This study aimed to construct a management model for patient transfer in a multilevel healthcare system and to predict the effect of counseling with nurses on the patient transfer process.

Data were collected from the electronic medical records of 20,400 patients using the referral system in a tertiary hospital in Seoul from May 2015 to April 2017. The data were analyzed using system dynamics methodology.

The rates of patients who were referred to a tertiary hospital, continued treatment, and were terminated treatment at a tertiary hospital were affected by the management fee and nursing staffing in a referral center that provided patient transfer counseling. Nursing staffing in a referral center had direct influence on the range of increase or decrease in the rates, whereas the management fee had direct influence on time. They were nonlinear relations that converged the value within a certain period.

The management fee and nursing staffing in a referral center affect patient transfer counseling, and can improve the patient transfer process. Our findings suggest that nurses play an important role in ensuring smooth transitions between clinics and hospitals.

The purpose of this study was to examine correlations between nurses' self-leadership and individual work role performance and correlations between self-leadership in nursing units and team members' work role performance.

Participants were 202 conveniently selected general nurses from 5 general hospitals in Korea. The study was carried out on 35 nursing units. Data were collected during February 2015 with self-report questionnaires.

For factors affecting individual work role performance, self-expectation, self-goal setting, constructive thought, clinical career in the present nursing unit and marital status accounted for 44.0% of proficiency, while self-expectation, self-goal setting, constructive thought, and marital status accounted for 42.3% of adaptivity. Self-expectation, self-goal setting, constructive thought, self-reward, clinical career in the present nursing unit and position accounted for 26.4% of proactivity. In terms of team members' work role performance, self-reward and self-expectation in nursing units explained 29.0% of team members' proficiency. Self-reward and self-expectation in nursing units explained 31.6% of team members' adaptivity, and self-reward in nursing units explained 16.8% of team members' proactivity.

The results confirm that nurses' self-leadership affects not only individual self-leadership but also team members' work role performance. Accordingly, to improve nurses' work role performance in nursing units of nursing organizations, improvement in nursing environment based on self-leadership education is necessary and nurses' tasks rearranged so they can appreciate work-autonomy and challenges of work.

This paper reports a study exploring factors related to patient satisfaction and dissatisfaction with inpatient care.

A cross-sectional study design was used, employing data from the National Health and Nutrition Survey conducted in 2001. Socio-demographic factors, utilization, self-rated health status, and disease characteristics were assessed by employing univariate comparisons and multivariate logistic regression analyses.

Out of 37,769 respondents, 1,043 aged 20 years and over had been admitted to a hospital or clinic at least once during the past year. About a quarter of the respondents were discharged from tertiary hospitals and 21% from clinics. The majority of patients (58%) were satisfied with inpatient care received, whereas 11% were dissatisfied. Greater satisfaction was found in patients aged 45-64 years and those having formal education, discharge from tertiary hospitals, national health insurance as a payer, medical expenses not being burdensome, good self-rated health status, and neoplasm. Living in non-metropolitan urban areas, shorter length of stay, and musculoskeletal diseases were associated with greater dissatisfaction.

Different factors were related to patient satisfaction and dissatisfaction with care. Those factors need to be taken into account when evaluating and comparing satisfaction levels between health care institutions.