In proceeding with treatment, it is essential to make decisions using a patient care decision-making process that is satisfactory to the patients.　Recently, the concept “patient satisfaction” has been widely adopted.　However, to measure “satisfactory decision-making,” it is considered very important to adopt the concept of “Regret” in the assessment of the quality of health care.
　　Therefore, this study was conducted to verify the relationships among the score on the Japanese version of the “Decision Regret Scale,” score on health-related quality of life, and patient factors in patients who had undergone surgery for inguinal hernia, cholelithiasis, cholecystitis, or gallbladder polyp.
　　A self-administered questionnaire survey was conducted of 128 patients aged less than 85 years who were discharged from Hospital A in Tokyo between July and December 2012.　The questionnaire response recovery rate was 65%.　Valid responses (n=79) were analyzed using a path analysis technique within structural equation modeling.　The results showed that “gender” was the only factor directly affecting the score for “Regret,” and that the proportion of patients classified under “Regret” was higher in males than in females.　It was suggested that other patient factors, “age,” “surgical techniques” and “complications” did not have any direct effect on the score for “Regret” but had an indirect effect through health-related quality of life.

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　　The aim of this paper was to verify the sources of competitive advantages for hospital management by searching for mobility barriers among strategic groups.　In Japan, free competition in hospital management is restricted by various regulations.　However, since the necessary management resources are acquired through marketing transactions, management resources are concentrated in attractive hospitals and flow out of less attractive hospitals.　Therefore, it is necessary to make profits through hospital financial management, which are a source of purchasing hospital equipment and medical devices for patients in the region.　The aim of this paper was to verify the sources of competitive advantages, which is a factor influencing the profit differentials among hospitals, in Japanese hospital management by searching for “mobility barriers” among strategic groups in the medical industry.
　　In this paper, I discuss factors contributing to the “mobility barriers” stemming from profit differentials across hospitals of the Japan Red Cross Society, by verifying the differences in the mean variable values between high- and low-ranking hospital groups through multivariate analysis, during five fiscal year-periods from 2007 to 2011.
　　Our analysis revealed that the factors contributing to the “mobility barriers” creating profit differentials among hospitals were differences in the internal management resources, e.g., differences in the hospital scale and a high staffing level of physicians, and “management skills” involving hospital management, in general, among organizational capabilities.

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　　The purpose of this study was to examine measures taken toward recruitment and retention of nursing staff, and associated difficulties and turnover ratio employing a complete hospital survey in a selected prefecture.　We mailed and distributed anonymous self-administered questionnaires to all hospitals in a selected prefecture.　The response rate was 33%（N=120 hospitals） and the data was used for analysis.　Results showed that the mean cost for hiring one nursing staff was 101,829 yen（median=34,473 yen）.　For recruitment of nursing staff, 24% of the hospitals introduced a scholarship system for student nurses, while 22% used temporary staff services, and 6% used a private recruiting agency.　Half of the hospitals answered that recruitment and retention of nursing staff are difficult.　The findings that current conditions of measures taken toward recruitment and retention of nursing staff, and associated difficulties and turnover ratio suggested that the hospitals would require further efforts for recruitment and retention of nursing staff from the perspective of all nursing staff.

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　　The use of nursing staffing agencies （hereinafter referred to as “staffing agencies”） by hospitals has been on the rise.　However, a high placement fee is charged for hiring through staffing agencies.　Therefore, a questionnaire survey of nursing directors of small and medium-sized private hospitals to determine the current status of use of staffing agencies was conducted, in order to devise a suitable approach to establish future measures to ensure adequate nurse staff levels.
　　A mail survey was conducted, requesting the nursing directors of 987 small and medium-sized private hospitals extracted from Japan Hospital Association member hospitals, to fill out a self-administered questionnaire originally devised by us.　Answers obtained from 148 directors （recovery rate: 15.1%） were examined by the χ² test and t-test, using IBM SPSS Statistics 20 for Windows.　Free-text entries were categorized.
　　Medical corporations accounted for 75.7% of the facilities that the respondents belonged to, with a mean number of beds of 119.4 ± 48.2.　A significantly high proportion （66.9%） of the respondents answered ‘yes’ to the use of staffing agencies.　Free-text entries were obtained from 84 respondents （56.8%）, with 159 codes.　The responses were classified into 5 categories: “Hospitals’ use of staffing agencies,” “High placement fee,” “Nurses recruited by staffing agencies,” “Frustration towards staffing agencies” and “Future direction toward securing human resources.”
　　The survey results suggest the need for the development of strategies for use of staffing agencies, reinforcement of the nurse station function, and reinforcement of basic nursing education.

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