平成 28 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み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 29 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調査・研究委員会

目Ⅰ次

実施概要 ·························································································· 1
１．目的 ································································ 3
２．実施概要 ···························································· 3（１）病院アンケート調査················································· 4（２）モデル事業 ························································ 5（３）取組事例収集······················································· 5３．実施体制 ···························································· 6（１）検討委員会名簿····················································· 6（２）検討委員会の開催··················································· 8（３）ワーキンググループの開催··········································· 8

Ⅱ 提言～勤務環境改善の更なる推進のための目標設定の在り方～ ······················ 9
１．支援センターの取組に関する目標設定、評価指標、評価方法等の在り方について ····························· 11（１）目標の設定について················································· 11（目標設定の必要性）（目標設定の主体）（目標設定の方法）（目標設定の対象期間）（中長期目標と年次活動計画）（２）指標の設定について················································· 14（指標の設定と設定主体）（支援センターの活動の段階に応じた重点施策）（支援センターの指標例）（指標設定の留意点）（支援テーマを設定した指標例）（３）モニタリングの実施と評価について ··································· 18（モニタリングの実施）（モニタリングシートの活用）（評価の方法）２．医療機関の取組に関する目標設定、評価指標、評価方法等の在り方について · 21（１）目標の設定について················································· 21（目標設定の必要性）（目標の設定に向けた留意点）（２）指標の設定について················································· 23（指標の設定）（ハイリスク・アプローチ）（職種別アプローチ）
３．その他 ······························································ 26（支援センターの周知について）（支援センターの支援の工夫について）（小規模医療機関や診療所への支援について）

Ⅲ

病院アンケート調査結果 ······································································ 27
Ⅲ－１ 病院に勤務する医師の調査結果 ····································· 29
１．回答者属性 ·························································· 29
２．働き方・休み方について··············································· 33（１）労働時間 ·························································· 33①週所定労働時間······················································· 33②時間外労働時間······················································· 35（２）休日・休暇 ························································ 41（３）当直（宿直・日直）・夜勤・オンコールの回数 ·························· 44（４）宿直の拘束時間と実労働時間········································· 45（５）夜勤の勤務割時間と実労働時間······································· 47（６）最長連続勤務時間と最短勤務開始時間 ································· 49
３．勤務環境 ···························································· 51（１）勤務環境に対する満足度············································· 51（２）勤務環境に対する自由意見分類······································· 52①肯定的な意見 ························································ 52②否定的な意見 ························································ 53（３）健康・睡眠 ························································ 54（４）勤務環境改善に関する取組··········································· 55
Ⅲ－２ 病院に勤務する看護師の調査結果
１．回答者属性 ·························································· 57
２．働き方・休み方について··············································· 63（１）労働時間 ·························································· 63①週所定労働時間······················································· 63②時間外労働時間······················································· 65（２）休日・休暇 ························································ 71（３）夜勤 ······························································ 74
３．勤務環境 ···························································· 79（１）勤務環境に対する満足度············································· 79（２）勤務環境に対する自由意見分類······································· 81①肯定的な意見 ························································ 81②否定的な意見 ························································ 82（３）健康・睡眠 ························································ 83（４）勤務環境改善に関する取組··········································· 85（参考）医師・看護師比較················································· 88①勤務している病院で取り組んでおり、勤務環境改善の効果があると感じているもの ························· 88②自分の職場で取り組んでほしいと思うもの ······························· 90
Ⅲ－３ 病院調査結果····················································· 92
１．回答者属性 ·························································· 92
２．勤務環境改善の取組··················································· 98（１）現状認識 ·························································· 98（２）取組状況 ·························································· 99（３）マネジメントシステム取組状況······································· 100（４）75 項目の取組内容 ·················································· 101

（５）医師・看護師と施設の取組評価の比較 ································· 107①医師 ································································ 108②看護師 ······························································ 109（６）医師・看護師の取組期待············································· 110①医師 ································································ 111②看護師 ······························································ 112（７）経営上のメリット··················································· 113
３．労働条件の明示等····················································· 115
４．
「いきいき働く医療機関サポート Web」 ·································· 120
５．
「医療勤務環境改善支援センター」 ······································ 123
Ⅳ モデル事業の実施 ·············································································· 125
１．モデル事業の実施内容················································· 127
２．ヒアリング内容······················································· 127（１）医療勤務環境改善支援センターを訪問した際 ··························· 127（２）医療機関を訪問した際··············································· 128
３．モデル事業参加都道府県··············································· 129
４．モデル事業のまとめ··················································· 130（１）医療勤務環境改善支援センターについて ······························· 130①取組状況 ···························································· 130（導入定着支援業務）（好事例の把握・活用）②課題 ································································ 130（２）医療機関について··················································· 131①取組状況 ···························································· 131（方針表明）（体制整備）（現状分析）（取組の実施）②課題 ································································ 131
Ⅳ－１ 岩手県 ·························································· 132
１．支援センター ························································ 132
２．医療機関（岩手医科大学付属病院） ····································· 135
Ⅳ－２ 山形県 ·························································· 138
１．支援センター ························································ 138
２．医療機関（最上町立最上病院）········································· 141
Ⅳ－３ 岐阜県 ·························································· 146
１．支援センター ························································ 146
２．医療機関（医療法人社団志朋会加納渡辺病院） ··························· 153
３．医療機関（社会医療法人緑峰会養南病院） ······························· 157
Ⅳ－４ 福岡県 ·························································· 162
１．支援センター ························································ 162
２．医療機関（医療法人社団敬信会大法山病院） ····························· 167

３．医療機関（医療法人昌和会見立病院） ··································· 173
Ⅴ労務環境改善の取組事例について ··························································· 177
１．収集方法 ···························································· 179
２．都道府県種別 ························································ 179
３．病院規模の分類······················································· 180
４．取組課題の分類······················································· 180
５．取組内容の分類······················································· 180６．取組内容の具体的事例················································· 181
７．特筆すべき傾向······················································· 182
８．取り組み事例の収集··················································· 183

参考資料 ······························································································· 189
１．平成 28 年度 医師票·················································· 191
２．平成 28 年度 看護師票················································ 201
３．平成 28 年度 施設票·················································· 210

用語解説
本報告書で使用している主な用語は以下のとおりである。
いきいき働く医療機関サポート Web
医療機関が医療従事者の勤務環境改善に取り組む際に参考となるさまざまな情報（国・都道府県の関係施策、医療機関の取組事例、全国の医療勤務環境改善支援センターのウェブサイトのリンク等）を掲載しているウェブサイト。略称は「いきサポ」。
いきサポのＵＲＬ： http://iryou-kinmukankyou.mhlw.go.jp/
医業経営アドバイザー
医療勤務環境改善支援センターに置かれるアドバイザーのうち、診療報酬、医療制度・医事法制、組織マネジメント・経営管理等の医業経営に関する専門知識を有し、医療機関の経営面に関する助言等を行うアドバイザー。
医師の職場環境改善ワークショップ研修会
日本医師会が、勤務医の健康支援のため、医療機関の産業医や管理者向けに実施している参加型の研修会。
日本医師会「医師のみなさまへ／勤務医」のページのＵＲＬ：
http://www.med.or.jp/doctor/hospital_based/
医療介護総合確保推進法
平成 26 年 6 月に公布された「地域における医療及び介護の総合的な確保を推進するための関係法律の整備等に関する法律」。この法律により医療法が改正され、医療機関における医療従事者の勤務環境の改善について法制化され、同年 10 月 1 日から施行された。
医療勤務環境改善支援センター
改正医療法に基づき都道府県が設置する医療従事者の勤務環境の改善を促進するための拠点。医療労務管理アドバイザーと医業経営アドバイザーを配置し、医療勤務環境改善マネジメントシステム等に関する周知・啓発、医療機関の実態やニーズの把握、医療勤務環境改善マネジメントシステムの導入等の支援等の業務を行う。
医療勤務環境改善支援センター運営協議会
都道府県が主体となって、医療関係団体、医療機関の支援に係る関係団体、関係行政機関等の地域の関係者を構成メンバーとして設置する医療勤務環境改善支援センターの運営に関する協議の場。
医療勤務環境改善支援センターの業務のポイント
医療勤務環境改善支援センターの役割や活動内容、医療勤務環境改善マネジメントシステムの導入支援における留意点、その他の参考資料をまとめた冊子。平成 27 年 3 月作成。
医療勤務環境改善マネジメントシステム
各医療機関において、幅広い医療スタッフの協力の下、一連の過程を定めて継続的に行う自主的な勤務環境改善の活動に関する仕組み。その内容は、改正医療法に基づき告示された「医療勤務環境改善マネジメントシステムに関する指針」（平成 26 年厚生労働省告示第 376 号）において定められている。
医療分野の「雇用の質」向上のための勤務環境改善マネジメントシステム導入の手引き
各医療機関が医療勤務環境改善マネジメントシステムを導入するに当たっての具体的な進め方や実際の取組事例、導入の際に活用できる各種支援ツール等をまとめた手引書。平成 26 年 3 月に作成され、平成 27 年 3 月に改訂版が作成された。
医療労務管理アドバイザー
医療勤務環境改善支援センターに置かれるアドバイザーのうち、労働時間管理、休暇取得促進、就業規則、賃金制度、安全衛生管理、福利厚生等の労務管理に関する専門知識を有し、医療機関の労務管理面に関する助言等を行うアドバイザー。
看護職のワーク・ライフ・バランス推進ワークショップ
日本看護協会が、看護職のワーク・ライフ・バランスの実現のため、医療機関向けに実施しているワークショップ。
日本看護協会「看護職のワーク・ライフ・バランス推進事業」のページのＵＲＬ：
https://www.nurse.or.jp/wlb/index.php