The changing scene of social work in hospitals: a report of a national study by the Society for Social Work Administrators in Health Care and NASW

Faculty Experiences of Merger and Organizational Change in a Social Work Program

Social work programs are experiencing unprecedented organizational changes due to budget cuts, dwindling resources, global, and technological challenges. However, there is limited information in the literature about the merger experiences of faculty in social work programs. On one hand undergoing merger and reorganization provides the opportunity to reorganize, reprioritize, re-assess, develop strategies, and explore previously untapped opportunities for social work programs. Conversely, merger experiences have caused frustration, intention to quit, confusion, and loss of professional identity for social work faculty. In this article the authors utilize a journaling method and sense-making approach of the merger experiences of some of the faculty members of a social work program in the United States. The authors suggest a framework to understand how the faculty confronted the challenges, overcame the pitfalls, and maximized the opportunities offered during the merger and organizational change process.

The why of practice: utilizing PIE to analyze social work practice in Australian hospitals

This research used a collaborative approach to gain a comprehensive, quantitative understanding of the breadth and depth of the social work role in health care. Data was collected from individual interviews with all employed hospital social workers (N = 120) across five Melbourne, Australia health networks about their most recently completed case. This data was coded using a revised version of the Karls and Wandrei (1994) Person-in-Environment (PIE) tool to retrospectively analyze the reasons for social work involvement over the course of the case. The findings demonstrate that the hospital social work role is multidimensional across a number of domains but centers predominantly on assisting clients and their significant others with issues of altered social roles and functioning; particularly in relation to role responsibility, dependency, and managing associated role-change losses. The findings of this study will assist hospital social workers, managers, and academics to better describe and effectively undertake this complex work. These findings will also assist in the development of professional training and education to up-skill social workers who operate within this complex setting.

A discussion of professional issues of hospital social workers in Saudi Arabia

Health care has evolved rapidly in Saudi Arabia, based on a Western model of service that incorporates multidisciplinary professional teams. Social work practice forms part of patient care. Within the cultural context of Saudi Arabia, social work education is developing and so too is the role of the practitioner in the hospital system. However, little is known about how social workers are integrated into the hospital setting. This study explores how Saudi social workers perceive their role and how they describe their practice. A quantitative methodology was employed using a self-administered questionnaire design. Analyses showed a number of perceived limitations that precluded effective performance in practicing social workers; these included difficulties related to updating job skills, followed by a perceived deficiency in current supervisory support.

Mammography FastTrack: an intervention to facilitate reminders for breast cancer screening across a heterogeneous multi-clinic primary care network

Health care information technology can be a means to improve quality and efficiency in the primary care setting. However, merely applying technology without addressing how it fits into provider workflow and existing systems is unlikely to achieve improvement goals. Improving quality of primary care, such as cancer screening rates, requires addressing barriers at system, provider, and patient levels. The authors report the development, implementation, and preliminary use of a new breast cancer screening outreach program in a large multicenter primary care network. This installation paired population-based surveillance with customized information delivery based on a validated model linking patients to providers and practices. In the first six months, 86% of physicians and all case managers voluntarily participated in the program. Providers intervened in 83% of the mammogram-overdue population by initiating mailed reminders or deferring contact. Overall, 63% of patients were successfully contacted. Systematic population-based efforts are promising tools to improve preventative care.

Diabetes information technology: designing informatics systems to catalyze change in clinical care

Current computerized reminder and decision support systems intended to improve diabetes care have had a limited effect on clinical outcomes. Increasing pressures on health care networks to meet standards of diabetes care have created an environment where information technology systems for diabetes management are often created under duress, appended to existing clinical systems, and poorly integrated into the existing workflow. After defining the components of diabetes disease management, the authors present an eight-step conceptual framework to guide the development of more effective diabetes information technology systems for translating clinical information into clinical action.

Journey of change and back: a case study of a reconstituted social work service

As a result of Total Quality Management and Reengineering principles during the VA's "Journey of Change" in the mid-1990s many hospital social work departments were re-organized under umbrella-care lines. Outcome studies of this movement have focused primarily on patient services. This study focused on the service providers' (including social workers) point of view and their satisfaction with the change in service structure. Data gathering consisted of a master thesis project by one of the co-authors, an administrative in-house survey of staff satisfaction, a qualitative presentation of staff concerns, and the perspective of the administrator who took the decision.

A career in hospital social work: do you have what it takes?

Hospitals present a variety of complex challenges for social work practitioners. Clinical social workers deal with emotionally intense and potentially draining cases in a setting where they are often faced with threats to their identity or existence. They must balance their role as patient advocates with institutional needs and be able to adjust to ever-changing models of health care delivery. Why do some social workers thrive in this environment while others struggle to survive? This article draws upon the author's twenty-year career in hospital social work to provide a "snapshot" of the clinical social work role in teaching hospitals. Included in the discussion are observations about the unique aspects of clinical practice in the hospital and strategies for surviving power struggles, turf battles and hospital "politics."

Coexistent concerns: assessing the social and health needs of dental clinic patients

University dental clinic professionals identified increasing numbers of patients with complex problems and generated 2 research questions: (1) Are there significant health and social concerns within the dental clinic population that indicate the need for high-risk screening and social work services?; and (2) How do age, gender, and income influence health and social concerns in this population? This exploratory descriptive cross-sectional study employed a brief self-report survey in a clinic waiting area. Logistic regression was used to understand the influence of age, gender and income on the existence of specific concerns. Results indicate that caregiving, finances and health are issues for 1/3 of the participants and that 44% endorsed 2 or more concerns. These findings were used to develop a routine high-risk screening tool for dental clinic patients and social work services within the clinic; they suggest that community clinics with dental services are an important place for identifying complex unmet needs.

Hospital social work: are we conducting the right type of research?

Given the current financial state of health care in the United States, intervention- or outcome-based research is essential for the survival of hospital social workers. The purpose of the current study was to systematically review the current literature on hospital social work to assess the effectiveness of hospital social work in implementing intervention- based research and to make recommendations for the future direction of research among hospital social workers. Over the 10-year period (1991-2001), a total of 44 peer-reviewed journal articles were identified for inclusion in the present study: 19 were qualitative articles and 25 were quantitative articles. Of these studies, only 5 studies were intervention based research. Possible strategies for increasing intervention research among hospital social workers were discussed.

Thriving in program management environments: the case of social work in hospitals

The shifts in hospitals from single-site functionally organized university and community hospitals to multilayered, mega institutions have had dramatic effects on social work practice. Through this longitudinal research we examine, using a strengths perspective and qualitative interviews, the strategies social workers in 22 hospitals across Ontario, Canada, utilized to survive and thrive. The findings identify the importance of clearly articulating one's value to the organization, staying current, and being flexible.

The impact of organizational change on social work staffing in a hospital setting: a national, longitudinal study of social work in hospitals

Market forces continue to shape the health care environment, producing radical changes within the hospital. These changes are affecting social work structure, staffing, and processes within the hospital setting, particularly in the area of social work staffing. This paper examines the changes impacting hospital settings over three fiscal years. A primary question is whether or not social work staffing is being negatively impacted by these hospital changes, and what factors predict the downsizing of social work staff.

The effect of organizational reengineering on job satisfaction for staff in hospital social work departments

The professional staff in five hospital social work departments participated in an exploratory study to assess the impact of organizational reengineering on job satisfaction, professional identity and other work related attitudes. A survey was used to explore how job functions had changed; whether or not staff felt adequately prepared to perform the new tasks; and whether the changes were consistent with their professional identities and academic preparation. Follow up focus group interviews were held to enrich the quantitative findings. The results of the study indicate that reengineering has a negative effect on job satisfaction and results in role changes that are experienced as inconsistent with the professional identity and academic preparation of social work staff. In addition to describing the results of the study, this paper provides a brief overview of reengineering, describes models of reengineering for hospital social work departments and suggests strategies for lessening the negative effect on staff.

Emotional dissonance in medical social work practice

This qualitative study examined several ecological aspects of medical social work practice that affect social workers' emotional well-being. Forty-seven medical social workers from seven hospitals participated in small group interviews in which practice experiences were explored. A grounded theory approach was used to analyze the data, with emotional dissonance emerging as a central theme. Community, family, and individual factors contributing to emotional dissonance are presented, and the effect of social support is examined.

Ethical activism: strategies for empowering medical social workers

Little empirical research examines the extent medical social workers try to change attitudes, norms, expectations, and protocols to create a hospital environment that encourages their participation in ethical deliberations. The researchers developed an ethical activism scale that measured the extent medical social workers engaged in such ethical activism, confirming its reliability from data obtained from a sample of 162 medical social workers in 37 hospitals in the Los Angeles basin. They tested seven hypotheses that probed the extent specific ethics-training, organizational, and demographic variables influence the extent social workers engage in ethical activism. Data strongly suggest the need to expand ethics training to include tactics of ethical activism, since many social workers do not engage in ethical activism. Data also suggest the need to target such training to social workers in hospitals that are relatively unreceptive to social workers' participation in ethical deliberations, since social workers are least likely to engage in ethical activism in such settings.

Retooling social work practice for high volume, short stay

The re-engineered acute care environment that emphasizes managed care, reduced costs per case and shorter lengths of stay also demands innovative approaches to the delivery of social work service. As departments disappear and other professions compete for roles in counselling, discharge planning and community liaison, there is a real threat to the viability of the acute hospital as a setting for social work. This paper focuses on the adaptive skills needed for the restructured acute care context, including (1) the creation of key roles for social work on the multidisciplinary team, (2) pre-admission high-risk screening and discharge planning, (3) high volume recording, (4) solution-focused brief interventions, and (5) the development of community partnerships. These conceptual strategies are implemented differently in examples drawn from three distinct high-volume patient groups: reconstructive orthopaedics, high-risk fetal assessment and thoracic oncology.

An evolving paradigm of supervision within a changing health care environment

As hospitals attempt to decrease their costs to survive in today's health care market, they are implementing resizing strategies that promise greater efficiency. A by-product has been the elimination of many management and supervisory positions. A self-administered questionnaire was sent to a stratified random sample of 750 hospitals (yielding a 46% return rate) to study the types of supervisory models being utilized and the factors associated with their differential use. While concern is expressed about the erosion of clinical supervision, the data suggests that the majority of social workers are receiving supervision from a social worker.

Managed care and its implications for social work curricula reform: clinical practice and field instruction

Managed care continues to be a major focus and debate within the health care field. Regardless of whether one is for or against managed care, it has become the predominant system for distributing finite health care resources. Many academicians and practitioners point to the uncertainty about the future of health care, and the role of social workers to practice within these new environments, schools of social work will need to integrate content related to managed care. Students should be exposed to a more balanced analysis of what is advantageous and problematic with managed care. This paper offers recommendations regarding ways in which the practice and field curriculum can be strengthened to more effectively prepare social workers for practice within a managed care environment.

Health care social work treatment of patient and family emotion: a synthesis and comparison across patient populations and practice settings

Health care practitioners and researchers alike are beginning to acknowledge the importance of emotion in health. Nevertheless, health care social workers continue to assume most of the responsibility for actually dealing with the emotions of patients and families. Literature exploring social work interventions with emotion are restricted to a single patient population and practice setting. This study conducted a content analysis of pertinent literature, systematically codifying strategies across patient populations and practice settings according to a pragmatic conceptual foundation of the professional emotion treatment process. Analysis yielded a comprehensive conceptually clustered matrix of 45 strategies, establishing an objective and systematic basis for identifying and understanding this professional emotion treatment process for social work educators, practitioners, and researchers alike.

Understanding organizational reengineering in health care: strategies for social work's survival

Confronted with decreasing reimbursement and managed care, hospitals across the country have been "reengineering" in an effort to streamline processes and enhance revenue. Because of the financial implications of discharge planning, hospital social workers and their departments are typically examined and realigned in some way during a reengineering process. To survive in this environment, social workers must understand the principles of reengineering; its hoped for and actual impact; be able to identify opportunities to contribute; and have the capacity to cope with an evolving professional role. This paper presents a general overview of reengineering and its adaptation to the health care environment. Specific challenges for medical social workers are described along with strategies for surviving in a reengineered health care system.

The impact of hospital restructuring on social work services: a case study of a large, university-affiliated hospital in Canada

The study investigates the impact of organizational restructuring on social work practice at a large, university-affiliated hospital. The article first reviews relevant literature on the patient-focused care model and presents an overview of the study setting. Several hypotheses are then presented that informed the research process. Workload measurement, interview, and questionnaire data are analyzed to test these hypotheses. The results indicate that the shift to program management has had some intended effects, particularly regarding increases in direct services supporting patients. Social workers reported somewhat lower levels of job satisfaction than expected, which partly reflects the dismantling of the professional infrastructure. Finally, the authors discuss implications for the future of the social work profession under the program management model.

Self-care and psychosocial adjustment of patients following cardiac surgery

This research examined the role of self-care behavior of 151 patients (aged 40 to 80) on general psychological distress at one year after coronary artery bypass graft (CABG) surgery. A tested hypothesis was that self-care practices would be associated with a lower level of distress one year after surgery. The results supported the beneficial effect of self-care on psychological adjustment, after controlling for the effects of the number of other chronic illnesses and post-CABG depression. The findings suggest that social work in health care and in-home care may help promote the psychosocial recovery process following surgery.