This article was downloaded by: [130.132.123.28] On: 27 December 2014, At: 11:36 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
EDITORIAL Helen Rehr Published online: 26 Oct 2008.
To cite this article: Helen Rehr (1977) EDITORIAL, Social Work in Health Care, 2:2, 135-138, DOI: 10.1300/ J010v02n02_01 To link to this article: http://dx.doi.org/10.1300/J010v02n02_01
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/terms-and-conditions
EDITORIAL:
Downloaded by [] at 11:36 27 December 2014
QUALITY AND QUANTITY ASSURANCE
Where do social workers in health care stand regarding quality and quantity assurance? Just as medicine has been slow-moving and even somewhat balky in getting on board, social work has been slow, too. What are the implications for social work? In this writer's opinion, the critical implication is the survival of professional social work not only in health care but in all fields. Before offering my viewpoint on what social work must do to get started, I present some programmatic "givens." Medicare, Medicaid and the Maternal and Child Health/Crippled Children's programs (Titles 18, 19, and 5), initiated in the mid1960s, represent the largest venture of government into thirdparty financing of medical services for selected populations (except for the military' and veterans' programs). As of 1972, a range of quality and quantity controls on professional and institutional services had been mandated as a condition of reimbursement for care given. Today, the newest federal regulations deal with Professional Standards Review Organizations (PSROs) and utilization review expectations for hospitalizations, including concurrent and retrospective review of institutional and professional care services. The review of long-term institutional care and mental health services are already under proposed federal regulations; soon t o come are regulations geared to ambulatory care, both institutional and private. The most recent government endeavor is in Public Law 93-641, which places a majority of consumers side-by-side with providers in local, state and national health services agencies. Their function is to exercise further controls by assuming responsibility for health care planning for prescribed geographic areas. PROFESSIONAL AND INSTITUTIONAL REVIEW The expectation of these mechanisms is accountability. The intentions are: (a) to eliminate unnecessary use and provision of health care services so as to contain costs; (b) t o improve the quality of care by the individual practitioner through peer review; (c) t o improve quality of care delivered by institutions through audits of care; (d) to provide data in uniform and systematic ways for use by professional peer groups, institutions, and the Social Work in Health Care. Vol. 2(2), Winter 197677
135
SOCIAL WORK IN HEALTH CARE
regional and federal system so that future allocations of health services may be made from an informed baseline; and (e) to implement continuing education for upgrading of professional practice.
Downloaded by [] at 11:36 27 December 2014
QUALITY CONTROLS Most quality controls have been forced on health care systems in response to abuse, misuse, waste, or as an attack on the inadequate voluntary controls emanating from professional and hospital accrediting systems. The intent of the federal regulations (notwithstanding internal confusion) is to substitute an accountability requirement for the current pattern of unenforceable monitoring. Thus individual practitioners or individual institutions are subject to rules, criteria standards and norms for previously uncontrolled, little-documented or unusual actions. Quality and quantity assurance accountability is here to stay whether under governmental, consumer, or professional auspices; most likely it will be a combination of the three. While PSRO has had many problems in getting started, it has behind it the clout of reimbursement, and this powerful motivation has forced a beginning and has surfaced a committed and interested leadership. Given, then, the external impetus to quality assurance, what actions do social workers take? There are a number of key firsts. PSRO/Utiization Review has been designated one of the first major accountability mechanisms. This deals with both admissions to and discharges from short-stay hospitals. A "utilization review" plan must be developed and implemented for each institution. Its work is related to validity of admissions, predicting length of stay, validating an extended or continued stay, and projecting sound discharge planning. The regulations also call for a medical care evaluationretrospective examination of the care rendered. For social workers in medical settings, this means a need to negotiate membership on utilization committees. Here we can contribute to planning for quality care, and that includes what patients and families should expect and get in the way of sound social work services. It means that social workers will have to identify who is "at social risk" so that they will be responsible for their own early casefinding or the training of others for quality referrals for social work services. Since time is of essence (based on predicted length of stay), this will call for early and skilled social diagnostic assessments to be joined with medical and nursing assessments, so that joint planning for optimum care is possible. Working with the patients' and families' needs in the early stages of becoming and being w in-patient will shift the emphasis from Pate referrals-
Downloaded by [] at 11:36 27 December 2014
Editorial
usually crisis requests for "discharge planning"--to early mutual agreements between social worker and clients, based on knowledge and awareness of the impact of specific illness and disorders in physical and social functioning. Such interactions with patients and families will place new expectations on interprofessional collaboration, and social workers will be in a position t o contribute diagnostic and therapeutic directions in both medical and social planning. This is quality "discharge planning." In addition t o responding t o the mandate t o document the medical chart with their decision-making actions on behalf of patients, social workers use the chart for critical communication with others and as an information base. In documenting with specific data relative to social work intervention and outcomes, the means t o socialhealth care evaluations (comparable t o medical audits) becomes possible. Internal social-health care audits should lead t o feedback t o staff for recommendations for improvement of care and for what professionals need in continuing education t o enhance their practice. The written documentation becomes a data base, not only for departmental and internal peer review, but also for regional review when data from other institutions are assessed collectively. Such regional review methods documenting gaps in service and needed resources constitute a baseline for social and political action by consumers and providers, whose mandate for planning together has been noted. QUALITY CARE NETWORK Social workers are a critical component in the networks of health care professionals who provide quality care, in relation t o practice on behalf of individuals and in relation t o planning for a service or system of services. Thus, social .work must negotiate a place for itself on national, state and regional levels in relation to PSRO. NASW has already negotiated for representation on the National Professional Standards Review Council which will interact with Department of Health, Education and Welfare on behalf of nonmedical professionals on PSRO matters. The collection of data is essential so that our contributions will be made from quality assessment rather than social entreaty. We have noted elsewhere that a regional social work system of review could be a critical underpinning t o PSRO. Regionalization can be one means t o develop the instruments for institutional or multi-department review, to create training components, and t o monitor individual practice and delivery of care for an area. Its usefulness will require solid professional commitment.
SOCIAL WORK IN HEALTH CARE
Social work has begun to develop its own accountibility measures. The rate of our accountability development as well as our initiative in claiming membership in quality and quantity assurance bodies are determinants in our health care leadership role. Social work is ready for membership in PSRO and has gained it in some regions.
Downloaded by [] at 11:36 27 December 2014
Helen Rehr
BOOK REVIEWERS NEEDED Social Work in Health Care welcomes volunteer book reviewers for future issues. I f you are interested in reviewing books for this journal, send a letter indicating your background qualifications and areas o f interest to: Maurice Russell, EdD, Book Review Editor, Social Work in Health Care, New York University Medical Center, 560 First Avenue, New York, NY 10016.
Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
EDITORIAL Helen Rehr Published online: 26 Oct 2008.
To cite this article: Helen Rehr (1977) EDITORIAL, Social Work in Health Care, 2:2, 135-138, DOI: 10.1300/ J010v02n02_01 To link to this article: http://dx.doi.org/10.1300/J010v02n02_01
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/terms-and-conditions
EDITORIAL:
Downloaded by [] at 11:36 27 December 2014
QUALITY AND QUANTITY ASSURANCE
Where do social workers in health care stand regarding quality and quantity assurance? Just as medicine has been slow-moving and even somewhat balky in getting on board, social work has been slow, too. What are the implications for social work? In this writer's opinion, the critical implication is the survival of professional social work not only in health care but in all fields. Before offering my viewpoint on what social work must do to get started, I present some programmatic "givens." Medicare, Medicaid and the Maternal and Child Health/Crippled Children's programs (Titles 18, 19, and 5), initiated in the mid1960s, represent the largest venture of government into thirdparty financing of medical services for selected populations (except for the military' and veterans' programs). As of 1972, a range of quality and quantity controls on professional and institutional services had been mandated as a condition of reimbursement for care given. Today, the newest federal regulations deal with Professional Standards Review Organizations (PSROs) and utilization review expectations for hospitalizations, including concurrent and retrospective review of institutional and professional care services. The review of long-term institutional care and mental health services are already under proposed federal regulations; soon t o come are regulations geared to ambulatory care, both institutional and private. The most recent government endeavor is in Public Law 93-641, which places a majority of consumers side-by-side with providers in local, state and national health services agencies. Their function is to exercise further controls by assuming responsibility for health care planning for prescribed geographic areas. PROFESSIONAL AND INSTITUTIONAL REVIEW The expectation of these mechanisms is accountability. The intentions are: (a) to eliminate unnecessary use and provision of health care services so as to contain costs; (b) t o improve the quality of care by the individual practitioner through peer review; (c) t o improve quality of care delivered by institutions through audits of care; (d) to provide data in uniform and systematic ways for use by professional peer groups, institutions, and the Social Work in Health Care. Vol. 2(2), Winter 197677
135
SOCIAL WORK IN HEALTH CARE
regional and federal system so that future allocations of health services may be made from an informed baseline; and (e) to implement continuing education for upgrading of professional practice.
Downloaded by [] at 11:36 27 December 2014
QUALITY CONTROLS Most quality controls have been forced on health care systems in response to abuse, misuse, waste, or as an attack on the inadequate voluntary controls emanating from professional and hospital accrediting systems. The intent of the federal regulations (notwithstanding internal confusion) is to substitute an accountability requirement for the current pattern of unenforceable monitoring. Thus individual practitioners or individual institutions are subject to rules, criteria standards and norms for previously uncontrolled, little-documented or unusual actions. Quality and quantity assurance accountability is here to stay whether under governmental, consumer, or professional auspices; most likely it will be a combination of the three. While PSRO has had many problems in getting started, it has behind it the clout of reimbursement, and this powerful motivation has forced a beginning and has surfaced a committed and interested leadership. Given, then, the external impetus to quality assurance, what actions do social workers take? There are a number of key firsts. PSRO/Utiization Review has been designated one of the first major accountability mechanisms. This deals with both admissions to and discharges from short-stay hospitals. A "utilization review" plan must be developed and implemented for each institution. Its work is related to validity of admissions, predicting length of stay, validating an extended or continued stay, and projecting sound discharge planning. The regulations also call for a medical care evaluationretrospective examination of the care rendered. For social workers in medical settings, this means a need to negotiate membership on utilization committees. Here we can contribute to planning for quality care, and that includes what patients and families should expect and get in the way of sound social work services. It means that social workers will have to identify who is "at social risk" so that they will be responsible for their own early casefinding or the training of others for quality referrals for social work services. Since time is of essence (based on predicted length of stay), this will call for early and skilled social diagnostic assessments to be joined with medical and nursing assessments, so that joint planning for optimum care is possible. Working with the patients' and families' needs in the early stages of becoming and being w in-patient will shift the emphasis from Pate referrals-
Downloaded by [] at 11:36 27 December 2014
Editorial
usually crisis requests for "discharge planning"--to early mutual agreements between social worker and clients, based on knowledge and awareness of the impact of specific illness and disorders in physical and social functioning. Such interactions with patients and families will place new expectations on interprofessional collaboration, and social workers will be in a position t o contribute diagnostic and therapeutic directions in both medical and social planning. This is quality "discharge planning." In addition t o responding t o the mandate t o document the medical chart with their decision-making actions on behalf of patients, social workers use the chart for critical communication with others and as an information base. In documenting with specific data relative to social work intervention and outcomes, the means t o socialhealth care evaluations (comparable t o medical audits) becomes possible. Internal social-health care audits should lead t o feedback t o staff for recommendations for improvement of care and for what professionals need in continuing education t o enhance their practice. The written documentation becomes a data base, not only for departmental and internal peer review, but also for regional review when data from other institutions are assessed collectively. Such regional review methods documenting gaps in service and needed resources constitute a baseline for social and political action by consumers and providers, whose mandate for planning together has been noted. QUALITY CARE NETWORK Social workers are a critical component in the networks of health care professionals who provide quality care, in relation t o practice on behalf of individuals and in relation t o planning for a service or system of services. Thus, social .work must negotiate a place for itself on national, state and regional levels in relation to PSRO. NASW has already negotiated for representation on the National Professional Standards Review Council which will interact with Department of Health, Education and Welfare on behalf of nonmedical professionals on PSRO matters. The collection of data is essential so that our contributions will be made from quality assessment rather than social entreaty. We have noted elsewhere that a regional social work system of review could be a critical underpinning t o PSRO. Regionalization can be one means t o develop the instruments for institutional or multi-department review, to create training components, and t o monitor individual practice and delivery of care for an area. Its usefulness will require solid professional commitment.
SOCIAL WORK IN HEALTH CARE
Social work has begun to develop its own accountibility measures. The rate of our accountability development as well as our initiative in claiming membership in quality and quantity assurance bodies are determinants in our health care leadership role. Social work is ready for membership in PSRO and has gained it in some regions.
Downloaded by [] at 11:36 27 December 2014
Helen Rehr
BOOK REVIEWERS NEEDED Social Work in Health Care welcomes volunteer book reviewers for future issues. I f you are interested in reviewing books for this journal, send a letter indicating your background qualifications and areas o f interest to: Maurice Russell, EdD, Book Review Editor, Social Work in Health Care, New York University Medical Center, 560 First Avenue, New York, NY 10016.
