종합적 질 관리 (TQM)를 위한 프로세스 분석 방법 -의약품 실체를 중심으로-

김명기,Kim, Myeng-Ki 한국의료질향상학회 1994 한국의료질향상학회지 Vol.1 No.1

Total quality management has been a focus of concern in recent years since some dissatisfaction with the results from implementation of quality assurance programs in the U.S. Many managerial methodologies and innovation guidelines from academic disciplines have been applied to promote TQM programs in the health field. This paper consists of two folds of aspects: firstly to examine TQM's managerial philosophy by comparing with the newly introduced managerial concepts in Business Reengineering; and then to introduce a method for an integrative way of process analysis, Entity Life-Cycle Diagram (ELCD) modeling. The analysis method was compared with Process Map, which is a well-known method for BR applications. To show effectiveness of ELCD modeling, a case of application was introduced using 'drug' as a target entity. With having TQM issues in mind, the result was reflected in designing Entity Relation Diagrams. The results of ELCD modeling turn out to be helpful in designing database related to quality monitoring, in that many monitoring check points can be identified in a systematic way and that queries cross-sectional over organizational boundaries can be generated with a consistent view focusing on the drug use as a single process. Full evaluation of the analysis method remains to be studied until the completion of the information system under construction. But as long as TQM is based on a process-oriented view and needs supports from information system, ELCD can be one of the appropriate choice as a tool for the process analysis.

본질적 논리모형에 근거한 원무관리시스템의 분석과 설계

김명기 ( Myeng Ki Kim ) 한국보건행정학회 1994 보건행정학회지 Vol.4 No.2

치과의료사고 및 분쟁에 대한 국내·외 문헌고찰

김명기(Myeng Ki Kim),조한아(Han A Cho),이진한(Jin-han Lee) 대한치과의사협회 2015 대한치과의사협회지 Vol.53 No.2

Background: Interest in medical malpractice claims and accidents is a day to day social issue to general public as well as medical personnel. Related laws and regulations already have been established, and institutions based on the laws and regulations also have been founded. However, in our dental community, interest and response to the issue seem insufficient. Methods: We searched four medical literature databases that are mainly cited in the medical community. Keywords including ‘dental malpractice claims’, ‘patient safety’ and ‘medical accident’ were used for the search. Among the selected literatures, we chose specific ones separately whose content is authentic and easily approachable. Results: Medical malpractice claims and accidents tend to increase around the world. As the cost or the difficulty level of surgery increases, the dispute rate also increases, which appears even more apparent in developed countries. Preventive measures to prevent the disputes and accidents are not significantly different. Three critical of them include relationship of doctor with patient, the informed consent and medical record. Conclusion: Tools for accident occurrence or communication improvement have been introduced. All of those cost time and money. However, education or professional request of liability insurance companies, self education and provision of guidelines can be immediately implemented. To implement those, dentists’ promotion at the regional or national level is imperative. rhBMP 2 is widely used at sinus augmentation, alveolar bone defect, and socket preservation.

치과의료경영학 교과과정개발

김명기(Myeng Ki Kim) 대한치과의료관리학회 2013 대한치과의료관리학회지 Vol.1 No.1

수요의 상호의존성을 고려한 의료 서비스 시장의 속성선호도 분석

김영주(Kim, Young Ju),김진환(Kim, Jin-Hwan),김명기(Kim, Myeng-Ki),김재환(Kim, Jaehwan) 한국소비문화학회 2012 소비문화연구 Vol.15 No.2

본 연구에서는 의료 서비스 시장에 잠재한 수요의 개인간 상호 의존성을 컨조인트 분석을 통해 규명하고자 한다. 의료 서비스 시장의 성장과 더불어 의료 서비스에 대한 소비자들의 욕구는 점점 복잡해 지고 있으며, 의료 서비스 제공자들 역시 소비자의 만족을 끌어내기 위한 주요 속성을 파악하기 위해 노력하고 있다. 본 연구는 의료 서비스 시장을 이해하는 데 보다 진일보된 소비자 측면의 접근이 필요하다는 데서 비롯되었다. 특히, 개별고객들의 의료서비스에 대한 수요는 소비자들 별로 독립된 것이 아니라 시장 내의 다른 소비자들과 잠재적으로 연결되어 있을 수 있다는 가능성을 열어두고, 의료 서비스 시장 수요의 상호의존성을 고려하여 고객의 선호도 분석을 시도했다. 가능한 적용분야로 치과진료 시장을 골랐으며, 소비자의 치과 선호를 임플란트, 충치시장 두 개로 나누어 각각 190명의 응답을 자료로 사용하였다. 분석 결과, 우리나라 의료 서비스 수요에서는 소비자들 간에 높은 상호 의존도가 존재하는 것으로 나타났다. 또한, 이러한 시장 내 의존성을 간과하였을 경우 소비자가 의료 서비스를 선택하게 된 중요한 요소들이 왜곡되는 것을 볼 수 있었다. 병원의 마케팅전략 수립 시 주요한 정보가 될 수 있는 의료진의 수준과 같은 인적요소, 혹은 시설과 규모와 같은 물적요소들의 상대적 중요도는, 소비자입장에서 이러한 상호의존도를 제대로 고려했을 때 바르게 이해되는 것으로 나타났다. In this study, the consumer demand for medical service attributes is analyzed at individual level based on the premise that individual preferences are interdependent. As the medical market grows, the market demand and the customers’ expectation on medical services become more complicated, which requires more careful understanding on the key service attributes that drive the final demand. The current study is aimed at proper understanding on the drivers of medical demand accounting for latent interdependence in utilities among the consumers in the market. Through a conjoint approach that allows for estimating the individual-level partworths for the model of spatial dependence form, we empirically investigated the level of dependence in Korean dental service market, and explored the potential bias researcher may have when ignoring the interdependence component in model specification. We use doctors’ experience, hospital staffs’ attitude, the size of the hospital, the facilities of the hospital, consultation fee, and the accessibility of the hospital as service attributes(i.e., explanatory variables), and the intention to visit the hospital as a dependent variable. The data is from 380 respondents, with 190 from implant service and 190 from treating cavity service, respectively. Key findings from empirical analysis are as follow: First, for the implant service, consumers consider the doctors’ experience, hospital staffs’ attitude, facilities of the hospital, consultation fees, and accessibility of the hospital in the evaluation of the dental service. Second, the treating cavity service, consumers consider doctors’ experience, hospital staff’s attitude, consultation fees, and the accessibility of the hospital as important factor. Finally, in both services, there is a substantial social dependence in utilities among the customers. It is to be noted that when ignoring the interdependence in analyzing the demand for medical service, many of the sensitivity parameters are distorted and appear not to be relevant.

Rapid Prototyping으로 제작한 3D Medical Model의 오차 측정에 관한 연구 - 임상적용 가능성 및 사례

최진영(Jin Young Choi),최정호(Jung Ho Choi),김남국(Nam Kuk Kim),이종기(Jong Ki Lee),김명기(Myeng Ki Kim),김명진(Myung Jin Kim),김영호(Yeong Ho Kim) 대한구강악안면외과학회 1999 대한구강악안면외과학회지 Vol.25 No.4

Presented in this paper are the experimental results that measure rapid prototyping (RP) errors in 3D medical models. We identified various factors that can cause dimensional errors when producing RP models, specifically in maxillofacial areas. For the experiment, we used a human dry skull. A number of linear measurements based on landmarks were first obtained on the skull. This was followed by CT scanning, 3D model reconstruction, and RP model fabrication. The landmarks were measured again on both the reconstructed models and the physical RP models, and these were compared with those on dry skull. We focused on major sources of errors, such as CT scanning, conversion from CT data to STL models, and RP model fabrication. The results show that the overall error from skull to RP is 0.64±0.36㎜(0.71±0.66%) in absolute value. This indicates that the RP technology can be acceptable in the real clinical applications. A clinical case that has applied RP models successfully for treatment planning and surgical rehearsal is presented. Although the use of RP models is rare in the medical area yet, we believe RP is promising in that it has a great potential in developing new tools which can aid diagnosis, treatment planning, surgical rehearsal, education, and so on.

중소 규모의 치과의원에 균형성과표를 적용하기 위한 핵심성과지표 개발

김상석 ( Sangsuk Kim ),김명기 ( Myeng Ki Kim ),최형길 ( Hyungkil Choi ) 한국병원경영학회 2017 병원경영학회지 Vol.22 No.1

The purpose of this study is to develop the KPIs(Key Performance Indices) needed to improve management and strategy in the dental clinic based on the four perspectives of BSC(Balanced Scorecard). The questionnaire was conducted on 52 dentists approved by Dental Managment Research Committee in Seoul National University as a panel. Using the Delphi technique, the top five KPIs for each point of perspective in BSC were extracted from KPI pools. In the third survey, the top five KPIs of all points were compared with each other through AHP(Analytic Hierarchy Process) method, and priority and overall importance rankings were calculated. The biggest difference in the three level AHP results was the customer perspective took priority to others. In the second survey, the financial perspective, which was number one, was pushed back. The overall significance of KPIs was in the order of customer, internal process, finance, learning and growth perspective, with the exception of medical profits (5th of 20) and new patient growth (10th of 20). We were able to overcome the limitations of the Delphi Technique with the AHP method. In general, the financial perspective in BSC is known to be the most important, but we conclude that the customer perspective is more important through the pairwise comparison survey. In the current dental service market, which is a long-term recession, excessive competition, customer satisfaction and customer relationship management seem to be the first goal to pursue in dental clinic.

Evaluation of Dental Terminology System Using GRAIL: A Pilot Study

김영준,이종기,김명기,고홍섭,Kim, Young-Jun,Lee, Jon-Ki,Kim, Myeng-Ki,Kho, Hong-Seop The Korean Academy of Orofacial Pain and Oral Medi 2001 Journal of Oral Medicine and Pain Vol.26 No.3

본 연구는, 기존의 나열식 분류체계의 문제점을 극복할 수 있는 GRAIL을 이용하여 두경부의 해부학적 구조물들 및 구강 악안면 영역의 주요 질병들과 관련된 치의학 개념들의 모델을 구축한 뒤, 완성된 치의학 개념 모델이 두경부의 해부학적 구조물들 및 구강 악안면 영역의 주요 질병들을 잘 표현할 수 있는지와 기존의 GRAIL 모델이 지닌 특징에 잘 부합하는지를 평가하고자 시행되었다. 서울대학교 치과병원 내원 환자 중 포괄적인 치과 치료 병력을 지닌 환자 150명의 치과 의무기록을 내용별로 분석하고, 각종 치의학 교과서와 기존의 의학용어 분류체계에서도 모델 구축에 필요한 치의학 용어를 선택하였다. 이들 자료를 바탕으로, GRAIL 모델 구축을 진행하고 구축된 모델을 평가할 수 있는 소프트웨어 프로그램인 'KnoME'에서 치의학 개념 모델을 구축하고 평가하여, 다음과 같은 결론을 얻었다. 1. 환자 150명의 치과 의무기록을 내용별로 분석한 결과, 우선적으로 모델 구축이 필요한 치의학 용어로는, 해부학적 구조물의 경우 치아, 치은, 악관절, 입술, 턱, 혀 등의 순서로 나타났으며, 구강악안면 영역의 병소에서는 치아 우식증, 치주염, 치은염, 악관절 장애, 매복 지치, 치경부 마모 등의 순서로 나타났다. 2. GRAIL을 이용하여 치아, 치주조직, 구강점막조직, 치아 우식증, 치수 및 치근단 병소, 치주질환, 구강점막질환의 모델 구축을 시행한 결과, 치의학 개념간의 다양한 관계가 대다수 잘 표현되었다. 그러나, 구강 악안면 영역의 해부학적 구조물에 대한 공간 정의의 한계성과 구강 악안면 질환의 진행 양상에 있어서 표현의 어려움이 관찰되었다. 이러한 부분은 GRAIL을 치의학 분야에 적용할 때, 극복해야 할 한계로 나타났다. 3. 치의학 개념들에 관한 다양한 질의를 시행한 후 그 응답 내용을 평가한 결과, 완성된 모델 내에서 치의학 개념의 자동적인 분류가 이루어 졌으며, 다양한 목적의 검색이 가능하였다. 이와 같은 사실로 미루어 보아서, 완성된 모델은 기존의 GRAIL 모델의 특성에 잘 부합되는 것으로 생각되었다.

치과 환자의 항생제 처방에 영향을 주는 요인

김혜성 ( Hyesung Kim ),김명기 ( Myeng Ki Kim ),최형길 ( Hyungkil Choi ) 대한예방치과·구강보건학회 2017 大韓口腔保健學會誌 Vol.41 No.1

Objectives: Resistance to antibiotics is getting worse every day. Antibiotics are commonly prescribed medicines for the prevention and treatment of bacterial infections in dental clinics. Nationally, we are attempting to reduce the use of antibiotics, but this cannot be easily achieved. As a precedent study, we investigated factors affecting antibiotic prescription in dental clinics. Methods: We analyzed electronic patient records of S dental hospital located in a big city. A total of 12,711 medical records were analyzed. The type of prescribed antibiotic, the prescription rate, and the number of prescription days were analyzed by chi-square test and t-test. Factors associated with the rate of antibiotic prescription were analyzed using logistic regression by dividing the independent variables into four groups: patient characteristics, dentist characteristics, treatment characteristics, and time characteristics. Results: The rate of antibiotic prescription was 91.7% for the first implant surgery and 60.0% for minor operations including incision and drainage. The duration of antibiotic prescription differed according to the sex of the dentist and the type of treatment. The logistic regression analysis showed that the rate of antibiotic prescription was higher in male patients, in older patients, and in female dentists, and decreased with increasing age of the dentist. Compared with basic treatment, the odds ratio of first implant surgery was highest at 102.166 times, minor operation at 18.997, and extraction of impacted tooth at 14.429. Conclusions: This is the first study to analyze the factors affecting prescription rate of antibiotics in dental clinics. We found that the antibiotic prescription rate was significantly different for each dental treatment. It was necessary to analyze the prescription rate of antibiotics according to the type of treatment. The fact that prescribing antibiotics differed according to dentist characteristics indicated that consistent guidelines need to be established and promoted.

가구 소득과 보건의료비 지출의 형평성: 누진성과 소득재분배 효과

신호성 ( Ho Sung Shin ),김명기 ( Myeng Ki Kim ),김진숙 ( Jin Sook Kim ) 한국보건행정학회 2004 보건행정학회지 Vol.14 No.2

The present study attempts to examine the progressivity of health care financial sources based on the income approach, for which it decomposes redistributive effects into vertical, horizontal, and re-ranking components. The study data include Korean Household Expenditure Survey (2000) conducted every 5 year by Korea National Statistical Office. The data were sampled from the national population by the multistage probabilistic sampling method, and amounts to 23,270 households. For the better application of the income approach, the study employs household total expenditure in Korea instead of total income, because the former data source is more reliable and less fluctuated over time. Progressivity of health care financing was measured by Kakwani index. Aronson`s decomposition equation was used in case of the analysis where differential treatment of health care expenditure needs to be considered. Despite the progressivity of Korea`s governmental contributions, total expenditure of health care showed regressive pattern, which may largely be attributable to the higher regressivity in out-of-pocket money. With the result of negative Kakwani index, differential treatment increased income redistribution biased for better-off. It is worth to note that social insurance displays not only negative Kakwani index, but also horizontal inequality, suggesting that the first step of health care financing reform should be the revision of social insurance premium rates toward effective and equable way.