Predicting patterns of social work staffing in hospital settings

One long-standing problem of social work departments in acute care hospitals has been their diverse patterns of staffing. The lack of a standard or guide has tended to diminish the utilization of social work services in hospital settings. Over a period of six years, the Society for Hospital Social Work Directors of the American Hospital Association developed and revised a guide for inpatient staffing. The guide is designed to assist hospital and social work administrators establish an inpatient line staffing plan which is based on the number of hospital beds, the number of patients to be served and the number of functions carried. The logic of the inquiry and the findings can serve as a base for future research in inpatient, ambulatory care and other settings which serve special populations.     

A survey of patient and family satisfaction with social work services

Client satisfaction can be important indicator of the quality of social work services. This article reports the results of a survey conducted by a social work department of a large urban teaching hospital to elicit patient and family reaction to its services. A random, proportionate sample of in- and out-patient cases in medical and psychiatric programs was used. In general, staff was seen as helpful, although with interesting variations depending on the social work function performed. The findings have implications for education, supervision, quality assurance, levels of staffing and staff's perception of their usefulness.     

Proprietary hospital social work

The rapid growth of the proprietary sector in the provision of social services creates a challenge for the social work profession. Little is known about social work services in for-profit organizations or about how they compare with similar services in nonprofit setting. The authors report on a comparative study of social work services in proprietary and nonprofit hospitals that used the results of the Membership Survey, 1985 of the Society for Hospital Social Work Directors and a sample of 50 proprietary hospital social work departments. Services and staffing, characteristics of directors, and responses to diagnostic related groups are contrasted, and the significance for the profession discussed.     

A frame for defining social work in a hospital setting.

A frame for articulating the unique role of social work in a hospital setting is presented which links the patient's experience of the disruptive impact of illness and hospitalization with the historical roots of the profession of social work. The presentation emphasizes the social worker's role in orienting patients and families to the importance of their part in the process of healing and helps partialize this task into specific areas of work with the social worker. A consideration of the process of discharge planning within this framework is discussed.     

The future of health social work

The practice of social work in health care is at a critical juncture, and laces an uncertain future. The authors provide an overview of the challenges facing social work practice within the health care setting, as well as recommendations for enhancing social work practice and education. Challenges discussed include economic factors, demographic changes, and technological advances influencing the practice of social work in health care. The need for a proactive stance among social work professionals and educators is promoted. The proposed changes are intended to stimulate discussion and an exchange of ideas needed to maintain Social Work's relevance and integrity in the evolving health care delivery system.     

Applying a theory of expertise in health social work administration and practice in Australia

Social workers in health care have been urged to identify the nature of their expertise and to articulate profession specific roles (Peckuconis et al., 2003). This paper reports on the use of a theory of professional expertise (Fook, Ryan, & Hawkins, 2000) in management and clinical practice within two Australian hospital social work settings. This theory, directly applicable to social work, was applied within these hospitals to differentiate levels in social work industrial awards, in staff selection, in supervision and continuing professional development. Specific and broader implications for application of this theory are discussed.     

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.     

A longitudinal look at social work leadership in hospitals: the impact of a changing health care system

This article examines the responses of social work administrators to the changes occurring throughout their hospitals over three time periods in the 1990s; the major accomplishments of social work services in their facilities; and the failures, frustrations, and obstacles in the delivery of social work services. It compares the reports of social work director cohorts on the changes they experienced over an eight-year period with what they had expected in their settings. It also analyzes their perceptions over time of obstacles and opportunities for hospital social work administrators in response to these changes. The authors present the ways in which social work administrators understand and address the complexities they face.     

Evaluation research on social work interventions: a study on the impact of social worker staffing

This study examined the impact of social worker staffing on depression and health-related quality of life (QOL) of end-stage renal disease patients on hemodialysis. Social workers in most dialysis units work a 5-day week. Patients are usually dialyzed three times per week. Patients on a Monday-Wednesday-Friday schedule have access to their social worker 3 days a week, while the Tuesday-Thursday-Saturday schedule patients have only 2 days; that is, contact with the social worker is reduced by one third for those patients. Findings demonstrated that those patients who had access to the social workers one third less time had statistically significant poorer QOL on 4 of the 5 domains measured, and had clinically indicated levels of depression. Findings reinforce the importance of the social worker in the life of the dialysis patient.     

The challenge of change: enhancing social work services at a time of cutback

Little systematic attention has been paid to the process of cuts in resources in hospital social work departments and to the implications of such events over time. This article describes the activities of a social work department in response to hospitalwide downsizing. It outlines conceptual premises for action, recommends a step-by-step process for analysis and implementation, reviews implications of cutback, and describes outcomes for department and personnel. In this particular case, social work administration was able to make changes in department organization to improve quality, efficiency, and professional control of practice while modeling cutback and reorganization to the larger hospital community.     

Staying in hospital social work

Hospitals have traditionally been large employers of social workers. As workplaces they are often identified as being challenging and ambiguous environments for social work practice. In this study the experience of hospital work is explored. Social workers' 'tolerance' of the hospital environment is identified as a way of explaining 'staying.' Staying has both positive and negative features which arise from the interaction between workers' tolerance of the environment and their qualities of 'self-actualisation.' The identification of this relationship informs and challenges existing theories of retention and turnover of workers.     

Hospital restructuring and the work of registered nurses

American hospitals have undergone three waves of organizational restructuring in the past two decades. These changes have had direct effects on a key set of employees--nurses. A review of the relevant literature to identify the ways in which hospital restructuring affects the work of registered nurses focuses on three important structural characteristics of nursing work: nurses' work roles, workload, and control of work. The review concludes that the impact of restructuring on each of the characteristics affects nurses' satisfaction with their work and may also affect the quality of patient care. While much of the policy debate around restructuring focuses on the extent to which reductions in nurse staffing levels affects quality of care, it is important to examine not only changes in nurse staffing levels, but changes in the work performed by registered nurses, as well.     

An evidence-based case for the value of social workers in efficient hospital discharge

A study was undertaken to make an evidence-based case for the value of social workers in efficient discharge of patients from acute care hospitals and to assist hospital managers in making informed staffing decisions. Hospital administrative databases from March 1 to November 30, 2008, were used for the analysis of inpatient discharges on days when social workers were on vacation compared with days fully staffed with social workers. Two performance measures, daily discharge rate and average length of stay, were evaluated. During the study period, 1825 patients were discharged from the General Internal Medicine inpatient service. Team discharge rates were significantly lower on social work vacation Fridays versus regular Fridays. In contrast, the average length of stay for patients discharged on social work vacation Fridays was significantly shorter than that for patients discharged on regular Fridays. It was concluded that daily discharge rate better quantified the role of social work in patient discharge. More generally, these results provide preliminary support for the need for adequate social work staffing in timely and efficient patient discharge.     

Developing and sustaining a practice-based research infrastructure in a hospital social work department: Why is it important?

The future of hospital social work departments depends on their ability to demonstrate their effectiveness, efficiency, and consequently, their value to their host organizations. In order to demonstrate and enhance social work’s contribution, research activities of various kinds must be encouraged. These include research consumption as well as production and utilization by clinicians, supervisors, managers, and administrators. The authors sought to develop a sustainable research environment in a large social work department of an academic health system. Continued work is needed to understand practice-research “best practices” within hospitals and how to ensure their sustainability within an ever changing health care environment.     

Changing needs of patients and families in the acute care hospital: implications for social work practice

Much attention has been given in recent years to changing reimbursement for hospital care, shortened lengths of stay, and changes in the delivery of health care. The corollaries to these changes are more restrictive admission criteria, increased severity of patient illness, and changes in patient care. The purpose of the present paper is to describe the inpatients who remain in the acute care hospital, and to examine both how the patients and families in need of social work consultation are identified and the implications of these methods of identification for social work practice.     

Hospital graduate social work field work programs: a study in New York City

Twenty-seven hospital field work programs in New York City were studied. Questionnaires were administered to program coordinators and 238 graduate social work students participating in study programs. High degrees of program structural complexity and variation were found, indicating a state of art well beyond that described in the general field work literature. High rates of student satisfaction with learning, field instructors, programs, and the overall field work experience found suggest that the complexity of study programs may be more effective than traditional field work models. Statistically nonsignificant study findings indicate areas in which hospital social work departments may develop field work programs consistent with shifting organizational needs, without undue risk to educational effectiveness. Statistically significant findings suggest areas in which inflexibility in program design may be more beneficial in the diagnostic related groups era.     

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 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.     

Timing of social work intervention and medical patient's length of hospital stay

Findings report that hospital inpatients who receive social work intervention present difficult problems and have longer-than-average lengths of stay and that the earlier in the hospitalization that intervention occurs, the shorter the stay will be. A total of 243 patients referred for social services at a 440-bed teaching hospital were evaluated. Paired t-tests indicated a significant difference in the mean length of stay based on normative data. Timing of the intervention accounted for a significant amount of variance (13 percent) in length of hospital stay. The major clinical implications of the study are that social work intervention has the potential to decrease length of hospitalization, and that this methodology may be used reliably to evaluate changes in discharge planning protocol.     

Toward a healthy work environment

Patient safety and the quality of patient care have become important topics in U.S. hospitals in recent years. Nearly all hospitals have made mechanical and procedural changes to improve safety. But a truly healthy hospital is one in which caregivers, especially nurses, are treated with respect. The American Association of Critical-Care Nurses argues that a genuinely healthy work environment has six qualities: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition of staff members' contributions, and authentic leadership. Although training is often needed to create a respectful and healthy workplace, some leaders are reluctant to allocate dollars on what they see as "soft" relationship issues. However, hospital leaders dedicated to improving safety and quality of care will see that they cannot afford to neglect such issues.