平成 29 年度厚生労働省委託

医療勤務環境改善マネジメントシステムに基づく医療機関の取組に対する支援の充実を図るための調査･研究事業報告書

平成 30 年 3 月

医療分野の勤務環境改善マネジメントシステムに基づく医療機関の取組に対する支援の充実を図るための検討委員会

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Ⅰ

事業の概要 ································································ 1
１．目的 ····································································· 3
２．実施概要 ································································· 3（１）医療機関アンケート調査············································ 4（２）モデル事業························································ 7（３）取組事例収集······················································ 7３．実施体制 ································································· 8（１）検討委員会名簿···················································· 8（２）検討委員会の開催·················································· 10Ⅱ 提言～勤務環境改善の更なる推進のために～ ··································· 11
１．国の医療勤務環境改善の更なる推進の必要性について ·························· 13（１）医療勤務環境改善に向けた今までの取組 ······························ 13（２）病院の勤務環境改善の更なる推進の必要性 ···························· 14（３）有床診療所の勤務環境改善の必要性 ·································· 16
２．国の支援の方策について···················································· 16（１）マネジメントシステムの効果的な活用の提示 ·························· 16（２）「いきサポ」を活用した情報発信の充実・強化 ························· 18（３）支援センター機能の充実・強化に向けて ······························ 19
Ⅲ 医療機関アンケ―ト調査結果 ················································ 21１

医療機関アンケート調査結果のまとめ ·········································· 23

２

医師の調査結果 ····························································· 28
１．回答者属性 ······························································· 28
２．働き方・休み方について···················································· 35（１）労働時間·························································· 35（２）休日・休暇························································ 47（３）当直（宿直・日直）
・夜勤・オンコール ······························· 51（４）最長連続勤務時間と最短勤務開始時間（病院のみ） ···················· 55
３．勤務環境 ································································· 59（１）現在の勤務環境···················································· 59（２）勤務環境改善に関する取組（病院のみ） ······························ 65

３ 看護職の調査結果···························································· 71
１．回答者属性 ······························································· 71
２．働き方・休み方について···················································· 78（１）労働時間·························································· 78（２）休日・休暇························································ 90（３）夜勤 ····························································· 95（４）最長連続勤務時間と最短勤務開始時間 ································ 104

３．勤務環境 ································································· 111（１）現在の勤務環境···················································· 111（２）勤務環境改善に関する取組（病院のみ） ······························ 120
４ 病院・有床診療所の調査結果·················································· 126
１．回答者属性 ······························································· 126
２．フルタイム勤務の正規職員について·········································· 135
３．勤務環境改善の取組························································ 140（１）現状認識·························································· 140（２）取組状況·························································· 143（３）マネジメントシステム取組状況（病院のみ） ·························· 145（４）勤務環境改善に関する取組（病院のみ） ······························ 148（６）経営上のメリット、認定、表彰、宣言の状況 ·························· 164
４．労務管理等について························································ 166
５．
「いきいき働く医療機関サポート Web」 ······································· 168
６．
「医療勤務環境改善支援センター」 ··········································· 171
Ⅳ アンケート調査結果からみる現在の状況 ······································· 175
Ⅴ モデル事業の実施 ·························································· 189
１．モデル事業の実施内容······················································ 191
２．取組支援ツール ··························································· 192（１）職員及び施設に対するアンケート調査 ································ 192（２）支援ツールフォーマット············································ 192
３．モデル事業個別事例························································ 195（１）吉成医院·························································· 195（２）バークレーレディースクリニック ···································· 199（３）西原クリニック···················································· 200（４）高山胃腸科・外科·················································· 203（５）名古屋整形外科・人工関節クリニック ································ 207
４．スカイプ研修の実施························································ 208
Ⅵ 取組事例について ·························································· 211
１．事例の収集方法 ··························································· 212
２．H29 に収集した事例の概要 ·················································· 212
３．事例の詳細 ······························································· 212（１）事例収集した病院の基本情報について ································ 212（２）事例の詳細について················································ 213
参考資料 ······································································ 219