Journey of Change and Back: A Case Study of a Reconstituted Social Work Service

ABSTRACT

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.     

Service users' perspectives of social treatment in social service departments in Israel: Differences between standard and poverty-aware treatments

This article uses mixed methods to examine service user satisfaction with social work treatment in social services departments (SSDs) in Israel—its level, the factors that influence it and its experiential dimensions. A total of 235 service users (SUs) from 11 SSDs were interviewed for this study. They were divided into three groups: (a) SUs receiving standard treatment; (b) SUs participating in poverty-aware programs and (c) SUs receiving a poverty-aware standard treatment. The quantitative findings indicated a significant higher level of satisfaction among the SUs who had been included on poverty-aware programs or received a poverty-aware standard care compared to SUs who had received standard treatment. Additionally, high reported levels of satisfaction were influenced by the frequency of meetings between the service user and the social worker, while the history of care in the SSD had no apparent impact on satisfaction levels. The qualitative analysis indicated that high levels of satisfaction were linked to the service user perceiving the social worker as active, supportive and respectful, and as responsive to the user's emotional and material needs. These findings are discussed in the context of the Poverty-Aware Paradigm and relationship-based social work.     

公立医院医务人员工作满意度影响因素与治理机制

针对当前医务人员工作满意度偏低、医患矛盾突出的社会现状,现有医务人员工作满意度研究缺失考察患者对医务人员的理性尊重、认可、信任,现行社会医疗体制、公共舆论环境等内容及条目设计,也缺乏将医务人员满意度测评与多元利益相关主体协同治理体系结合起来等理论与现实问题,本文在大量文献研究基础上,界定了治理视角下公立医院医务人员工作满意度概念;提出了"工作本身、组织管理、工作条件、工作回报、人际关系"五要素测评的内在维度;厘清了政府—医患—社会层面参与公立医院治理的主要利益相关主体以及各自职能、权利与社会医疗责任,探寻了影响医务人员工作满意度的外在治理因素;构建了医务人员工作满意度概念及多元协同治理结构逻辑模型,分析了各主体之间及其对医务人员工作满意度的作用机制;针对性提出了治理机制框架及思考,供学界争鸣与讨论。     

患者满意度测评问题与治理路径思考

患者满意度是评价医疗系统综合改革及治理成效和衡量医疗服务质量的重要指标。针对当前患者对医疗服务普遍不满意评价现状及其背后成因的深层次分析,本文在借鉴国内外研究成果和剖析患者满意度形成机理及其背后隐含多元主体监管治理特征的基础上,厘清患者满意度的概念及内涵;从医疗服务结构—过程—结果要素层面梳理与归纳出患者满意度内在维度;从政府—社会—医患层面挖掘社会医疗体制与政策、医院组织管理、社会医疗舆情、公众参与、患者认知等因素对患者满意度的潜在作用及影响;根据患者满意度内在维度—影响因素—职责分析—治理主体的双向作用逻辑思路,结合利益相关主体影响—参与—协同治理前沿理论,构建患者满意度测评与治理路径框架,并提出模型实证的研究展望。     

Hypnosis: Exploring the Benefits for the Role of the Hospital Social Worker

This article will provide an examination of Erickson's model of hypnosis and the impact hypnosis has made on the psychosocial well being of the medically ill patient. The intrinsic three stage process of a hypnotic intervention, as well as its value, practice assumptions, and its relevance to alleviating pain, distress, and anxiety with oncology patients will be discussed. We have found this approach to be particularly effective with adult oncology patients at alleviating the side effects of the arduous treatment that is often endured. Case vignettes will demonstrate the benefits of utilizing this intervention with adult patients in the hospital setting as well as provide specific insight into the creative methods in which we have woven hypnosis into our clinical work. Finally, we will explore the use and rationale of hypnosis in medical settings and the impact of using this intervention on the role of the hospital social worker.     

Factors associated with the recruitment and retention of social workers in Wales: employer and employee perspectives

Despite acute staffing shortages in social work, workforce planning within the UK social care sector is compromised by poor workforce intelligence. This study aimed to inform the evidence base providing new data on recruitment and retention in Wales, examining what personal and organizational characteristics are associated with intentions to leave, and what initiatives or incentives might mediate that effect. A multi‐method design facilitated comparisons between two data sources – a census of all 22 Welsh local authority employers about recruitment and retention practices and a survey of all social workers and senior practitioners employed in social services (n = 998; response rate 45.9%) about demography, workforce characteristics, working patterns, morale and plans and reasons for leaving one's job. Vacancy (mean 14.4%) and turnover (mean 15%) rates were statistically significantly higher in children's services than in adult services; vacancy rates were also higher in authorities that offered higher starting salaries. The provision of certain types of traineeship might also be associated with higher vacancy rates but these results should be treated with some caution. There was little evidence that recruitment and retention initiatives were associated with lower vacancy or turnover rates, despite employers’ perceptions about their effectiveness. Social workers derived a lot of satisfaction from their work, but more than a quarter wanted to leave their job within 6 months, and almost as many were actively seeking alternative employment. Intention to leave was explained by job and employer satisfaction, and negative feelings about pay. Senior practitioners and staff members with longer lengths of service were less likely to want to leave, even if they were dissatisfied with their job or employer. Job and employer dissatisfaction was associated with retention initiatives related to facilities, good caseload management and home‐working, suggesting that dissatisfied staff might remain in employment for longer if these initiatives were in place.     

Nursing Home Social Services and Post-Acute Care: Does More Qualified Staff Improve Behavioral Symptoms and Reduce Antipsychotic Drug Use?

ObjectivesAn increasing number of post-acute care patients are admitted to skilled nursing facilities (SNFs) with behavioral symptoms such as wandering and rejecting care, which can interfere with care and place a patient at risk of social isolation or injury. This study examines whether increasing the qualifications of social service staff through using a greater proportion of qualified social workers (QSWs) instead of paraprofessionals improves patients' behavioral symptoms and reduces the use of antipsychotic medications.DesignSecondary data analysis of national data drawn from the Minimum Data Set, Medicare Beneficiary Summary File, and Certification and Survey Provider Enhanced Reporting surveys.Setting and participantsNewly admitted, Medicare fee-for-service patients aged ≥65 years who received post-acute care after a hospitalization from 2011-2015 (1,201,096 patient admissions in 5383 unique SNFs).MethodsA regression discontinuity approach is used to identify how changes in the qualifications of social service staffing affect changes in patient outcomes, through exploiting a federal regulation that requires 1 full-time QSW for SNFs with at least 121 beds.ResultsSNFs with a greater proportion of QSWs improved behavioral symptoms that affected residents or others and reduced the use of antipsychotic medications. Marginally significant improvements were also found in patients' rejecting care, wandering, and having any behavioral symptoms. There was no statistically significant change in delusions.Conclusions and implicationsAlthough the focus of most research and effects on improving patient outcomes in SNFs has focused on nursing staff, our results underscore the importance of staffing in social services. Specifically, social service staff with higher qualifications are integral to improving care through reducing patients' behavioral symptoms and avoiding the use of antipsychotic medications. It may be time for SNFs to revisit efforts to improve staffing in social services.     

Enhancing social networks: a qualitative study of health and social care practice in UK mental health services

People with severe mental health problems such as psychosis have access to less social capital, defined as resources within social networks, than members of the general population. However, a lack of theoretically and empirically informed models hampers the development of social interventions which seek to enhance an individual's social networks. This paper reports the findings of a qualitative study, which used ethnographic field methods in six sites in England to investigate how workers helped people recovering from psychosis to enhance their social networks. This study drew upon practice wisdom and lived experience to provide data for intervention modelling. Data were collected from 73 practitioners and 51 people who used their services in two phases. Data were selected and coded using a grounded theory approach to depict the key themes that appeared to underpin the generation of social capital within networks. Findings are presented in four over‐arching themes – worker skills, attitudes and roles; connecting people processes; role of the agency; and barriers to network development. The sub‐themes which were identified included worker attitudes; person‐centred approach; equality of worker–individual relationship; goal setting; creating new networks and relationships; engagement through activities; practical support; existing relationships; the individual taking responsibility; identifying and overcoming barriers; and moving on. Themes were consistent with recovery models used within mental health services and will provide the basis for the development of an intervention model to enhance individuals’ access to social capital within networks.     

ATTITUDES TOWARD SOCIAL WORK IN FAMILY MEDICINE

An initial survey of attitudes among Family Medical Center staff rated social work as highly consistent with the values of family medicine, capable of competently addressing difficult problems, and contributing valuably to a team approach to continuous and comprehensive family medical care. After integration of a social worker into the practice, a repeat survey documented significant attitude changes, rating social work as more competent, passive, and difficult, and lowering the estimate of patients potentially helped by a social worker from 38 percent to 31 percent. Such attitudes may influence the evolution of the social worker's role in the family medicine patient care team.     

CONSULTATION

Concern about the steady increase in transfer of patients to nursing homes as well as the need for social work coverage of local nursing and shelter care homes led to the development of a social work consultation program. This program is provided as a departmental service of a community hospital's Social Services Department. This discussion deals with isues and practice in consultation followed by some notes on the structure for establishing such a consultation program.     

Medical Clowning: Even Adults Deserve a Dream

The article examines the significance of the integration of medical clowns as an intervention strategy with adult outpatients suffering from chronic illnesses. The study is based on content analysis of the documentation of the work of two medical clowns over two years. The dominant theme involves the definition of the clown's role and includes perspectives on his integration into the hospital's multidisciplinary medical staff and his impact on the staff and on patients and their families. The finding is discussed in light of the dual role of the medical social worker as coordinator and as a case manager, and the challenge of integrating medical clowns in treatment of adult patients. There is room for further exploration of the contribution of medical clowns to assisting and improving the quality of life for patients and hospital staff.     

医务人员心理健康与工作满意度研究

目的讨综合性医院医务人员心理健康状况与工作满意度的关系。方法采用症状自评量表（SCL-90）和《明尼苏达满意问卷》,对丽水市6家综合性医院1100名医务人员进行系统抽样问卷调查,采取集体施测方式,施测人员讲解指导语,当场收回填答问卷,收回1050份,有效问卷1006份。研究数据使用SPSS13.0软件进行统计分析。结果被调查的医务人员中39.2%有心理问题,其中躯体化368人（36.8%）,强迫235人（23.5%）,人际关系敏感234人（23.4%）,抑郁285人（28.5%）,焦虑306人（30.6%）,敌对255人（25.5%）,恐怖118人（11.8%）,偏执127人（12.7%）,精神病性55人（5.5%）。SCL-90各因子得分除恐怖因子、精神病性因子外,均显著高于国内正常人的水平。女性在躯体化、人际关系敏感、抑郁、焦虑、强迫因子得分高于男性,不同岗位的医务人员工作满意度存在显著差异。临床医师对医院的物理环境、经济收入、晋升、管理者、工作稳定性、工作风险及同事之间的关系方面的满意度均值要高于其他科室的人员。在经济收入、晋升、社会承认满意度方面护士总体满意度最低。结论医务人员心理健康状况与工作满意度呈显著相关,临床医师和护士心理压力普遍较大,存在明显的心理健康问题。应采取不同措施及激励手段,以提高医务人员的心理健康和工作满意度。     

基于患者满意度提高多学科门诊就医获得感

目的调查多学科门诊患者就诊的满意度情况,为提高患者就医获得感提供依据。方法对2019年4—5月就诊上海市某三甲医院多学科门诊的患者进行问卷调查。结果患者对就诊多学科门诊满意度总体较高。结论提高多学科门诊患者的就医获得感主要方式为,第一,提高患者的就诊效率,缩短等待时间;第二,增进医患沟通,促进患者参与决策,护理人员参与多学科诊疗,应用临床护理路径开展健康教育。     

Affective and Instrumental Communication in Primary Care Interactions: Predicting the Satisfaction of Nursing Staff and Patients

Verbal and nonverbal communication between nursing staff and patients has received scant research attention. This study examined patients' and nursing staff members' global affective and instrumental communication, mutual influence, and relationship to postvisit satisfaction. This study employed ratings of videotaped primary care visits of 81 nursing staff members with 235 patients, and assessed communication in 2 channels: nonverbal visual and speech including vocal tone. Communication channel differences and prediction of patient satisfaction were examined. The visual and vocal communication of nursing staff members and patients robustly predicted each other's satisfaction and reflected their own satisfaction with the dyadic visit. Affect was communicated more clearly through the speech with vocal tone channel, whereas instrumental communication was stronger in visual nonverbal behavior. Patients' and nursing staff members' behaviors of pleasantness and involvement frequently co-occurred.     

Drivers of change: Learning from the lived experiences of nursing home social workers

In response to the growing attention to integrated health care and the cultural change movement in nursing homes, this study examines the lived experiences of nursing home social workers to better understand their role perceptions, job satisfaction, and relationship with other staff members. Hermeneutic phenomenology was used in order to understand the lived experience of being a nursing home social worker. Ten nursing home social workers were recruited from a southern state and individual interviews were conducted. From the interviews, four themes emerged: challenge, coping, mattering, and rewarding. Guided by identity negotiation theory and social identity theory, these findings are discussed. Also, implications for social work education, nursing home administration, and policy is discussed.     

Satisfied as professionals,but also exhausted and worried!!: The role of job demands,resources and emotional experiences of Spanish nursing home workers during the COVID-19 pandemic

Nursing home workers have been exposed to great physical and mental burdens during the COVID-19 pandemic. Although this has generated high levels of exhaustion, it may also have contributed to feelings of professional satisfaction. The objective of this study was to explore the levels of satisfaction among nursing home workers during the COVID-19 pandemic, as well as the role of job demands, resources and emotional experiences in explaining their levels of satisfaction. This cross-sectional study was conducted in Spain between March and May 2020. Three hundred and thirty-five nursing home workers participated. A quantitative analysis was conducted, as was a content analysis of the responses to an open-ended question about the respondents' perceptions of job demands and resources during the crisis. The results showed that workers had very high levels of satisfaction. Social pressure from work, contact with death and suffering, and emotional exhaustion were negatively associated with satisfaction. Moreover, under conditions of extensive contact with suffering people and great fear of contagion, social support at work was shown to promote professional satisfaction. In conclusion, nursing home workers in Spain experienced high rates of satisfaction during the COVID-19 crisis despite the high job demands, lack of job resources, fear of contagion and exhaustion. The main practical implication of this study is the importance of ensuring optimal working conditions in the nursing home sector in order to guarantee professional satisfaction, prevent burnout, reduce turnover and promote post-crisis resilience.     

论社会工作在医院急诊服务中的运用

现代急诊医疗服务所面临的问题越来越复杂，所需要提供的服务也不仅限于疾病治疗，更需要心理辅导、社会支持以及纠纷处理等方面的支持。因此，发展针对急诊室的社会工作服务契合了急诊病人、急诊团队以及急诊管理的需要。社会工作针对不同种类的急诊病人提供了不同的服务内容与服务策略，在减少急诊纠纷、构建和谐医院中发挥了重要的功能。     

护理工作差错与工作满意度、职业倦怠的关系——基于部分三甲医院的实证研究

目的:统计三甲医院护理人员的护理工作差错发生情况,分析其与护理工作满意度、职业倦怠的关系。方法:2017年2月—8月采用整群随机抽样方法,选择4所三甲医院中符合标准的护理人员320名。采用一般资料调查问卷、护理工作差错调查问卷、工作满意度调查问卷、职业倦怠调查问卷对护理人员的工作情况进行调查分析,探讨护理工作差错与工作满意度及职业倦怠的相关性。结果:65.61%的护理人员承认在过去1年工作中发生护理差错。护理工作差错发生与工作满意度及职业倦怠呈相关性,护理人员个人的成就感、去人格化以及超负荷工作、工作不被认可、管理缺失、责任不明、福利待遇低等原因容易导致护理工作差错的发生。结论:基于工作满意度与职业倦怠对护理人员工作差错的影响,应通过制度优化,提高护理人员满意度,缓解职业倦怠,从而降低护理差错发生率。     

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.     

Patients' perceptions of primary health care in an inner-city practice

BACKGROUND: The 1978 Alma Ata declaration by the World Health Organization emphasized the importance of primary health care, which includes social services and participation, as well as primary medical care. In the UK, primary medical care is based on general practice, increasingly working from purpose-built premises with primary care teams. However, this does not usually include social services or involve patient participation. Both general practice and social services are undergoing reorganization as separate entities, with little emphasis on intersectoral collaboration. OBJECTIVES: We aimed to assess patients' perceptions of primary health care in an inner-city practice in terms of primary medical care, social services and participation. METHODS: Perceptions of medical and social services, together with levels of satisfaction and patient participation, were assessed by self-completed questionnaires for 248 patients attending an inner-city health centre and by 74 home interviews for those who had requested house calls. RESULTS: Patients were more satisfied with primary medical care than with other aspects of primary health care, such as housing. Older patients at home were less satisfied with primary medical care and more satisfied with social services than younger patients attending the health centre. Physiotherapy, chiropody and pharmacy were the services most requested at the health centre. A domiciliary pharmacy, help with hearing aids and a social worker at the health centre were the main requests by older patients at home. CONCLUSIONS: Medical and social services at primary care level should have coterminous boundaries based on general practice populations, ideally with access through multipurpose health centres.