활동기준원가계산(ABC)을 이용한 간호활동 분석 및 간호서비스 원가분석

Abstract

[한글]

본 연구는 활동기준원가계산방법(ABC)을 일 산부인과 간호단위에 적용, 간호부문에 ABC의 적용가능성을 확인하고, 병원 프로세스 리엔지니어링 등에 필요한 원가정보를 제공함으로써 간호행정가 뿐 아니라 의료기관 관리자의 의사결정에 도움을 주고자 한다. 연구대상은 서울시 소재 일 대학병원 산부인과 간호단위의 간호서비스이다 연구의 주요결과는 다음과 같다.

1. 간호활동을 ABC에 필요한 형태로 다차원적으로 정의하였다. 문헌고찰과 면접, 설문조사를 통하여 60개의 간호활동군을 분류한 후 직접활동과 간접활동으로 구분였고, 다시 직접활동은 개별활동과 묶음활동으로, 간접활동은 간접서비스활동과 일반관리활동으로 구분하였다.

2. 간호활동은 직책별, 근무번별로 차이가 있음을 확인하였다. 책임간호사는 대부분 간접서비스활동과 일반관리활동을 수행하고 있었으며, 환자별로 간호활동 투입량이 거의 유사한 것으로 나타났다. 일반간호사는 개별활동과 묶음활동을 수행하고 있었으며, 투약활동이 26.8%, 대상자 사정이 25.0%, 관리 및 기타활동이 20.3%, 대상자 정보관리가 10.7%, 의사소통이 8.0%, 간호처치가 6.8%, 입퇴원관리가 1.2%, 교육활동이 1.2%로 조사되었다. 근무번별 간호활동의 내역을 살펴보면 낮번과 저녁번은 차이가 없으나 밤번에서는 간호대상자의 사정에 관련된 활동이 증가하였다.

3. ABC에 의한 정상분만 산모에 대한 간호서비스 원가는 일반간호사의 직접활동원가 85.9%, 일반간호사의 간접활동원가 19.0%, 책임간호사와 수간호사의 활동원가 14.1%로 구성되어 있었다.

본 연구결과는 간호단위 또는 간호부서 행정관리자와 의료기관 경영자에게 유용한 정보를 제공하여 원가통제, 업무흐름개선 등과 관련된 각종 의사결정에 활용될 수 있을 것이며, 부가가치분석에 의한 활동기준관리(ABM) 및 병원 프로세스 리엔지니어링과 관련된 연구로 확장될 수 있을 것이다.

[영문]

The purpose of this study is to examine a possibility of applying the ABC system to analyze the cost of nursing service on one obstetrics and gynecology (OB/GYN) unit in a major medical center.

The activities of nurses on an OB/GYN unit were analyzed for 4 days for 96 hours, 2 week days and 2 days on weekend. Total cases included in the study were activities of 12 charge nurses and 12 staff nurses. Activities were categorized into direct and indirect activities in order to calculate the cost of activities.

Nursing activities were defined multidimesionally in order to utilize the ABC system. The 60 nursing activities were classified into the direct nursing activities and the indirect nursing activities based on a literature review, interview, and survey results, The direct activities were further categorized into

the single nursing activities and the multiple nursing activities. The indirect activities were classified into the indirect nursing service activities and the general management activities.

The major findings of this study were as follows :

1. There were differences in activities according to the positions and duties of the nurses. The charge nurses mostly performed the indirect nursing service activities and the general management activities. Almost all of their indirect nursing activities spent on each patient were similar. The staff nurses performed the single nursing activities and the multiple nursing activities.

2. The activities of staff nurses included medication, patient assessment, rounding and organizing the unit, patient education, nursing treatment, admission and discharging of patients. There was no differences in types and amount of time spent between the nurses on day-time duty and evening-time duty, but the patient

assessment activity increased during the night-time.

3. The cost of post partum nursing services for women who had a normal vaginal delivery using the ABC system included the cost incurred by direct nursing activities provided by the staff nurses(85.9%), indirect nursing activities incurred by the staff nurses(19.0%) and the nursing activities by the charge nurses

and the head nurse(14.1%).

The ABC system is a relatively new method of cost analysis, The results of this study can provide the nursing and hospital managers with useful information on cost control. It is suggested that more studies should be done using the ABC system and extend the scope of studies to include value analysis to aid the Activity-Based Management(ABM) and/or the reengineering of hospital process.