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.     

Studies of hospital social stays in the frail elderly and their relationship to the intensity of social work intervention.

The elderly frequently suffer long lengths of hospital stay (LOS). These long stays are often associated with long social care stays which occur when patients no longer require acute care and are awaiting post-discharge services. In this study, actual acute care LOS and social care LOS were studied specifically in hospitalized frail elderly. Our data demonstrate that frail elderly receiving only acute care do not suffer markedly prolonged total LOS (TLOS). However, in hospitalized frail elderly patients who experience acute care and social care stays, social care LOS accounts for over half of all hospital days. When patients were grouped and studied according to the type of post-discharge services being sought by the health care team, significant differences in acute LOS and social care LOS were noted. Subgroups of patients were also identified among the various groups which differed significantly in their LOS parameters. Patients who required more than one discharge plan during the course of hospitalization experienced the longest hospital stays of all groups, and spent almost 70% of these days receiving non-acute social care. In a study of the relationship between the intensity of social work intervention and social care LOS in the frail elderly, a statistically significant relationship was noted between the timing and frequency of social work intervention and the actual length of social care stays. Early and frequent social work interventions were associated with significantly shorter social care LOS. We conclude that the study of TLOS should include acute LOS and social care LOS to obtain a reliable measure of the course and cost of hospital care for the frail elderly. The study of social care subgroups may facilitate future investigations to define the social care problems which contribute most to TLOS, and the patient populations which should be most heavily targeted for early and intensive social work intervention.     

Hospital Social Work in Australia: Emerging Trends or More of the Same?

Social work in health care has been established for more than 100 years and is one of the largest areas of practice for social workers. Over time, demographic changes and growth in the aging population, increased longevity rates, an explosion in rates of chronic illness together with rapidly increasing cost of health care have created serious challenges for acute hospitals and health social workers. This article reviews the Australian health care system and policies with particular emphasis on the public hospital system. It then examines current hospital social work roles, including the continued role in discharge planning and expanding responsibility for emerging client problems, such as patient complexity, legal, and carer issues. The article concludes with a discussion of evolving issues and challenges facing health social work to ensure that social work remain relevant within this practice context.     

Peer counseling in health care: a collaboration of social work and voluntarism

Professional-volunteer collaboration is a growing trend in social work practice in health care. The social work profession can benefit from partnerships with volunteers to extend, enhance, and maximize the scope and quality of patient care. This article examines a program of social work collaboration with volunteers, trained as peer counselors, in a hospital setting. A model is described which provides long-term social support to chronically and terminally ill patients and their families during hospitalization and after discharge. Implications for replication in other settings are discussed.     

The posthospital needs and care of patients: implications for discharge planning

Sixty-nine patients hospitalized for a serious illness and discharged to their own or relative's homes were followed up to learn about patient's posthospital needs; sources of help they received and how well they met these needs; and the extent to which hospital social work targets these needs in the discharge planning process. The patients, who were mostly elderly, had substantial needs for care. The family was the major care provider. Although service provision was limited, the social worker had a pivotal role in linking the patient to community services. This exploratory study points to gaps in the hospital screening and discharge planning process.     

Social work at the heart of the medical team

This paper proposes one model of hospital social work delivery services that places social work in a facilitative role within the medical team, and describes a pilot project designed to evaluate these services. Social work's role in this teaching hospital setting was tailored to provide patients and medical staff access to social work services upon admission, rather than at the time of discharge. This change places social work at the pivotal juncture to improve medical care and addresses the social, cultural and environmental concerns as they surface during patient stay. Unique to this demonstration model is the added advantage of placing the social worker at the hub of the physician-led medical team. Medical students, residents, and attending physicians all learn, observe, and experience the advantages social workers bring to the process. Educating medical students on teams with social workers bodes well for the profession. The authors summarize the program design, results and implications for social work practice in a teaching hospital 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.     

The role of social work in discharge planning

Changing social policy and scarce resources affect the delivery of health and social services. Higher costs mean shorter stays in hospitals. People are being discharged ‘quicker and sicker’. This paper considers discharge planning policies and practices in America, in relation to a recent study on hospital social work in Madison, Wisconsin. It supports the view that discharge planning is a highly skilled activity, integral to social work and best done by qualified, trained workers. Such findings have relevance for Britain, where demands for cost effectiveness in the managemennt of care has raised the profile of discharge planning. In processing these changes, social workers are having to redefine their role in health care.     

Working with problems of assault to self-image and life-style.

This paper defines two groups of patients in general hospitals who require special attention to the social and emotional components of their illnesses: those patients who experience assaults to self-image and those patients who must make basic changes in their life-style. These two groups comprise a large segment of the adult patient population found in medical and surgical services of the general hospital. The emotional reactions of patients and family members to the process of illness and its treatment by surgery and prescribed regimen are examined. Although therapeutic intervention is the shared responsibility of all health care practitioners, the social worker is particularly equipped to deal with these attitudes and reactions. Methods of social work intervention useful to both groups of patients during hospitalization are discussed. The author urges greater utilization of therapeutic milieu concepts in medical and surgical services and identifies the role of the social worker in fostering this.     

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."     

The Challenges of Health Care Reform for Hospital Social Work in the United States

This article examines the potential impact of the Patient Protection and Affordable Care Act (ACA) of 2010 on the practice of hospital social work in the United States and its implications for social work education and training. It briefly traces the history of hospital social work, outlines some contemporary issues in the health care field, particularly those that create persistent health disparities, summarizes the major provisions of the Act that have implications for social work practice, and discusses how social workers in hospital settings might respond effectively to the changes produced by the legislation.     

Hospice: social work's response to a new form of social caring

Social work's response to hospice, as a new form of social caring, is portrayed by a social work process paradigm, conceptualized from the practice and research experiences of the authors. Guidelines are suggested for working with patients, families, care providers, and other concerned persons through the four phases of hospice care. As changes occur in the patient and the hospice settings, the participants join together to bring about a satisfactory fit between the person needing care and the environment. By anticipating the needs and reactions of the terminally ill patient to each transition in the care process, the social worker assists in orchestrating proactive interventions through the continuum of hospice care. Future research studies are recommended for determining what difference social work actions make toward ensuring a "safe passage."     

Making body work sequences visible: an ethnographic study of acute orthopaedic hospital wards

Within health and social care, academic attention is increasingly paid to understanding the nature and centrality of body work. Relatively little is known about how and where body work specifically fits into the wider work relations that produce it in healthcare settings. We draw on ethnographic observations of staff practice in three National Health Service acute hospital wards in the United Kingdom to make visible the micro-processes of patient care sequences including both body work and the work contextualising and supporting it. Our data, produced in 2015, show body work interactions in acute care to be critically embedded within a context of initiating, preparing, moving and restoring and proceeding. Shades of privacy and objectification of the body are present throughout these sequences. While accomplishing tasks away from the physical body, staff members must also maintain physical and cognitive work focussed on producing body work. Thus, patient care is necessarily complex, requiring much staff time and energy to deliver it. We argue that by making visible the micro-processes that hospital patient care depends on, including both body work and the work sequences supporting it, the complex physical and cognitive workload required to deliver care can be better recognised. (A virtual version of this abstract is available at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA )     

Changing needs of patients and families in long-term care facilities: implications for social work practice

The purpose of this paper is to describe the changing needs of patients in long-term care facilities and their families. The argument will be made that the characteristics of residents have changed significantly with implementation of prospective payment for hospital care of Medicare patients. In addition to the traditional nursing home resident, staff will be expected to respond to the needs of patients who are both more acutely ill and responsive to aggressive rehabilitative efforts as well as to patients who are more critically ill and near death. The implications of these changes for the social work staff of long-term care facilities will be discussed.     

Exploring patient, co-worker, and management burnout in health care: an empirical study

Previous work in services marketing reveals that much is to be gained by considering distinct types of employee burnout. The current work extends these findings into the health care environment by examining the antecedents and effects of patient, co-worker, and management burnout. It is suggested that the distinction among the various types of burnout are especially important in the increasingly competitive and stressful health care setting. Several hypotheses are derived from burnout, social support, and exchange theory, and an empirical study from a hospital setting is discussed. The results indicate that of the three burnout types, management burnout has the strongest influence on employee service delivery, job satisfaction, organizational commitment, and intentions to leave the health care organization. Implications for managers and suggestions for future research are discussed.     

Changing Needs of Patients and Families in Long Term Care Facilities

The purpose of this paper is to describe the changing needs of patients in long-term care facilities and their families. The argument will be made that the characteristics of residents have changed significantly with the implementation of prospective payment for hospital care of Medicare patients. In addition to the traditional nursing home resident, staff will be expected to respond to the needs of patients who are both more acutely ill and responsive to aggressive rehabilitative efforts as well as to patients who are more critically ill and near death. The implications of these changes for the social work staff of long-term care facilities will be discussed.     

An expanded social work role in a university hospital-based group practice: service provider, physician educator and organizational consultant

This paper reports the development of social work role and functions in a primary medical group practice which was established to replace the general medical clinics of a large urban voluntary teaching hospital in an academic medical center. It traces the shaping and implementation of a role which is functionally integral to the care, teaching and research goals of the practice; is operationalized into its service delivery system; and utilizes a full range of sophisticated social work skills. Along with physicians and nurse practitioners, the social worker is a principal provider of patient care, as well as physician educator and organizational consultant who contributes to coordinated, comprehensive and resource conservative care. Implications for other settings are noted.