Original Article J Health Info Stat 2019;44(1):41-52 https://doi.org/10.21032/jhis.2019.44.1.41 pissn 2465-8014 eissn 2465-8022 의료기관종사자의직무만족및직무성과에미치는직무스트레스영향요인 김혜경 1, 김성수 2 1 청주성모병원경영지원팀보건관리자, 2 청주대학교보건행정 헬스케어학부교수 A Study on Influence Factors of the Job Stress on Job Satisfaction and Job Performance Hye Kyung Kim 1, Sung-Soo Kim 2 1 Healthcare Manager, Department of Management Support, Cheongju St. Mary s Hospital, Cheongju; 2 Professor, Division of Health Administration & Healthcare, Cheongju University, Cheongju, Korea Objectives: The purpose of this study was to contribute to the improvement of hospital management by understanding the relationship between job stress and job performance and providing systematic and professional basic data. Methods: The research method examines the general characteristics (8 items) of the hospital staff and identifies the relationship between job stress (43 items), job satisfaction (5 items), and job performance (7 items). Data collected through the questionnaire (self-administration survey) were analyzed using reliability, frequency analysis and descriptive statistics, mean, independent sample (t-test), one-way ANOVA, correlation, and hierarchical regression analysis. Results: The results of the study showed that job stress according to the general characteristics of the research subjects was not significant in job satisfaction and job performance. Job satisfaction was found to be related to job stress, job instability, and compensation inadequacies among job stress factors. In addition, the relationship conflicts and job instability among the job stress factors were found to have a significant relationship with job performance, and job satisfaction was found to affect job performance. Conclusions: In order to increase job satisfaction and job performance of the medical institution workers, it is necessary to identify those who have a high level of job stress among general characteristics group and to provide professional and systematic management to reduce job stress in order to encourage them to demonstrate their abilities to the fullest extent. Key words: Hospital workers, Job stress, Job satisfaction, Job performance 서론 우리나라는의료산업, 즉의료기관의개방화, 등급화, 투명화, 넘쳐나는인터넷정보공유로인해환자의의료수준이향상되었다. 이에따라공급자중심에서수요자중심으로의료환경의변화와병원간의경쟁이심화되어양질의의료서비스를제공하여야한다는부담의증가로 인해서의료기관직원들은직무스트레스에많이노출되어있다 [1-3]. 직무스트레스란업무상황중에불안, 갈등, 압박감을느끼는것으로환경적또는내적요구가충족되지않는상태에서일어나는것으로, 현직무로부터의정신적, 행동적이직을야기시키며직원의직무소진, 직무만족저하, 정신적혼란에의한노동의손실, 이직률을증가시킨다 [4]. 세계적으로저성장이가속화되고있어구조조정, 고용의불안 Corresponding author: Sung-Soo Kim 298 Daeseong-ro, Cheongwon-gu, Cheongju 28503, Korea Tel: +82-43-229-7998, E-mail: mra7033@naver.com Received: January 17, 2019 Revised: February 21, 2019 Accepted: February 23, 2019 *This is a summary of Hye Kyung Kim's dissertation. No potential conflict of interest relevant to this article was reported. How to cite this article: Kim HK, Kim SS. A study on influence factors of the job stress on job satisfaction and job performance. J Health Info Stat 2019;44(1):41-52. Doi: https://doi.org/10.21032/jhis.2019.44.1.41 It is identical to the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) whichpermit sunrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 2019 http://www.e-jhis.org 41
Hye Kyung Kim and Sung-Soo Kim 정등이생기는외적요인과업무수행중에서나타나는직무스트레스로인해육체적정신적건강이악화되고있다. 국제사회조사프로그램의연구결과에따르면, 우리나라는직무만족비율이 69% 로 Organisation for Economic Co-operation and Development (OECD) 국가의평균인 81% 보다낮은반면, 직무수행중느끼는스트레스는 87% 로 OECD평균 78% 보다높다고한다 [1]. 이처럼우리나라의근로자는심각한직무스트레스에노출되어있는데, 특히의료기관은의료시장의경쟁심화와인간생명을다루어야하는특성으로인해서다른산업분야보다심각한위험에노출되어있다 [5]. 또한환자만족을위한서비스향상에대한요구가늘고있고, 환자를직접치료하는의사, 간호사등전문직부터단순노동에종사하는다양한직종으로이루어져있어직무수행중일어나는대인관계에서의갈등과건강취약계층인환자를상대로감정노동을하는비중이크기때문에스트레스에더욱민감하다 [6]. 의료서비스를제공하는인력중에서가장많은비중을차지하는간호직종은스트레스강도가높은것으로보고되고있다 [7]. 의료인의직무스트레스는당사자에게부정적인영향을미칠뿐만아니라진료서비스를제공받는고객인환자에게궁극적으로영향을끼쳐의료서비스의질적저하를초래하고지역사회의건강문제까지이르게된다 [8,9]. 이러한직무스트레스유발요인은일반적으로의사소통, 개인의특성, 근로에대한보상, 사회적지지, 대처등이알려져있다. 즉, 사회 환경적요인으로대인관계를기반으로하는직장내직무수행중에서생기는인간관계의갈등, 직무과중, 직무자율성의부족, 부정적인직장내조직문화및보상부적절등이주요위험으로인식되어있다 [10]. 의료기관은다양한교육수준의종사자가근무하는노동집약적인인적특성을가지고있어개인, 부서간갈등이의사소통의주요원인이므로이에대한관리가중요하다 [9]. 다양한산업분야의종사자를대상으로시행한연구에서직무스트레스는직무만족과관련이있다는보고가있다 [11-13]. 이는직무성과와밀접하게연관되어있어직장내직무스트레스관리가중요시되고있다 [14,15]. 생애주기에서삶의많은시간을직장내에서보내고있으므로근무중느끼는스트레스는직무만족및직무성과에큰영향을미칠것이다 [16]. 앞서살펴본바와같이여러산업분야의근로자를대상으로직무스트레스와직무만족, 직무스트레스와직무성과의관계에대한연구와의사, 간호사등특정직종에한정한연구가주를이루었으나, 다양한직종으로구성된의료기관의전직원을대상으로한직무스트레스가직무만족, 직무성과의영향요인이라고규명한연구는부진하였다 [9,17,18]. 이에노동집약적이고다양한직종으로구성된의료기관의특성을고려한직무스트레스감소방안에큰관심을가져야할때이며, 나아가직무스트레스가직무만족및직무성과에미치는요인및관계에대한연구가필요하다. 의료기관은점점환자유치를위해대형화와전문화를추진하면서경쟁이날로심해지고있다. 이에의료기관종사자는심리적, 육체적으로취약한환자를대상으로서비스를제공해야하므로감정소진과스트레스가가중되고있다 [19,20]. 따라서본연구는이러한의료기관종사자의직무스트레스수준을평가하고직무만족과직무성과에어떠한영향을미치는지규명하고자한다. 또한직무스트레스와직무만족이직무성과에미치는효과를인구학적특성을통제하고직무스트레스의직접효과를중심으로확인하고자한다. 그동안외부고객인환자를중심으로서비스를개선하여조직의성장과발전을도모하였다면, 내부고객인직원의성과향상요인에관심을가질필요가있다. 따라서본연구는의료기관의내부고객인직원의직무스트레스감소가직무만족과직무성과향상에기여할수있다는이론적근거를제시할수있으며, 더불어직무스트레스의건강장해예방조치를시행하고나아가내부직원관리의효과적경영전략수립에필요한기초자료로활용될수있을것이다. 연구방법 연구모형본연구는병원직원의일반적특성 ( 사회인구학적특성, 직업관련특성 ) 과직무스트레스가직무만족및직무성과에미치는영향을실증하고, 직무만족이직무성과에미치는영향을규명하고자한다. 이때일반적특성을통제하고직무스트레스, 직무만족의영향을밝히고자 Figure 1과같이연구모형을설계하였다. 연구대상본연구의목적을달성하기위해서충북지역의대표적인일개종합병원에종사하고있는직원들을대상으로설문조사를실시하였다. 충북소재종합대학의연구진과자문계약을체결하고설문지를개발하였으며, 산업안전보건기준에관한규칙제669조에따라직무스트레스에의한건강장해예방조치를위하고매년실시할조사를원활하게진 General characteristics Job performance Job stress Job satisfaction Figure 1. Research model. 42 http://www.e-jhis.org
Influence Factors of the Job Stress 행할목적으로병원정보시스템에적용하도록프로그램을구축하였다. 설문에응답하기전에조사목적과취지에대한안내문을확인할수있도록하였고, 개인정보제공을동의한대상에한하여자기기입식설문조사형태로진행되었다. 최종설문응답자는 489명이었고, 각문항에서무응답이없도록병원정보시스템상에서프로그램화하였기때문에불충분한응답으로인한결손표본은없었다. 하지만응답자중의사는 1명으로조사되었는데, 다른직종에비해현저히적어대표성이없다고판단하여최종분석에서제외하였다. 측정도구본연구에서는종합병원종사자들의직무스트레스에따른직무만족, 직무성과를파악하기위하여구조화된설문지를사용하였으며, 설문내용은일반적특성 8개문항, 한국인직무스트레스기본형측정도구 43개문항, 직무만족 5개문항, 직무성과 7개문항으로총 63개문항이며, 전혀그렇지않다 1점, 그렇지않다 2점, 그렇다 3점, 매우그렇다 4점, Likert 4점척도로구성하였다. 이들문항에대한내용을요 약하면 Table 1과같다. 일반적특성은인구사회학적특성과직업관련특성으로구분하였다. 인구사회학적특성으로성별, 나이, 학력, 결혼여부, 자녀수의 5개문항이며, 직업관련특성으로는근무부서, 근속연수, 직급의 3개문항으로구성하였다. 직무스트레스란직무요건이근로자의능력 (capabilities), 자원 (resources), 바람 (needs) 과일치하지않을때생기는유해한신체적, 정서적반응이라고정의할수있다 [21]. 근로자들이업무과정중에직면하고있는직무스트레스의문제는각각의근로자에게심각한고충을야기함은물론직무성과등에도부정적인영향을미친다. 직무스트레스개념을측정하기위한측정문항은 Park [21] 과 KO- SHA [22] 가분류한한국인직무스트레스기본형측정도구인 8개요인의하위영역 43개문항을사용하였다. 8개문항은물리환경, 직무요구, 직무자율, 관계갈등, 직무불안정, 조직체계, 보상부적절, 직장문화로구성되어있다. 점수가높을수록직무스트레스가높은것을의미하며, 직무스트레스를측정하는문항내용이낮은스트레스를의미할 Table 1. Difference of job stress by general characteristics (n=488) Variables n (%) Mean ± SD t or F p Sex Male 87 (17.8) 44.01±8.09-2.28 0.023 Female 401 (82.2) 46.06±7.49 Age (y) 20-29 188 (38.5) 45.16±8.12 1.90 0.129 30-39 166 (34.0) 46.71±7.84 40-49 106 (21.7) 45.57±6.70 50 28 (5.70) 43.76±5.75 Level of education High school 67 (13.7) 46.47±7.78 0.94 0.423 College 181 (37.1) 46.07±7.88 University 217 (44.5) 45.33±7.59 Graduate school 23 (4.7) 43.96±5.22 Marital status Unmarried 234 (48.0) 45.63±8.33-0.17 0.869 Married and other 254 (52.0) 45.75±6.95 Children per family 0 270 (55.3) 45.76±8.31 0.49 0.692 1 61 (12.5) 45.11±6.70 2 131 (26.8) 46.10±6.82 3 26 (5.3) 44.42±6.27 Position Staff 360 (73.8) 45.92±8.12 2.53 0.080 Middle managers 93 (19.1) 45.88±6.15 Administrator or higher 35 (7.2) 42.91±5.27 Working years <1 90 (18.4) 43.24±7.92 8.82 <0.001 1-5 140 (28.7) 45.70±8.03 6-10 72 (14.8) 48.75±7.68 11-15 86 (17.6) 47.82±6.77 16 100 (20.5) 43.88±6.21 Working department Nursing department 334 (68.4) 46.05±7.56 1.78 0.170 Medical Assistant 97 (19.9) 44.40±8.46 Administration 57 (11.7) 45.81±6.39 SD, standard deviation. http://www.e-jhis.org 43
Hye Kyung Kim and Sung-Soo Kim 경우역코딩하였으며, 각영역별환산점수와총점의산출식은 Park [21] 과 KOSHA [22] 의연구를근거로아래와같이계산하여최종분석에이용하였다. Conversion score by section = (Measurement score-count item) 100/(Max-Count item) Total score = ( Conversion score by section)/8 직무만족이란개인이조직내직무를통해경험하게되는욕구만족의정도에관한것, 직무에대한태도의하나로서한개인의직무나직무경험평가시에발생하는유쾌하고긍정적인정서상태로정의하고있다 [23]. 이는자기실현의감정과가치있는성취감이만족의차원과정도를결정하는것으로욕구와가치가관련되어있는것으로본것이다. 직무만족개념을측정하기위한측정문항은 You and Kim [23] 과 Lee [24] 의연구를참고하여병원직원의특성에맞게내용을조정하여사용하였다. 점수가높을수록직무만족이높은수준을의미한다. 직무성과란조직구성원들의직무가얼마나달성되었는가를판단하는것으로활동, 작업등이이루어짐으로써생긴행위, 결말의상태또는영향이나변화라고정의하고있다. 또한실무자들이조직의목표나과업을달성하기위하여보여준노력의결과라고하였다 [25]. 조직구성원의직무가얼마나성공적으로달성되었는지여부를가르는개념으로서조직구성원의성취라는보다포괄적이라는개념을담고있다. 따라서직무성과는조직이측정하고영향력을미치기를바라는조직에서조직구성원행동의한측면이된다. 그래서직무성과란이러한조직구성원들의행동이직무와밀접하게얽혀있는것을뜻한다. 직무성과개념을측정하기위한측정문항은 Hackman and Lawler [25] 와 Williams and Anderson [26] 이분류한병원직원의직무성과연구를참고하고연구대상에적합하게조정하여사용하였다. 점수가높을수록직무성과가높은것을의미한다. 연구도구의내적일관성에따른신뢰성을확인하기위해서도구의신뢰도 (Cronbach s α) 를분석하였다. 직무스트레스 0.86, 직무만족 0.65, 직무성과 0.87로최소기준인 0.6 이상을만족하여신뢰성을만족한것으로나타났다 [27]. 분석방법본연구의분석방법은다음과같다. 첫째, 연구에사용된변수들의측정문항의신뢰도 (Cronbach s α) 를분석하였다. 둘째, 일반적특성, 직무스트레스수준을파악하기위해빈도분석및기술통계분석을실시하였다. 앞서제시한직무스트레스산술식에따라영역별환산점수와총점을분석하고스트레스정도 (Q1-Q4) 에따라 4개집단의비율을 분석하였다. 셋째, 일반적특성에따른직무스트레스, 직무만족, 직무성과의평균비교를위해독립표본 t-검정 (t-test), 일원배치분산분석 (ANOVA) 을실시하였다. 넷째, 직무스트레스, 직무만족및직무성과요인간상관관계를확인하고자피어슨상관계수 (Pearson s correlation coefficient) 를이용한상관분석을실시하였다. 다섯째, 직무스트레스가직무만족, 직무성과에미치는효과를실증하고자일반적특성을통제하고투입되는독립변수의수준에따라단계별모형을제시하는위계적회귀분석 (hierarchical regression analysis) 을실시하였다. 연구에사용한분석도구로 SPSS 23.0 (IBM Corp., Armonk, NY, USA) 프로그램을사용하였다. 연구결과 연구대상자의일반적특성연구대상자의일반적특성은 Table 1과같다. 전체연구대상은 488명이며, 의료기관이라는특성으로인하여여자가 82.2% 로남자 17.8% 보다월등히많았다. 연령별로는 20대가 38.5%, 30대 34.0%, 40대 21.7%, 50대이상은 5.7% 순으로나타났다. 학력은대졸이 44.5% 로가장많았으며, 전문대졸 37.1%, 고졸이하 13.7%, 대학원이상은 4.7% 순으로나타났다. 미혼응답자는 48.0% 이고기혼및기타가 52.0% 분포를보였다. 자녀가없는응답자가 55.3% 로가장많았고 2명 26.8%, 1명 12.5%, 3 명이상은 5.3% 순으로나타났다. 직급은사원이 73.8% 로다수를차지하였으며, 중간관리자 19.1%, 관리자이상은 7.2% 로가장적게분포하였다. 근속연수는 1-5년이하가 28.7% 로가장많이차지하였으며, 16 년이상 20.5%, 1년미만 18.4%, 11-15년이하 17.6%, 6-10 년이하 14.8% 순으로나타났다. 부서는간호부가 68.4% 로가장많이차지하였고, 진료지원부서 19.9%, 행정부서 11.7% 순으로나타났다. 일반적특성에따른직무스트레스의총점의차이를분석한결과, 여자의직무스트레스총점은 46.06으로남자 44.01에비해높은것으로나타나통계적으로유의한차이가있었다 (p = 0.023). 근속연수가 6-10년이하응답자가직무스트레스총점이 48.75로가장높았고, 11-15년이하가 47.82, 1-5년이하 45.70, 16년이상 43.88, 1년미만은 43.24 순이며통계적으로유의한차이를보였다 (p < 0.001). 근무부서별로는간호부가 46.1로가장높고, 행정부 45.8, 진료지원부가 44.4로분석되었지만통계적으로유의한차이는없었다. 연구대상자의직무스트레스정도연구대상자의직무스트레스정도를분석한결과는 Table 2와같다. 연구방법에서제시한직무스트레스의각영역별환산점수와 8개영역의직무스트레스총점을계산하여분석하였다. 분석결과직무요구가 44 http://www.e-jhis.org
Influence Factors of the Job Stress Table 2. Descriptive analysis of job stress (n=488) Job stress Min Max Mean SD Reference range (%) 1 Q1 Q2 Q3 Q4 Physical environment 0.0 88.9 44.65 14.25 10.45 22.34 34.63 32.58 Job demands 4.2 95.8 56.80 13.91 8.20 37.91 26.23 27.66 Job autonomy 6.7 80.0 50.23 11.28 45.29 37.09 7.38 10.25 Relational conflict 0.0 100.0 33.73 13.59 0.00 19.26 59.63 21.11 Job insecurity 0.0 72.2 41.59 11.26 31.97 52.87 2.46 12.70 Organization system 4.8 95.2 48.11 13.28 32.99 28.48 18.24 20.29 Lack of reward 11.1 100.0 50.38 12.70 57.99 28.28 9.43 4.30 Occupational climate 0.0 83.3 40.08 13.75 13.11 34.43 38.11 14.34 Total 18.1 77.4 45.70 7.63 67.01 11.07 14.34 7.58 SD, standard deviation. 1 Q1: the bottom 25%, Q2: the bottom 50%, Q3: top 50%, Q4: top 25%. 56.80으로가장높고보상부적절 50.38, 직무자율성 50.23, 조직체계 48.11, 물리환경 44.65, 직무불안정 41.59, 직장문화 40.08 순으로나타났다. 관계갈등은 33.73으로가장낮은수준의직무스트레스정도를보이고있었다. KOSHA CODE H-42-2006 직무스트레스요인측정지침 에참고치를기준으로환산점수를 4개구간으로나누어분석하였다. 물리환경의스트레스정도가심한 Q4 ( 환산점수남자 66.7 이상, 여자 55.6 이상 ) 의비율이 32.58% 로가장많았으며, 다음으로직무요구 Q4 ( 환산점수남자 58.4 이상, 여자 62.6 이상 ) 는 27.66%, 관계갈등 Q4 ( 환산점수남자 50.1 이상, 여자 41.7 이상 ) 21.11%, 조직체계 Q4 ( 환산점수남녀 62.0 이상 ) 20.29%, 직장문화 Q4 ( 환산점수남녀 50.1 이상 ) 14.34%, 직무불안정 Q4 ( 환산점수남자 61.2 이상, 여자 55.6 이상 ) 12.70%, 직무자율 Q4 ( 환산점수남자 60.1 이상, 여자 66.7 이상 ) 10.25%, 보상부적절 Q4 ( 환산점수남녀 77.8 이상 ) 4.30% 순으로나타났다. 스트레스총점의평균은 45.70이며, Q4 ( 환산점수남자 56.6 이상, 여자 56.7 이상 ) 는 7.58% 로비교적낮은비율을보였다. 일반적특성에따른직무만족및직무성과평균비교일반적특성에따라직무만족의평균차이를분석하였다 (Table 3). 학력은대졸이 2.80으로가장높게나타났으며대학원이상 2.76, 전문대졸 2.73, 고졸이하 2.62 순으로통계적으로유의하였다 (p = 0.024). 직급은관리자이상이 2.89, 사원 2.74, 중간관리자 2.71로관리자이상의직무만족이높고통계적으로유의한차이가있었다 (p = 0.041). 근무부서는간호부응답자의직무만족평균이 2.78로가장높고, 행정부 2.69, 진료지원부가가장낮은 2.66인것으로나타났으며통계적으로유의한차이가있었다 (p = 0.027). 일반적특성에따라직무성과의평균차이가있는지분석하였다. 연령별로는 40대의직무성과평균이 3.07로가장높게나타났으며, 50대이상 3.06, 30대 3.04, 20대 2.96으로통계적으로유의한차이가있었다 (p = 0.015). 결혼여부와관련해서는기혼및기타 3.07로미혼 2.97보다높아유의한차이가있었고 (p < 0.001), 자녀와관련해서는자녀가 1명인응답자의직무성과평균이 3.09로가장높아자녀와직무성과와유의한차이가있었다 (p = 0.002). 직무스트레스, 직무만족, 직무성과간의상관관계직무스트레스요인인물리환경, 직무요구, 직무자율, 관계갈등, 직무불안정, 조직체계, 보상부적절, 직장문화, 직무만족, 직무성과간의상관관계를알아보기위해상관분석을실시하였다 (Table 4). 물리환경은직무요구 (r = 0.47, p < 0.01), 직무자율 (r = 0.12, p < 0.01), 조직체계 (r = 0.23, p < 0.01), 보상부적절 (r = 0.28, p < 0.01), 직장문화 (r = 0.29, p < 0.01) 에양의상관관계를보였고, 직무만족 (r = -0.13, p < 0.01), 직무성과 (r = -0.10, p < 0.05) 는음의상관관계를보였다. 직무요구는관계갈등 (r= 0.16, p <0.01), 조직체계 (r= 0.28, p <0.01), 보상부적절 (r= 0.37, p <0.01), 직장문화 (r= 0.39, p <0.01) 에양의상관관계가보였고, 직무불안정 (r = -0.09, p < 0.05), 직무만족 (r = -0.15, p < 0.01) 은음의상관관계가보였다. 직무자율에는관계갈등 (r = 0.18, p < 0.01), 직무불안정 (r = 0.17, p < 0.01), 조직체계 (r = 0.32, p < 0.01), 보상부적절 (r = 0.37, p < 0.01), 직장문화 (r = 0.17, p < 0.01) 에양의상관관계가보였고, 직무만족 (r = -0.41, p < 0.01), 직무성과 (r = -0.12, p < 0.01) 는음의상관관계를보였다. 관계갈등은직무불안정 (r = 0.25, p < 0.01), 조직체계 (r= 0.39, p < 0.01), 보상부적절 (r = 0.33, p < 0.01), 직장문화 (r = 0.32, p < 0.01) 에양의상관관계가보였고, 직무만족 (r = -0.36, p < 0.01), 직무성과 (r = -0.16, p < 0.01) 는음의상관관계를보였다. 직무불안정에서는조직체계 (r = 0.21, p < 0.01), 보상부적절 (r = 0.14, p < 0.01), 직장문화 (r = 0.12, p < 0.01) 에양의상관관계가보였고, 직무만족 (r = -0.34, p < 0.01), 직무성과 (r= -0.26, p < 0.01) 는음의상관관계를보였다. 조직체계는보상부적절 (r= 0.57, p <0.01), 직장문화 (r= 0.36, p <0.01) http://www.e-jhis.org 45
Hye Kyung Kim and Sung-Soo Kim Table 3. Difference of job satisfaction and job performance by general characteristics Variables Job satisfaction Job performance Mean±SD t or F p Mean±SD t or F p Sex Male 2.74 ± 0.41-0.17 0.862 3.06 ± 0.34 1.20 0.229 Female 2.75 ± 0.37 3.01 ± 0.31 Age (y) 20-29 2.80±0.36 1.31 0.269 2.96±0.32 3.54 0.015 30-39 2.72 ± 0.41 3.04 ± 0.32 40-49 2.69 ± 0.36 3.07 ± 0.30 50 2.79 ± 0.36 3.06 ± 0.35 Level of education High school 2.62±0.44 3.17 0.024 3.01±0.39 1.18 0.315 College 2.73 ± 0.37 3.05 ± 0.31 University 2.80 ± 0.37 2.99 ± 0.30 Graduate school 2.76±0.34 3.05±0.36 Marital status Unmarried 2.78±0.38 0.69 0.491 2.97±0.31-3.54 <0.001 Married and other 2.72±0.38 3.07±0.32 Children per family 0 2.77±0.40 0.25 0.861 2.97±0.30 4.91 0.002 1 2.75 ± 0.34 3.09 ± 0.34 2 2.70 ± 0.38 3.08 ± 0.32 3 2.67 ± 0.31 3.05 ± 0.33 Position Staff 2.74 ± 0.38 3.22 0.041 3.01 ± 0.32 1.85 0.159 Middle managers 2.71±0.38 3.05±0.29 Administrator or higher 2.89±0.37 3.10±0.34 Working years <1 2.87±0.34 1.57 0.180 2.99±0.33 1.43 0.224 1-5 2.70 ± 0.40 3.01 ± 0.34 6-10 2.72 ± 0.38 2.98 ± 0.32 11-15 2.67 ± 0.40 3.04 ± 0.27 16 2.79 ± 0.35 3.08 ± 0.31 Working department Nursing department 2.78±0.37 3.64 0.027 3.00±0.32 2.25 0.106 Medical assistant 2.66±0.40 3.04±0.32 Administration 2.69 ± 0.39 3.09 ± 0.32 Total 2.68 ± 0.26 3.02 ± 0.32 Table 4. Correlation analysis of job stress, job satisfaction and job performance Variables 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 2 1. Job stress 1.1 Physical environment 1.2. Job demands 0.47** 1.3. Job autonomy 0.12** 0.07 1.4. Relational conflict 0.03 0.16** 0.18** 1.5. Job insecurity -0.04-0.09* 0.17** 0.25** 1.6. Organization system 0.23** 0.28** 0.32** 0.39** 0.21** 1.7. Lack of reward 0.28** 0.37** 0.37** 0.33** 0.14** 0.57** 1.8. Occupational climate 0.29** 0.39** 0.17** 0.32** 0.12** 0.36** 0.39** 2. Job satisfaction -0.13** -0.15** -0.41** -0.36** -0.34** -0.52** -0.54** -0.28** 3. Job performance -0.10* -0.01-0.12** -0.16** -0.26** -0.05-0.11* -0.17** 0.18** *p < 0.05, **p < 0.01. 에양의상관관계가보였고, 직무만족 (r = -0.52, p < 0.01) 은음의상관관 계를보였다. 보상부적절에서는직장문화 (r = 0.39, p < 0.01) 에양의상관 관계가보였고, 직무만족 (r = -0.54, p < 0.01), 직무성과 (r = -0.11, p < 0.05) 는음의상관관계를보였다. 직장문화는직무만족 (r = -0.28, p < 0.01), 직 무성과 (r = -0.17, p < 0.01) 에음의상관관계를보였다. 직무만족은직무 성과 (r = 0.18, p < 0.01) 에양의상관관계를보였다. 46 http://www.e-jhis.org
Influence Factors of the Job Stress 직무스트레스가직무만족및직무성과에미치는영향직무만족및직무성과에대한직무스트레스의영향정도를분석하기위해일반적특성을통제한위계적회귀분석을실시하였다 (Tables 5, 6). 분석결과의해석에앞서회귀가정을살펴본결과 Dubin-Watson 통계량은 1.5-2.0으로 2.0에근접하여자기상관에문제가없었으며, 다 중공선성을확인하기위한분산팽창인자 (variation inflation factor, VIF) 는모든독립변수가 10 이하를만족하였다. 일반적특성을통제한상태에서직무스트레스가직무만족에미치는순수한영향정도를분석하였다 (Table 5). 일반적특성변수를독립변수로한모델 1에서는직무만족에미치는영향의회귀모델은유의하 Table 5. Factors affecting job satisfaction of hospital employees Variables Model 1 Model 2 β t p β t p Constant 33.142 < 0.001 34.607 < 0.001 Sex (ref: female) 0.041 0.809 0.419 0.010 0.235 0.814 Age (y, ref: 20-29) 30-39 -0.036-0.488 0.626-0.055-0.877 0.381 40-49 -0.091-1.111 0.267-0.057-0.814 0.416 50-0.015-0.214 0.831 0.025 0.408 0.684 Level of education (ref: high school) College 0.137 1.949 0.052 0.074 1.210 0.227 University 0.185 2.526 0.012 0.099 1.547 0.123 Graduate school 0.021 0.363 0.717-0.019-0.385 0.700 Marital status (ref: married and other) 0.005 0.053 0.958 0.068 0.885 0.377 Children per family (ref: 0) 1 0.017 0.233 0.816 0.016 0.261 0.794 2 0.002 0.021 0.983 0.020 0.280 0.780 3-0.019-0.325 0.746-0.026-0.527 0.599 Position (ref: staff) Middle managers 0.040 0.589 0.556 0.040 0.687 0.493 Administrator or higher 0.130 1.897 0.058 0.050 0.849 0.396 Working years (ref: <1) 1-5 -0.073-1.159 0.247 0.020 0.362 0.718 6-10 0.000 0.001 0.999 0.135 2.345 0.019 11-15 -0.058-0.760 0.448 0.098 1.478 0.140 16 0.026 0.280 0.779 0.075 0.935 0.350 Working department (ref: administration) Nursing department 0.099 1.292 0.197 0.061 0.907 0.365 Medical assistant -0.047-0.654 0.513-0.056-0.908 0.364 Job Stress Physical environment -0.031-0.655 0.513 Job demands 0.009 0.168 0.867 Job autonomy -0.156-3.480 0.001 Relational conflict -0.011-0.240 0.811 Job insecurity -0.206-4.961 <0.001 Organization system -0.126-2.353 0.019 Improper reward -0.257-4.952 <0.001 Work cultures -0.083-1.817 0.070 R 2 0.061 0.346 R 2 0.285 Adjusted R 2 0.023 0.307 F 1.597 9.008 p 0.053 < 0.001 ref, reference. http://www.e-jhis.org 47
Hye Kyung Kim and Sung-Soo Kim Table 6. Factors affecting job performance of hospital employees Variables Model 1 Model 2 Model 3 β p β p β p Constant < 0.001 < 0.001 < 0.001 Sex (ref: female) 0.035 0.495 0.043 0.386 0.042 0.399 Age (y, ref: 20-29) 30-39 0.079 0.289 0.116 0.104 0.123 0.081 40-49 0.065 0.432 0.157 0.048 0.165 0.037 50 0.001 0.989 0.080 0.247 0.076 0.265 Level of education (ref: high school) College 0.067 0.343 0.020 0.773 0.010 0.889 University -0.005 0.942-0.072 0.318-0.086 0.232 Graduate school -0.016 0.793-0.049 0.387-0.046 0.411 Marital status (ref: married and other) -0.046 0.613-0.011 0.900-0.020 0.813 Children per family (ref: 0) 1 0.063 0.383 0.081 0.235 0.078 0.245 2 0.095 0.268 0.088 0.282 0.085 0.294 3 0.032 0.596 0.048 0.401 0.051 0.362 Position (ref: staff) Middle managers -0.066 0.335-0.089 0.175-0.095 0.147 Administrator or higher 0.033 0.637-0.019 0.773-0.026 0.692 Working years (ref: <1) 1-5 -0.028 0.656-0.060 0.329-0.063 0.305 6-10 -0.105 0.112-0.120 0.066-0.138 0.033 11-15 -0.055 0.477-0.027 0.714-0.041 0.581 16-0.026 0.780-0.060 0.510-0.070 0.436 Working department (ref: administration) Nursing department -0.093 0.228-0.093 0.217-0.102 0.176 Medical assistant -0.059 0.410-0.032 0.639-0.025 0.720 Job Stress Physical environment -0.068 0.206-0.063 0.234 Job demands 0.103 0.072 0.102 0.074 Job autonomy -0.035 0.494-0.013 0.800 Relational conflict -0.157 0.002-0.156 0.002 Job insecurity -0.257 <0.001-0.228 <0.001 Organization system 0.063 0.298 0.080 0.183 Improper reward -0.005 0.938 0.031 0.601 Work cultures -0.093 0.074-0.081 0.117 Job satisfaction 0.139 0.008 R 2 0.049 0.169 0.182 R 2 0.120 0.013 Adjusted R 2 0.011 0.121 0.132 F 1.275 3.473 3.646 p 0.195 < 0.001 < 0.001 ref, reference. 지않았다 (p = 0.053). 일반적특성에직무스트레스 8개요인을추가한모델 2의회귀모델은유의하였고 (p < 0.001), 설명력은 34.6% 로나타났다. 직무만족에유의하게영향을미치는변수는직무자율 (β = -0.156, p = 0.001), 직무불안정 (β = -0.206, p < 0.001), 보상부적절 (β = -0.257, p < 0.001) 이었다. 직무자율성, 직무불안정, 보상부적절에대한스트레스가 낮을수록직무만족이유의하게높은것으로나타났다. 일반적특성을통제한상태에서직무스트레스가직무만족에영향을미치는회귀모형에대한설명력의변화 ( R 2 ) 는 28.5% 로분석되었다. 즉, 직무스트레스 8개요인의변수를추가한모델 2는모델 1에비해회귀모형의설명력이 28.5% 증가하였다. 48 http://www.e-jhis.org
Influence Factors of the Job Stress 일반적특성을통제한상태에서직무스트레스가직무성과에미치는영향을분석한결과 Table 6과같다. 일반적특성변수를독립변수로한모델 1에서는직무성과에미치는영향의회귀모델은유의하지않았다 (p = 0.195). 일반적특성에직무스트레스 8개요인을추가한모델 2에서는직무성과에미치는영향의회귀모델이유의하였다 (p < 0.001). 직무성과에유의하게영향을미치는변수는관계갈등 (β = -0.157, p = 0.002), 직무불안정 (β = -0.257, p < 0.001) 으로나타났다. 즉, 관계갈등과직무불안정에대한스트레스가낮을수록직무성과가유의하게높은것으로나타났다. 모델 2의설명력은 16.9% 로나타났다. 모델 2에서모델 1의설명력차이, 즉일반적특성을통제한상태에서직무성과에대한직무스트레스 8개요인에의한설명력변화 ( R 2 ) 는 12.0% 로나타났다. 이는추가로투입한직무스트레스 8개요인의변수로인해서모델 1에비하여모델 2의회귀모형설명력이 12% 증가한것을의미한다. 일반적인특성과직무스트레스에직무만족을추가한모델 3에서는직무성과에미치는영향의희귀모델은유의하였다 (p < 0.001). 모델 3에서직무성과에유의하게영향을미치는변수는관계갈등 (β = -0.156, p = 0.002), 직무불안정 (β = -0.228, p < 0.001), 직무만족 (β = 0.139, p = 0.008) 이었다. 앞선모델 2에서처럼관계갈등과직무불안정에대한스트레스가낮을수록직무성과가증가하였으며, 직무만족이높으면직무성과도향상되는것으로나타났다. 모델 3의설명력은 18.2% 로나타났다. 일반적특성과직무스트레스 8개요인을통제시킨상태에서모델 2와모델 3의설명력의변화 ( R 2 ) 는 1.3% 로나타났다. 즉, 직무만족을독립변수로추가투입하였을때회귀모형의설명력은 1.3% 증가하였다. 고찰 본연구는충북지역의종합병원에근무하고있는간호사, 의료기사, 행정직원들의일반적특성및직무스트레스에따른직무만족, 직무성과수준을파악하고직무만족이직무성과에도영향이있는지를확인하고자시도하였으며직무스트레스가직무만족과직무성과에미치는영향을규명하고자하였다. 빠르게변화되는병원환경에대처해야하는직원의직무스트레스를조사하여향후병원직원의건강위험에대한예방조치를시행할수있도록병원경영에필요한기초자료를제공하고자한다. 선행연구를고찰하여직무스트레스측정도구를이용한자기기입식설문조사를시행하였다. 조사의효율성과응답의신속성을위해병원정보시스템에설문항목을프로그램하고각질문에무응답이없도록관리하였다. 측정도구로는타당도와신뢰도가검증된한국인직무스트레스측정도구인 Korean Occupation Stress Scale (KOSS) 을사용하였고본연구에서도신뢰도분석결과문제가없었다 [6,21,22]. 연구의 내용타당성을높이기위해서산업체인의료기관과대학의연구진이자문계약을맺고공동연구를진행하였다. 직무스트레스의 8개영역과총점을분석한결과물리환경, 직무요구, 관계갈등에서스트레스정도가높은응답자가나타나직무스트레스의경감을위한조치들이우선적으로시행될필요가있다. 1,000명이상제조업사업장의남녀근로자를대상으로단축형직무스트레스도구를사용한 Park and Jung [28] 의연구에서는남자는 45.3점, 여자는 48.6점으로본연구의남녀평균 45.70과비슷한수준이었으나영역별로는직무요구, 직무자율, 조직체계순으로본연구와차이를보였다. 이러한결과는연구대상의산업분야의차이로인해영역별직무스트레스강도가다르게나타난것으로볼수있으며, 병원종사자들은물리환경과관계갈등이직무스트레스에취약한영역임을보여주는것이라하겠다. 같은의료기관내에서도직종에따라서물리환경이다르고직종이다양하여관계갈등의스트레스가주요하게작용한것으로판단된다. 일반적특성에따른직무스트레스의차이를분석한결과남자보다는여자가, 근속연수는 6-10년이하응답자에서가장높은것으로분석되었으며통계적으로도유의하였다. 연령별로는 30대, 학력은낮을수록, 결혼상태여부에서는기혼및기타응답자가, 자녀와관련해서는자녀가 2명인응답자가, 직급은사원에서, 근무부서별로는간호부에서높게나타났으나통계적으로는유의하지않았다. 의료인의직무스트레스영향요인을실증한선행연구에서는여자보다는남자, 대학교졸업자의경우에직무스트레스정도가높아본연구와는일치하지않았다 [9]. 본연구가의료인인간호사외에도진료지원부서, 행정부서응답자를포함한것에기인한것으로해석되어다양한직종별심층분석을통해직무스트레스경감정책을고려해야할것이다. 일반적특성에따른직무만족및직무성과와의관계에서통계적으로유의한결과만을살펴보면, 우선직무만족과의차이에서는대졸이상, 관리자이상, 간호부서에서직무만족이높은것으로나타났다. 직위가높을수록, 급여를많이받을수록, 간호및행정부서에서직무만족도가높게나온선행연구와비슷한결과를보였다 [29]. 직무성과와의차이를보면, 40대, 기혼및기타, 자녀수 1명에서직무성과가높은것으로나타났다. 연구자마다일반적특성에따른직무스트레스요인별차이가있음을보여주고있으며, 또한직무만족및직무성과에도차이가있음을나타내고있다. 이는연구대상및연구시기, 병원규모의차이로인한것으로생각된다. 따라서본연구목적의타당한결과를얻기위해직무만족과직무성과의영향요인을규명할때일반적특성을통제할필요가있다. 일반적특성과직무스트레스가직무만족에미치는영향에대한분석결과, 일반적특성들은유의한영향을미치지않았으나직무자율, http://www.e-jhis.org 49
Hye Kyung Kim and Sung-Soo Kim 직무불안정, 보상부적절요인에서영향을미치는것으로나타났다. 일반적특성과직무스트레스가직무성과에미치는영향에대한분석결과, 일반적특성은직무성과에유의한영향을미치지않았으나관계갈등, 직무불안정, 직무만족요인은직무성과에유의한영향을미치는것으로나타났다. 선행연구에서는구성원들의직무스트레스, 직무만족, 직무성과에미치는영향의결과를살펴본결과, 직무스트레스가클수록직무만족, 직무성과가낮게나타났으며, 직무스트레스가낮을수록직무성과는높고 [30], 직무만족이높을수록직무성과도높았다 [23]. 직무스트레스요인중대인관계와관련된직무만족영향을살펴본선행연구에서는조직구성원의대인관계스트레스가감소할수록직무만족도가증가하였음을나타내는결과도있으며, 또한종합병원의간호사를대상으로직무스트레스와직무만족도의관련성을분석한결과직무스트레스요인즉, 업무요구도, 업무자율성, 동료및상사와의지지도에의해서영향을받고있음을나타내는연구도있다 [16,31]. 병원행정직종사자들의직무만족도의수준을파악하기위해실시한연구에따르면급여가낮을수록, 업무에대한신체적부담이클수록, 직무만족도는낮음을보였고직무스트레스가낮을수록직무만족도는유의하게증가하는양상을보이고있었다 [32]. 이러한연구결과는본연구와일치하였으나과도한스트레스나너무적은스트레스는사람들의일상생활및직장생활에바람직하지못하다는견해가있고 [33], 동일한조직내에서개인의욕구및가치에따라특정인에게는그조직이스트레스의긍정적측면인기회와관련되는반면다른사람에게는스트레스가부정적측면인제약과관련될수있기때문에 [34] 과도한직무스트레스를관리하여적정한상태로유지할필요가있다. 본연구에서는의료기관전체직종을대상으로확대한연구를실시하여전반적으로직무스트레스가직무만족및직무성과에부정적영향이있음을제시하였다. 정리하면의료기관직원의직무스트레스를줄이는것은직무만족및직무성과를높여경영의효율성및향상에긍정적인영향이있음을실증하였다. 무성과가향상되는결과를보였다. 따라서적절한보상과직무불안정요인을추가로확인하고개선하며, 업무자율성을높이는조직체계의정비가필요하고직무만족을높여직무성과를향상시킬수있는지속적인정책을모색해야할것이다. 또한직무스트레스가높은집단을파악하여직무스트레스를줄일수있도록전문적인보건관리자의역할이중요할것이다. 연구대상을충북지역에소재한종합병원 1개소에근무하는간호부, 진료지원부, 행정부를대상으로한정하여지역별특수성이나전국적인규모의특수성을고려하지못하였기때문에일반화시키기에는제한이있다. 향후의료기관과직종을확대한심층연구가수행되어야할것이다. 직무스트레스관련연구들이특정시점에조사한결과를발표하고있다. 이는단면연구에따른제한이있으므로지속적인직무스트레스관찰과감소에대한효과를분석하기위해종단적연구가필요하다. 본연구에앞서자문을통해병원정보시스템에설문을프로그램화하고주기적으로실시하여종단적분석이가능하도록시스템화하였기에향후종단분석에대한심층적인연구결과를기대한다. 또한인구학적특성외에직무스트레스의선행요인을규명하고, 이를통해직무만족및직무성과를높일수있는방안을모색하는연구가필요하다. 그리고직무만족및직무성과에영향을미치는직무스트레스요인을심층적이고다양한변수들을포함한다차원적인관점에서의료기관통합모델에대한연구가이루어지기를기대한다. 더불어의료기관현장에서는직무스트레스의예방및관리를위한전문적인보건관리자의역할확대와교육전담부서를통한교육프로그램등을개발하여의료기관종사자의직무스트레스를감소시킬수있는정책이필요함을제안한다. ORCID Sung-Soo Kim https://orcid.org/0000-0002-7205-0758 결론 본연구는충북의대표적인일개종합병원에종사하고있는직원들을대상으로직무스트레스, 직무만족, 직무성과정도를파악하고직무만족과직무성과에미치는직무스트레스의영향요인을파악하기위한실증연구이다. 주요연구결과를요약하면다음과같다. 일반적특성을통제하고직무만족에영향을미치는직무스트레스요인으로는보상부적절, 직무불안정, 직무자율, 조직체계순으로확인되었다. 직무성과에대한직무스트레스영향요인으로는직무불안정, 관계갈등순으로확인되었으며, 직무만족정도가높으면유의하게직 REFERENCES 1. Lee HK, Nam CY. The effects of job stress, depression, and psychological happiness on job satisfaction of office workers. J Korean Acad Soc Nurs Educ 2015;21(4):489-497 (Korean). 2. Lim KM, Tak JK. The effects of job demands on job stress: the moderating effects of job control and procedural justice. Korean J Ind Organ Psychol 2016;29(2):61-83 (Korean). 3. Yang CH, Kwon YM, Shin HJ. A study on influence of job stress factors on job burnout and organization effectiveness. Korean J Res Devel 50 http://www.e-jhis.org
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