”), which were evaluated using five-point scale separately for free and for charging on a regular basis.

    As a result, the evaluation of "Emotional value" and "Healthcare-related value" significantly higher when charging than when free. It was suggested that “Emotional value” and “Healthcare-related value” are the elements of value for in-app purchase of smartphone healthcare application.

  • 羽明 英敏, 高橋 泰
    2024 年 18 巻 1 号 p. 55-66
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    The "Community Medicine Path," a key tool for delivering uninterrupted medical services and achieving community-based care through the differentiation and coordination of medical care functions, has seen slow adoption despite its introduction in insurance coverage since 2006.

    This paper utilizes NDB open data to analyze the calculation status of additional fee for community medicine care plan in both metropolitan and regional medical areas, and contemplates the potential for its proliferation within the integrated community care system.

    The results reveal that the path is progressing in regional medical areas, but lagging in metropolitan ones. In densely hospital-populated metropolitan areas, the requirement of holding more than three meetings annually for additional fee is considered a hindrance to building collaboration networks. With the rapid advancement of digital technology enabling remote information sharing and communication, the paper suggests that leveraging medical DX to relax calculation requirements could enhance the efficiency and spread of the path.

  • ―属性と医療安全風土との関係―
    鈴木 佳世子, 田中 芳幸, 山口 久美子
    2024 年 18 巻 1 号 p. 67-77
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    In a survey conducted using anonymous self-administered questionnaires, the relationship between reporting behavior (Level 0 incidents) and the safety culture among nurses working in specialized function hospitals was investigated. The response rate was 85.7%, and 62.4% of nurses reported engaging in reporting behavior. Significant differences were observed in nurse experience, department tenure, attendance at safety training, and safety manager experience. Among those who reported incidents, safety culture scores were significantly higher. Compliance with reporting rules and safety leadership from other professions also showed significant differences. Notably, communication freedom was associated with department tenure, and safety manager experience influenced compliance with reporting rules. These findings highlight the importance of fostering a culture conducive to reporting behavior, emphasizing the role of open communication.

  • 山口 久美子, 田中 芳幸, 上田 理恵, 草刈 由美子
    2024 年 18 巻 1 号 p. 79-90
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    The purpose of this study was to clarify the relationship between ward management and work environment for nurses working at university hospitals. We conducted an anonymous self-administered questionnaire survey of nurses and managers working in the wards of one university hospital. We examined the correlation between 21 items on the 3 subscales of the Japanese version of the NWI-R and 17 items on ward management. The effects of the items with significant correlations on the work environment were examined by multiple regression analysis. Furthermore, we examined the effects of the items with significant correlations on the work environment. The number of valid responses from staff was 598 (valid response rate: 83.2%), and the number of valid responses from managers was 46 (valid response rate: 80.7%). It was shown that the five items of "alignment of organizational goals with individual goals" had a positive and significant influence on the work environment.

  • 藪下 千恵美, 渡部 鉄兵, 高橋 泰
    2024 年 18 巻 1 号 p. 91-100
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    The purpose of this study is to quantitatively clarify the regional uneven distribution of childbirth and obstetricians in Japan.

    Using government-released data, we calculated the number of births and number of obstetricians per female population of childbearing age in each region and conducted an analysis that correlated them with childbirth-related events in each region.

    It has been revealed that there is a shortage of obstetricians in depopulated areas, and that many births are attended by obstetricians in depopulated areas. In addition, 11 areas where there is a high possibility that childbirth will no longer be possible in the future were selected that require attention, based on the size of the area, the number of births, and the number of obstetricians.

    We hope that the accuracy of government data will be improved and that policy decisions regarding the uneven distribution of childbirth will be made based on such quantitative data.

  • 石川 雅俊, 瀬戸 僚馬, 小黒 道子, 佐藤 嘉乃
    2024 年 18 巻 1 号 p. 101-107
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    Obstetricians and Gynecologists (OBGYNs) have longest working hours, making it difficult to promote work style reforms. In this study, we conducted a questionnaire survey to the heads of departments working at hospitals across Japan, and collected information about the progress of physician workstyle reforms and the hospital attributes. A questionnaire was sent to 1,170 hospitals, and valid responses were received from 325 physicians. The most common responses that “already implemented” included “objective management of hospital stay using time cards”, ”in-hospital nursery school” and “childcare leave (female doctors)”. On the other hand, the lowest percentage of respondents who answered “already implemented” were “introducing shift work”, “childcare leave (male doctors)”, and “planning to obtain B level”. Number of doctors: 10 or more was associated with the ease of implementing restrictions on work intervals and continuous working hours. In OBGYN, it is necessary to prioritize centralization of medical institutions in parallel with workstyle reform.

調査報告
  • 座光寺 佑樹
    2024 年 18 巻 1 号 p. 109-120
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    <Background> We aimed to identify the present system issues faced in the operation of home-visit nursing stations in order to respond to the increasing severity, diversity, and complexity of home health care, and to prepare basic data for the revision of remuneration.

    <Methods> Questionnaire surveys were filled out by the worker at home-visit nursing stations in Japan. The respondents were asked for free comments their issues with the system based on their experiences, which were categorized and analyzed by after-coding.

    <Results> Seventy-seven workers answered the questionnaire (response ratio:15.4%). The issues were extracted into eight categories: “Personnel”, “Differences in Remuneration”, “Unscheduled Services”, “Non-compensable Services”, “Additional Fees”, “Non-service Operations”, “Collaboration”, and “Inservice Support”.

    <Conclusions> The role of home-visit nursing stations should be expanded by fully examining the issues identified and reflecting them in today's revisions of medical and nursing care reimbursement.

  • 田村 桂一, 荒井 耕
    2024 年 18 巻 1 号 p. 121-128
    発行日: 2024年
    公開日: 2024/10/11
    ジャーナル フリー

    A survey of hospitals and contractors was used to identify the factors that influence hospital construction project duration.

    The results revealed differences by hospital attributes, although these factors cannot be arbitrarily changed by the hospital organization itself. Specifically, public hospitals were found to have, on average, one year longer project durations than private hospitals, and large hospitals had, on average, one year longer project durations than small and medium-sized hospitals.

    On the other hand, speed of decision-making and availability of policy changes were revealed as factors that can be arbitrarily changed in the hospital organization itself. In order to increase the speed of decision-making, it is necessary to have a clear decision-making structure and process on the hospital side, which can be addressed by the governance of the hospital organization. In addition, policy changes seem to be inevitable in hospital construction projects, but they can be controlled through governance.

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