This article was downloaded by: [University of Glasgow] On: 02 January 2015, At: 12:21 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
COMPARISON OF OPINIONS OF SOCIAL WORK ADMINISTRATORS AND HOSPITAL ADMINISTRATORS TOWARD LEADERSIP TASKS a
b
Shirley H. Wattenberg MA, ACSW , Michael Miller Orr & Thomas O'Rourke PhD, MPH
c
a
Associate Professor, School of Social Work, University of Illinois at Champaign-Urbana, Urbana, IL, 61801 b
Research Assistant, School of Social Work, University of Illinois
c
Associate Professor, Department of Health and Safety Education, University of Illinois Published online: 26 Oct 2008.
To cite this article: Shirley H. Wattenberg MA, ACSW , Michael Miller Orr & Thomas O'Rourke PhD, MPH (1977) COMPARISON OF OPINIONS OF SOCIAL WORK ADMINISTRATORS AND HOSPITAL ADMINISTRATORS TOWARD LEADERSIP TASKS, Social Work in Health Care, 2:3, 285-293, DOI: 10.1300/J010v02n03_04 To link to this article: http://dx.doi.org/10.1300/J010v02n03_04
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
COMPARISON OF OPINIONS OF SOCIAL WORK ADMINISTRATORS AND HOSPITAL ADMINISTRATORS TOWARD LEADERSHIP TASKS
Downloaded by [University of Glasgow] at 12:21 02 January 2015
Shirley H. Wattenberg, MA, ACSW Michael Miller Orr Thomas W. O'Rourke, PhD, MPH
ABSTRACT. The purpose of this article is to report on the attitudes of hospital administrators and social work administrators toward specific leadership tasksperformed by social workers in hospitals. The study population was comprised o f all hospitals offering social services in a sixteen-county Midwest area. Opinions on the importance of the tasks and the frequency with which they were performed are assessed. The data indicate that there is no significant difference between attitudes o f the hospital administrators and social work administrators in their evaluation o f the importance of these tasks or the frequency of performance. These unexpected findings offer implications for hospital-based social workers seeking expanded influence in their institutions.
A recent article in Social Work and Health Care' directed attention t o the potential for influence and leadership available t o social workers in hospitals. The article by Schoenfeld, a hospital administrator, thoughtfully delineated a series of tasks he felt social workers could perform which would strengthen their role in the hospital structure. The tasks he mentioned were the following: (1)provide leadership for the social improvement of the hospital organization; (2) act as ombudsman; (3) become a "partner" with the hospital administration and medical staff in developing new ways t o implement changes; (4) represent the hospital in the community; (5) improve patients' understanding of hospital policies; (6) participate in education of geneMs. Wattenberg is an Associate Professor in the School o f Social Work, University o f Illinois at Champaign-Urbana,1207 West Oregon Street, Urbana, IL 61801. Mr. Orr is a Research Assistant in the School o f Social Work, University o f Illinois; and Dr. O'Rourke is an Associate Professor in the Department o f Health and Safety Education, University o f Illinois. This study was carried out with the support o f the Area Health Education System 3B Contractor: University o f Illinois U.S. DHEW PHS Health Resources Administration. Technical assistance was given by the staff o f the Survey Research Laboratory 01 the University o f Illinois. Social Work in Health Care, Vol. 2(3), Spring 1977 285
SOCIAL WORK IN HEALTH CARE
ral staff of hospital; (7) participate in education of medical staff; (8) offer t o personnel departments their expertise in social problems and counseling t o employees on all levels; (9) design special review and evaluation programs; and (10) develop orientation programs for new employees.
Downloaded by [University of Glasgow] at 12:21 02 January 2015
IMPORTANCE O F LEADERSHIP ROLE Historically, social workers have been struggling with their status in the hospital hierarchy. As the structure and mission of hospitals has changed and expanded, the social component of health care has had increased acceptance. However, for a number of reasons, this has not necessarily increased the status of social service departments within the hospitals. There has been a series of articles in the literature encouraging hospital social workers t o broaden their scope of practice in order t o achieve more influence.'v3 The implication has been that social workers have been limited by other professionals in their leadership role, and that various strategies should be employed t o improve their ~ t a t u s . ~ The " question arises of how social workers in administrative positions in hospitals view the importance of these leadership tasks. Do their views diverge from those of the directors of the hospitals to the extent that this acts as a deterrent t o performing the tasks? Over the past year, the authors have been engaged in a study of the social services provided in seventeen hospitals in a health planning area in central Illinois. The hospital administrators and social work administrators in each of these hospitals were interviewed for the purpose of ascertaining their attitudes about tasks performed by social workers in hospitals. The following is a report of the attitudes of these hospital administrators and social work administrators toward the specific leadership tasks mentioned by Mr. Schoenfeld in his article. Results obtained from our study are compared t o findings of a similar study conducted by Jules Schrager with a population from a series of teaching
hospital^.^ METHODOLOGY As a result of a survey of the literature and consultation with experts in the field, a comprehensive list of 102 tasks performed by social workers in hospitals was assembled. Following pretesting, the tasks were reduced t o 89. These were grouped into six major categories and 26 subcategories. However, for the purpose of this study, only the twelve leadership tasks relevant t o Schoenfeld's discussion were analyzed. In each case, the hospital administrator and social
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Wattenberg, Orr, and O'Rourke
service administrator were asked "How important do you consider this task for social service?" and "How frequently is this task performed?" A seven-point scale was employed regarding the importance of the task, ranging from a score of 1,"extremely unimportant," to a score of 7, "extremely important." A four-point scale was employed depicting the frequency with which the task was performed. The scale ranged from 1,"never performed," t o a score of 4, "frequently performed." An analysis of variance technique was utilized in an effort to assess whether there was a significant difference between the opinions of the social work administrators (N = 17) and the hospital administrators (N = 17) in relation to: (1)the importance of the leadership tasks; and then, (2) the frequency of performance of each of the tasks. For each group, the mean score and the standard deviation are recorded, as well as the t value comparing the two groups. The hypothesis was that there was a difference in the perception of the hospital administrators and social work administrators in relation t o the importance of the various leadership tasks being measured. Specifically, it was hypothesized that social workers would consider these tasks t o be more important than would hospital administrators. Also, it was anticipated that the leadership tasks would be performed infrequently by the social workers. PRESENTATION AND DISCUSSION A comparison of the mean scores of the social work administrators and the hospital administrators in relation to the importance attributed to each of the tasks is presented in Table 1, in order of rank by the social work administrators. The last column of Table 1 shows there was no significant statistical difference of opinion at the p < .05 level between the perceptions of hospital administrators and the social work administrators. For the most part, these tasks were considered quite important, but not extremely important. However, there are differences which can be observed from the data that are worth considering in view of the fact that it represents the opinion of all the social work administrators and all the hospital administrators in the area. Participating in planning for improvement of patient care and developing inservice training programs were ranked as the most important tasks by both groups. We note that not only are the means high for both groups, but the standard deviations are smaller than those of other tasks, thus indicating a greater uniformity of response. Although not statistically different, acting as advocate for the family is rated as slightly more important by the social work group than by the hospital administrators. Lesser importance was placed by both groups on participating in committees regarding long-range planning for im-
SOCIAL WORK IN HEALTH CARE
TABLE I Comparison of Attitudes of Social Work Administrators and Hospital Administrators toward Importance of Leadership Tasks * -
Task
Social Work Administrators X s.d.
Develop inservice training programs
6.1 7
-
Hospital Administrators X s.d.
-
-
2-Tailed t-Value Probability
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Act as advocate ombudsman for patientlfamily 6.17 Interpret hospital policies and services
6.06
Participate in planning committee regarding improvement of care
6.06
Participate in development committee regarding long-range planning
5.83
Participate in community councils representing hospitals 5.73 Policy planning for hospital personnel health and welfare
5.50
Participate in review of utilization services (PSRO)
5.50
Formal teaching (lecture) to other health disciplines 5.38 Clinical teaching to other health professions
5.33
Clinical teaching to medical students1 resident interns
5.27
Formal teaching (lecture) to medical students1 resident interns 5.00 Range of importance: 7 = Extremely important; 6 =Quite important: 5 =Slightly important; 4 = Neither important nor unimportant; 3 = Slightly unimportant: 2 = Quite unimportant; 1 = Extremely unimportant.
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Wattenberg, Orr, and O'Rourke
provement of patient care mentioned above. In the case of long-range planning, five of the social work administrators and six of the seventeen hospital administrators considered the task inappropriate, while none thought planning for improved patient care was inappropriate. Analysis of mean scores revealed that formal and clinical teaching of medical students had a relatively low priority. This was not surprising since there are no medical students placed in these hospitals at this time. The formal teaching of medical students or residents was considered inappropriate by 82% (N = 14) of the social work administrators and 64% (N = 11) of the hospital administrators. Clinical teaching of medical students was considered inappropriate by 35% of the social work administrators (6) and 53% of the hospital administrators (9). Table 2 compares the mean scores of the opinions of social work administrators and hospital administrators in relation to the frequency of performance of these tasks. With one exception, Table 2 indicates no significant difference between the judgment of the hospital administrators and the social work administrators as t o the frequency with which the leadership tasks are performed. Only the formal teaching t o other health professionals was found to indicate significant difference at the p < .05 level of probability. In this case, the social workers rated a higher frequency of performance. Eleven (64%) hospital administrators as compared t o six (35%) social work administrators believed this task was never performed. It should be noted, however, that both groups rated the tasks infrequently performed. None of the tasks considered in this paper were rated by either of the groups t o be performed frequently. Acting as advocate was the task rated by both groups as being performed most often. Developing inservice programs, interpreting hospital policies, and participation in utilization review activities are also in the upper third of the ratings of frequency of performance, although performed only occasionally. Teaching medical students is never performed. Other tasks are performed only seldom. We therefore note that, despite the importance attributed t o these leadership tasks, in actuality they are performed only occasionally or seldom, with the possible exception of acting as advocate. COMPARISON WITH REPORT ON TEACHING HOSPITALS Jules Schrager reported in 1974 on the attitudes of four professional groups toward a range of tasks similar t o those in this study. He obtained data from the staffs of twelve major universityowned hospitals. His informants included 1 3 hospital administrators and 2 3 senior social workers.
SOCIAL WORK IN HEALTH CARE
TABLE 2 comparison of O p i n i o n s o f Social Work Administrators and Hospital Administrators toward the Frequency of Performance of Administrative-Leadership Tasks *
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Social Work Administrators
-
Task
X
Develop inservice training programs
3.00
1.1 2
Act as advocate ombudsman for patientlfamily 3.41
.79
s.d.
Interpret hospital policies and services
2.77
1.09
Participate in planning committe regarding improvement of care
2.35
1.20
Participate in development committee regarding long-range planning
1.58
.79
Participate incommunity councils representing hospitals 2.29
1.26
Policy planning for hospital personnel health and welfare
2.18
1.24
Participate in review of utilization services (PSRO)
2.71
1.36
Formal teaching (lecture) to other health disciplines 1.94
.82
Clinical teaching to other health professions
2.40
1.12
Clinical teaching to medical students1 resident interns
1.41
.80
Formal teaching (lecture) to medical students1 resident interns 1.OO
' Scale:
4 =
Frequently:
3=
Hospital Administrators s.d.
X
0
Occasionally; 2 = Seldom;
1 = Never.
2-Tailed Probability
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Wattenberg, Om,and O'Rourke
His purpose was t o "discern consonance and dissonance in perception of social work task importance among four groups of health professionals." Schrager used a five-point scale with 5 being "very important." We used a seven-point scale with 7 being "extremely important" and 6 "quite important." We combined these two categories for purposes of comparison. There were ten tasks which overlapped with the twelve being discussed in this report. Schrager's items were used along with others to permit comparison of findings. Figure 1 indicates the percentage of social workers and hospital administrators in each of the studies who considered the tasks t o be very important. The thick lines represent the central Illinois staffs and the thin lines represent the staffs of the teaching hospitals studied by Schrager. There is considerable agreement of the findings of the two studies in terms of overall importance as presented in Figure 1. However, in the Schrager study, the social workers were more likely to consider the tasks important than the hospital administrators (eight out of ten items). This was far less true of the Illinois group (three out of ten). The attitudes toward importance were closer in the Illinois group than the Schrager group. Participation ii improvement of patient care committees was the task rated most important by all respondents of both groups. The differences between the groups become most evident around the formal and clinical training which is naturally seen as more important in the teaching hospitals. The exception to the above is developing of inservice training programs, which is seen as very important by the Illinois study group. Participation in review utilization services, which has been strongly emphasized by the social work profession, shows a relatively lower priority of importance by the Illinois group of social work administrators than by the research hospital administrators. CONCLUSIONS AND IMPLICATIONS Reflecting on the leadership tasks mentioned by Schoenfeld, we find that the social workers and hospital administrators studied have very similar views on the importance of these tasks. They judged them t o be quite important, but not extremely important. The hypothesis that there was a difference of opinion between these two professionals was not substantiated. On the other hand, the assumption that the leadership tasks were performed infrequently was found t o be correct. The social work administrators and hospital administrators in central Illinois were found to have attitudes similar t o a comparable group
SOCIAL WORK IN HEALTH CARE
Task
Percentage
0 10 20 30 40 50 60 70 80 90 100
Illi~ois
x
Develop inservice training programs
Act as advocate ombudr man for palientlfamily
Participate in planning committee regarding improvement of care
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Interpret hospital policies and services
Participate in community councils representing hosoitals
Participate in review of ~ t i l i z a t i o nservices (PSRO)
SWA
Formal teaching (lecture) to other health disciplines
SWA HA
Clinical teaching to other health professions
SWA HA
Clinical teaching to medical studentd resident interns
HA
Formal teaching (lecture1 to medical students1 resident interns
l=kk&u
SWA
SWA HA
= % o f staffs in central Illinois judging tasks "quite important" plus "extremely important." N = 17 SWA lsocial work administrators); N = 17 HA (hospital administrators).
- = % o f staffs i n teaching hospitals studied by Schrager judging tasks "very important." N = 23 SWA (senior social workersl; N = 13 HA (hospital administratorsl.
FIGURE 1. Percentage of social work and hospital administrators considering administrative/leadership tasks very important.
serving in twelve major universityawned hospitals. However, tasks related to formal and clinical teaching were more highly valued in the teaching hospitals. It should be reassuring t o social workers to know that hospital administrators' attitudes are similar t o their own. If social workers were to take a more active role in relation t o administrative activities, they
Wattenberg, Ow, and O'Rourke
would have the support of the hospital administrators. The hospital administrators are rather well informed on the frequency with which the social workers are carrying out these tasks. It could then be concluded that the option of playing a larger administrative role in hospitals is mainly a matter of social work administrators' exercising their own initiative.
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REFERENCES 1. Harvey Schoenfeld, "Opportunities for Leadership for the Social Worker in Hospitals," Social Work in Health Care 1 , no. 1 (Fall 1975):93-96. 2. Sidney Hirsch and Abraham Lurie, "Social Work Dimensions in Shaping Medical Care Philosophy and Practice," Social Work 14, no. 2 (April 1969):75-79. 3. Emanuel Hallowitz. "Innovations in Hosvital Social Work." Social Work 17. no. 4 (July 1972):89-97. 4. Brian Segal, "Planning and Power in Hospital Social Service," Social Casework 51, no. 7 (July 1970):399-405. 5. John Wax. "Develovine Social Work Power in a Medical Oreanization." Social Work 13, no. 4 (0ctbbe; 1968):62-71. 6. Jules Schrager, Social Work Departments in University Hospitals, University of Syracuse Manpower Monograph, no. 6 (Syracuse, N. Y.,1974).
-
Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
COMPARISON OF OPINIONS OF SOCIAL WORK ADMINISTRATORS AND HOSPITAL ADMINISTRATORS TOWARD LEADERSIP TASKS a
b
Shirley H. Wattenberg MA, ACSW , Michael Miller Orr & Thomas O'Rourke PhD, MPH
c
a
Associate Professor, School of Social Work, University of Illinois at Champaign-Urbana, Urbana, IL, 61801 b
Research Assistant, School of Social Work, University of Illinois
c
Associate Professor, Department of Health and Safety Education, University of Illinois Published online: 26 Oct 2008.
To cite this article: Shirley H. Wattenberg MA, ACSW , Michael Miller Orr & Thomas O'Rourke PhD, MPH (1977) COMPARISON OF OPINIONS OF SOCIAL WORK ADMINISTRATORS AND HOSPITAL ADMINISTRATORS TOWARD LEADERSIP TASKS, Social Work in Health Care, 2:3, 285-293, DOI: 10.1300/J010v02n03_04 To link to this article: http://dx.doi.org/10.1300/J010v02n03_04
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
COMPARISON OF OPINIONS OF SOCIAL WORK ADMINISTRATORS AND HOSPITAL ADMINISTRATORS TOWARD LEADERSHIP TASKS
Downloaded by [University of Glasgow] at 12:21 02 January 2015
Shirley H. Wattenberg, MA, ACSW Michael Miller Orr Thomas W. O'Rourke, PhD, MPH
ABSTRACT. The purpose of this article is to report on the attitudes of hospital administrators and social work administrators toward specific leadership tasksperformed by social workers in hospitals. The study population was comprised o f all hospitals offering social services in a sixteen-county Midwest area. Opinions on the importance of the tasks and the frequency with which they were performed are assessed. The data indicate that there is no significant difference between attitudes o f the hospital administrators and social work administrators in their evaluation o f the importance of these tasks or the frequency of performance. These unexpected findings offer implications for hospital-based social workers seeking expanded influence in their institutions.
A recent article in Social Work and Health Care' directed attention t o the potential for influence and leadership available t o social workers in hospitals. The article by Schoenfeld, a hospital administrator, thoughtfully delineated a series of tasks he felt social workers could perform which would strengthen their role in the hospital structure. The tasks he mentioned were the following: (1)provide leadership for the social improvement of the hospital organization; (2) act as ombudsman; (3) become a "partner" with the hospital administration and medical staff in developing new ways t o implement changes; (4) represent the hospital in the community; (5) improve patients' understanding of hospital policies; (6) participate in education of geneMs. Wattenberg is an Associate Professor in the School o f Social Work, University o f Illinois at Champaign-Urbana,1207 West Oregon Street, Urbana, IL 61801. Mr. Orr is a Research Assistant in the School o f Social Work, University o f Illinois; and Dr. O'Rourke is an Associate Professor in the Department o f Health and Safety Education, University o f Illinois. This study was carried out with the support o f the Area Health Education System 3B Contractor: University o f Illinois U.S. DHEW PHS Health Resources Administration. Technical assistance was given by the staff o f the Survey Research Laboratory 01 the University o f Illinois. Social Work in Health Care, Vol. 2(3), Spring 1977 285
SOCIAL WORK IN HEALTH CARE
ral staff of hospital; (7) participate in education of medical staff; (8) offer t o personnel departments their expertise in social problems and counseling t o employees on all levels; (9) design special review and evaluation programs; and (10) develop orientation programs for new employees.
Downloaded by [University of Glasgow] at 12:21 02 January 2015
IMPORTANCE O F LEADERSHIP ROLE Historically, social workers have been struggling with their status in the hospital hierarchy. As the structure and mission of hospitals has changed and expanded, the social component of health care has had increased acceptance. However, for a number of reasons, this has not necessarily increased the status of social service departments within the hospitals. There has been a series of articles in the literature encouraging hospital social workers t o broaden their scope of practice in order t o achieve more influence.'v3 The implication has been that social workers have been limited by other professionals in their leadership role, and that various strategies should be employed t o improve their ~ t a t u s . ~ The " question arises of how social workers in administrative positions in hospitals view the importance of these leadership tasks. Do their views diverge from those of the directors of the hospitals to the extent that this acts as a deterrent t o performing the tasks? Over the past year, the authors have been engaged in a study of the social services provided in seventeen hospitals in a health planning area in central Illinois. The hospital administrators and social work administrators in each of these hospitals were interviewed for the purpose of ascertaining their attitudes about tasks performed by social workers in hospitals. The following is a report of the attitudes of these hospital administrators and social work administrators toward the specific leadership tasks mentioned by Mr. Schoenfeld in his article. Results obtained from our study are compared t o findings of a similar study conducted by Jules Schrager with a population from a series of teaching
hospital^.^ METHODOLOGY As a result of a survey of the literature and consultation with experts in the field, a comprehensive list of 102 tasks performed by social workers in hospitals was assembled. Following pretesting, the tasks were reduced t o 89. These were grouped into six major categories and 26 subcategories. However, for the purpose of this study, only the twelve leadership tasks relevant t o Schoenfeld's discussion were analyzed. In each case, the hospital administrator and social
Downloaded by [University of Glasgow] at 12:21 02 January 2015
Wattenberg, Orr, and O'Rourke
service administrator were asked "How important do you consider this task for social service?" and "How frequently is this task performed?" A seven-point scale was employed regarding the importance of the task, ranging from a score of 1,"extremely unimportant," to a score of 7, "extremely important." A four-point scale was employed depicting the frequency with which the task was performed. The scale ranged from 1,"never performed," t o a score of 4, "frequently performed." An analysis of variance technique was utilized in an effort to assess whether there was a significant difference between the opinions of the social work administrators (N = 17) and the hospital administrators (N = 17) in relation to: (1)the importance of the leadership tasks; and then, (2) the frequency of performance of each of the tasks. For each group, the mean score and the standard deviation are recorded, as well as the t value comparing the two groups. The hypothesis was that there was a difference in the perception of the hospital administrators and social work administrators in relation t o the importance of the various leadership tasks being measured. Specifically, it was hypothesized that social workers would consider these tasks t o be more important than would hospital administrators. Also, it was anticipated that the leadership tasks would be performed infrequently by the social workers. PRESENTATION AND DISCUSSION A comparison of the mean scores of the social work administrators and the hospital administrators in relation to the importance attributed to each of the tasks is presented in Table 1, in order of rank by the social work administrators. The last column of Table 1 shows there was no significant statistical difference of opinion at the p < .05 level between the perceptions of hospital administrators and the social work administrators. For the most part, these tasks were considered quite important, but not extremely important. However, there are differences which can be observed from the data that are worth considering in view of the fact that it represents the opinion of all the social work administrators and all the hospital administrators in the area. Participating in planning for improvement of patient care and developing inservice training programs were ranked as the most important tasks by both groups. We note that not only are the means high for both groups, but the standard deviations are smaller than those of other tasks, thus indicating a greater uniformity of response. Although not statistically different, acting as advocate for the family is rated as slightly more important by the social work group than by the hospital administrators. Lesser importance was placed by both groups on participating in committees regarding long-range planning for im-
SOCIAL WORK IN HEALTH CARE
TABLE I Comparison of Attitudes of Social Work Administrators and Hospital Administrators toward Importance of Leadership Tasks * -
Task
Social Work Administrators X s.d.
Develop inservice training programs
6.1 7
-
Hospital Administrators X s.d.
-
-
2-Tailed t-Value Probability
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Act as advocate ombudsman for patientlfamily 6.17 Interpret hospital policies and services
6.06
Participate in planning committee regarding improvement of care
6.06
Participate in development committee regarding long-range planning
5.83
Participate in community councils representing hospitals 5.73 Policy planning for hospital personnel health and welfare
5.50
Participate in review of utilization services (PSRO)
5.50
Formal teaching (lecture) to other health disciplines 5.38 Clinical teaching to other health professions
5.33
Clinical teaching to medical students1 resident interns
5.27
Formal teaching (lecture) to medical students1 resident interns 5.00 Range of importance: 7 = Extremely important; 6 =Quite important: 5 =Slightly important; 4 = Neither important nor unimportant; 3 = Slightly unimportant: 2 = Quite unimportant; 1 = Extremely unimportant.
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Wattenberg, Orr, and O'Rourke
provement of patient care mentioned above. In the case of long-range planning, five of the social work administrators and six of the seventeen hospital administrators considered the task inappropriate, while none thought planning for improved patient care was inappropriate. Analysis of mean scores revealed that formal and clinical teaching of medical students had a relatively low priority. This was not surprising since there are no medical students placed in these hospitals at this time. The formal teaching of medical students or residents was considered inappropriate by 82% (N = 14) of the social work administrators and 64% (N = 11) of the hospital administrators. Clinical teaching of medical students was considered inappropriate by 35% of the social work administrators (6) and 53% of the hospital administrators (9). Table 2 compares the mean scores of the opinions of social work administrators and hospital administrators in relation to the frequency of performance of these tasks. With one exception, Table 2 indicates no significant difference between the judgment of the hospital administrators and the social work administrators as t o the frequency with which the leadership tasks are performed. Only the formal teaching t o other health professionals was found to indicate significant difference at the p < .05 level of probability. In this case, the social workers rated a higher frequency of performance. Eleven (64%) hospital administrators as compared t o six (35%) social work administrators believed this task was never performed. It should be noted, however, that both groups rated the tasks infrequently performed. None of the tasks considered in this paper were rated by either of the groups t o be performed frequently. Acting as advocate was the task rated by both groups as being performed most often. Developing inservice programs, interpreting hospital policies, and participation in utilization review activities are also in the upper third of the ratings of frequency of performance, although performed only occasionally. Teaching medical students is never performed. Other tasks are performed only seldom. We therefore note that, despite the importance attributed t o these leadership tasks, in actuality they are performed only occasionally or seldom, with the possible exception of acting as advocate. COMPARISON WITH REPORT ON TEACHING HOSPITALS Jules Schrager reported in 1974 on the attitudes of four professional groups toward a range of tasks similar t o those in this study. He obtained data from the staffs of twelve major universityowned hospitals. His informants included 1 3 hospital administrators and 2 3 senior social workers.
SOCIAL WORK IN HEALTH CARE
TABLE 2 comparison of O p i n i o n s o f Social Work Administrators and Hospital Administrators toward the Frequency of Performance of Administrative-Leadership Tasks *
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Social Work Administrators
-
Task
X
Develop inservice training programs
3.00
1.1 2
Act as advocate ombudsman for patientlfamily 3.41
.79
s.d.
Interpret hospital policies and services
2.77
1.09
Participate in planning committe regarding improvement of care
2.35
1.20
Participate in development committee regarding long-range planning
1.58
.79
Participate incommunity councils representing hospitals 2.29
1.26
Policy planning for hospital personnel health and welfare
2.18
1.24
Participate in review of utilization services (PSRO)
2.71
1.36
Formal teaching (lecture) to other health disciplines 1.94
.82
Clinical teaching to other health professions
2.40
1.12
Clinical teaching to medical students1 resident interns
1.41
.80
Formal teaching (lecture) to medical students1 resident interns 1.OO
' Scale:
4 =
Frequently:
3=
Hospital Administrators s.d.
X
0
Occasionally; 2 = Seldom;
1 = Never.
2-Tailed Probability
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Wattenberg, Om,and O'Rourke
His purpose was t o "discern consonance and dissonance in perception of social work task importance among four groups of health professionals." Schrager used a five-point scale with 5 being "very important." We used a seven-point scale with 7 being "extremely important" and 6 "quite important." We combined these two categories for purposes of comparison. There were ten tasks which overlapped with the twelve being discussed in this report. Schrager's items were used along with others to permit comparison of findings. Figure 1 indicates the percentage of social workers and hospital administrators in each of the studies who considered the tasks t o be very important. The thick lines represent the central Illinois staffs and the thin lines represent the staffs of the teaching hospitals studied by Schrager. There is considerable agreement of the findings of the two studies in terms of overall importance as presented in Figure 1. However, in the Schrager study, the social workers were more likely to consider the tasks important than the hospital administrators (eight out of ten items). This was far less true of the Illinois group (three out of ten). The attitudes toward importance were closer in the Illinois group than the Schrager group. Participation ii improvement of patient care committees was the task rated most important by all respondents of both groups. The differences between the groups become most evident around the formal and clinical training which is naturally seen as more important in the teaching hospitals. The exception to the above is developing of inservice training programs, which is seen as very important by the Illinois study group. Participation in review utilization services, which has been strongly emphasized by the social work profession, shows a relatively lower priority of importance by the Illinois group of social work administrators than by the research hospital administrators. CONCLUSIONS AND IMPLICATIONS Reflecting on the leadership tasks mentioned by Schoenfeld, we find that the social workers and hospital administrators studied have very similar views on the importance of these tasks. They judged them t o be quite important, but not extremely important. The hypothesis that there was a difference of opinion between these two professionals was not substantiated. On the other hand, the assumption that the leadership tasks were performed infrequently was found t o be correct. The social work administrators and hospital administrators in central Illinois were found to have attitudes similar t o a comparable group
SOCIAL WORK IN HEALTH CARE
Task
Percentage
0 10 20 30 40 50 60 70 80 90 100
Illi~ois
x
Develop inservice training programs
Act as advocate ombudr man for palientlfamily
Participate in planning committee regarding improvement of care
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Interpret hospital policies and services
Participate in community councils representing hosoitals
Participate in review of ~ t i l i z a t i o nservices (PSRO)
SWA
Formal teaching (lecture) to other health disciplines
SWA HA
Clinical teaching to other health professions
SWA HA
Clinical teaching to medical studentd resident interns
HA
Formal teaching (lecture1 to medical students1 resident interns
l=kk&u
SWA
SWA HA
= % o f staffs in central Illinois judging tasks "quite important" plus "extremely important." N = 17 SWA lsocial work administrators); N = 17 HA (hospital administrators).
- = % o f staffs i n teaching hospitals studied by Schrager judging tasks "very important." N = 23 SWA (senior social workersl; N = 13 HA (hospital administratorsl.
FIGURE 1. Percentage of social work and hospital administrators considering administrative/leadership tasks very important.
serving in twelve major universityawned hospitals. However, tasks related to formal and clinical teaching were more highly valued in the teaching hospitals. It should be reassuring t o social workers to know that hospital administrators' attitudes are similar t o their own. If social workers were to take a more active role in relation t o administrative activities, they
Wattenberg, Ow, and O'Rourke
would have the support of the hospital administrators. The hospital administrators are rather well informed on the frequency with which the social workers are carrying out these tasks. It could then be concluded that the option of playing a larger administrative role in hospitals is mainly a matter of social work administrators' exercising their own initiative.
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REFERENCES 1. Harvey Schoenfeld, "Opportunities for Leadership for the Social Worker in Hospitals," Social Work in Health Care 1 , no. 1 (Fall 1975):93-96. 2. Sidney Hirsch and Abraham Lurie, "Social Work Dimensions in Shaping Medical Care Philosophy and Practice," Social Work 14, no. 2 (April 1969):75-79. 3. Emanuel Hallowitz. "Innovations in Hosvital Social Work." Social Work 17. no. 4 (July 1972):89-97. 4. Brian Segal, "Planning and Power in Hospital Social Service," Social Casework 51, no. 7 (July 1970):399-405. 5. John Wax. "Develovine Social Work Power in a Medical Oreanization." Social Work 13, no. 4 (0ctbbe; 1968):62-71. 6. Jules Schrager, Social Work Departments in University Hospitals, University of Syracuse Manpower Monograph, no. 6 (Syracuse, N. Y.,1974).
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