Social Work in Health Care

ISSN: 0098-1389 (Print) 1541-034X (Online) Journal homepage: http://www.tandfonline.com/loi/wshc20

Research on Organizational Issues in Health Care Social Work Leonard J. Marcus PhD To cite this article: Leonard J. Marcus PhD (1990) Research on Organizational Issues in Health Care Social Work, Social Work in Health Care, 15:1, 79-95, DOI: 10.1300/J010v15n01_07 To link to this article: http://dx.doi.org/10.1300/J010v15n01_07

Published online: 26 Oct 2008.

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Research on Organizational Issues in Health Care Social Work Downloaded by [University of Cambridge] at 20:35 05 November 2015

Leonard J. Marcus, PhD

ABSTRACT. A rich body of knowledge spans organizational topics relevant to the practice, conceptual development and planning of social work health care services. At a time when health care organizations are experiencing major changes in their structure and financing, organizational research informs both the system adjustments and leadership which social work can offer the health care field. Organizational research on health care social work is grouped into three categories: management and administrative issues; interprofessional and interorganizational relations; and s e ~ i c delivery c topics. Within each category, the major issues are presented with single site and multi-site research reviewed. Recommendations to improve the contributions of this body of research include greater attention to methodological rigor in designing and implementing research projects.

T h e picturc of a social worker in a health care setting is one of frequent bedside discussions with patient, family and other caregivers; regular rounds and meetings with other professionals attending to the patient's care; and ongoing negotiations across departments and with other organizations regarding patient transfcr and continuity of care. Health care social work is a n intensely organizational proccss in uniquely complex organizations (Germain, 1984). The social worker is in a pivotal role in this system, as helshe interLeonard J. Marcus was Associate Director of the Northeast Health Services Research and Development Field Program, Veterans Administration, when this article was prcpared. He is now Director of the Center for Health Care Negotiation, 12 Still Street, Boston, MA 02146-3444, and Assistant Professor at the Boston University School of Public Health. Social Work in Health Care, Vol. lS(1) 1990 0 1990 by The Haworth Press, Inc. All rights reserved.

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venes' at the interface of the patient and the organization (Germain & Gitterman, 1980). This article reviews the research on organizational aspects of social work in health care. Research on organizations spans wide bounds, examining interprofessional, interorganizational and interdependent aspects of health care systems (Marcus, 1987; Berkrnan et al., 1988). In conducting such a review, one is ever mindful of the parameters of definition. In particular, with so many elements of social work in health care practice having organizational ramification, how does one distinguish what is and what is not organizational research? One could argue that in a hospital, all interaction is cast in an organizational context. For the purpose of this discussion, organizational research encompasses systematic examination of patterned interaction among multiple parties who occupy defined positions and who conduct prescribed tasks. The general question posed by the research is the nature of those positions and that interaction as it affects the delivery of services. The field can be divided into three broad categories: management and administrative issues; interprofessional and interorganizational relations; and patient service delivery as influenced by organizational policies and operations. Within each category, the literature includes: relevant organizational and service delivery issues; single site and multi-site studies which are pertinent to the clarification of organizational issues in social work practice in health care. MANAGEMENT AND ADMZNZSTRATNE ISSUES The Mqjor Issues

The greatest challenge facing social work administration in health care settings has been responding to, coping with and strategizing for changes in service financing and reimbursement. Given that the bulk of a social service department's budget is devoted to personnel expenditures, it is only natural that shifting patterns of financing will affect staffing levels, a key indicator of survivability. But a restricted overall budget for the hospital does not necessarily translate into fewer social service positions, as one might expect. In some cases, departments have been expanded in order to expedite

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patient discharge. In other cases, key functions such as discharge planning have been transferred to other departments, such as nursing, thereby eliminating social service positions. Jansson and Simmons (1986) present a set of "survival" strategies which can be useful to social service departments. They view the social service department as a unit in a larger "host organization . . . typically dominated by professions other than social work." Distinguishing between what is a powerless versus a powerful unit, they present three models for enhancing survivability: credibility enhancing strategies; capacity building strategies and advocacy. They conclude that "the theoretical and empirical examination of the survival strategies of social work units in host organizations should be an important kind of inquiry for social work practitioners, theorists and researchers. Several projects are reported which provide guidance to the relative effectiveness of various staffing patterns and time management (Krell & Rosenberg, 1983; Sheriden, 1988). Most of the efforts in this area should be validated by comparing the relative effectiveness of service delivery at differing staffing levels, an admittedly difficult though valuable research question. Social service management and administrative issues are not restricted to internal matters such as staffing. The hospital's external environment likewise is a matter of concern, albeit less amenable to managerial manipulation. Trends in health care organization patterns affect the evolution of all departments. Reimbursement systcms such as DRGs and thc scrvicc incentives embedded therein arc a matter of ongoing attention (Walsh, 1987). The trend towards for profit corporative involvement in health care may be detrimental to social work services (Stoez, 1986; Edinburg, 1988). Leaders in social work rnanagemcnt rccommend that social work curricula include greater content in organizational theory, more training on working with power structures, and more skill building in negotiation strategies (Rosenberg & Clarke, 1987).

Single Site Studies While single site studies of administrative questions are limited in their generalizability, they do provide important information that can be translated to other institutions. Likewise, these studies pro-

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vide the basis for multi-site comparative studies which incorporate a wider spectrum of institutions. Time expenditures, productivity and cost are the primary issues examined in these studies but all have a common basic recommendation: the need for a strong management information system. Coulton, Keller and Boone (1985) studied the amount of time social workers typically spend with and on behalf of hospitalized patients, finding measures of psychosocial acuity to be most strongly associated with greater time expenditures. Spano and Lund (1986). report on the evolution of a comprehensive accountability structure which includes: management by objectives; a management information system; standardized client problem definitions: specific service standards for client problems, and a compreh&s;ve staff performance appraisal system. It is their conclusion that "hospital social work is faced with the need to change from values that emphasize high quality care at any price to values that emphasize quality care that is cost effective," and recommend that social work develop "data demonstrating the quality and quantity of our contribution to positive health outcomes . Haber-Scharf (1985) identifies three primary tasks in creating an information system: incorporating all expenses that are included in total cost; defining cost centers and units of service; and developing allocation methods for distributing personnel costs. More work is obviously needed on development of information systems, including their implementation and application. -

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Multi-Site Research

Multi-site studies which use a rigorous comparative methodology for data collection and analysis are clearly the most generalizable and applicable research models for advancing the knowledge and practice of social service administration. These studies, of course, are the most difficult to implement, not only because of expense, but more imoortantlv because of the numerous variables which must be accdunted ;or when explaining differences in organizational productivity or outcome. Nonetheless, serious attention must be given to studies which examine how different organizations respond to common external stimuli, be they in the form of reimbursement, regulation or a changing service population.

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Jansson and Simmons (1985) conducted a survey of 50 non-profit hospitals in Los Angcles County. Their dependent variable was the size of a social work department, measured as the ratio of social workers to the number of hospital beds. The independent variables were measures of organizational context, determined through a rating of the relative importance attached to various objectives by key decision makers. Each hospital was given a "mission complexity" score, based on the total number of mission objectives that were ascribed a high importance. They found that social work departments are more likely to expand where a mission exists that includes a variety of goals consonant with social work services, such as helping patients with social or personal problems, provision of community services, and assisting low income consumers. Patti and Ezc11 (1987) lend further support to the symbiotic relationship between the overall priorities of hospital management and the size and functioning of social service departments. They surveyed 55 hospital social service departments (representing a 59 percent response rate) to determine current priorities for eighteen performance goals by areas of performance, including: outputlproductivity; service quality/effectiveness; resource acquisition and domain maintenance; and research and education (in order from highest to lowest priority). The data suggests that what social service directors rank highest may mirror what their important constituencies, such as hospital administrators, likewise consider of greater importance. But since there was no valid measure of the priorities of these non-social work constituencies, the data do not offer conclusivc findings regarding this relationship. Dinerman et al. (1986) report on the impact of DRGs upon 82 hospital social work departments in New Jersey. Among their findings: regarding workload, 42 percent reported an increase in the size of dcpartmcnt staff, though 83 percent also reportcd an increase in caseload size; regarding tasks, 85 percent said the amount of time devoted to discharge planning increased; and regarding the influence of social work, 56 percent perceived an increase. Ortiz and Bassoff (1988) compared a group of 50 proprietary hospital social service directors with 308 American Society of Hospital Social Work Directors (ASHSWD) members. Thc findings must be viewed with caution, since 11.4 percent of the ASHSWD group themselves were in proprietary hospitals, thereby distorting

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the results. Nonetheless, some valuable distinctions were found, including a much higher percentage of masters degree graduates among the ASHSWD group. While each of these studies pose important questions regarding the operation and performance of social service departments, they share common weaknesses. First, each relies on the reporting and perceptions of a very limited number of respondents. This strategy raises obvious questions of bias, even if the results are kept confidential. There is generally inadequate attention to matters of validity or reliability in each of these studies. Likewise, greater attention must be given to the consistency of measures across organizations. For example, Jansson and Simmons used "the ratio of social workers to the number of hospital beds" as the important measure of their independent variable. But there is no distinction for part-time or full-time social workers, or a comparative level of training and experience among the staff. Furthermore, the size of the hospital does not account for occupancy or acuity. Needed is organizational research based on valid and reliable data which can have practical application to the administration of social service departments. The general question is the relationship between various organizational designs and strategies, for example in size, staff composition and social worker deployment throughout the hospital, and service outcomes, measured in productivity, patient outcomes and general organizational efficiency. A combination of descriptive, retrospective and prospective experimental studies would make for a rich body of health care social service management research. INTERPROFESSIONAL AND INTERORGANIZATIONAL RELATIONS The Mdor Issues Health service is an intensely social process, requiring the coordinated work of numerous professionals, agencies and related persons who exchange information, resources and the tangible tools of service delivery. That necessary interaction is framed by the organizational context in which it occurs, as the rules, roles, status and

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incentive systems which modify behavior operate to facilitate or impede collaboration. The most visible manifestation of that framework is the manner in which people relate to one another. Those relationships are a matter of great professional interest to social workers, whose intervention is often in the system aspects of the patient's continuum of care. If the patient is not understanding the physician's instructions, if the home health agency is not responding to the patient's needs, or if there are no nursing home beds available in the community, it is the province of the social worker to act and intervene. This role of the social worker as a force in the politics and negotiations of the organization has received a great deal of attention in the general social work literature (Holloway & Brager, 1985; Gummer & Edwards, 1985; Berkman et al., 1985; Rehr, 1985; Meenaghan & Gruber, 1986; and Marcus, 1987). The professional dyad which has received the most interest in the health care social work literature has been the physician-social worker relationship. Schilling and Schilling (1987) examine factors which promote or inhibit collaboration among the two, suggesting that current changes affecting both professions present opportunities for improving the relationship. Mizrahi and Abramson (1985) analyze sources of strain between medicine and social work, comparing: the organization and socialization process of training; attitudes regarding patient care, illness and professionalism; differences regarding the use of information and data; and attitudes regarding teamwork and the role of the social worker. They caution social workers that problems in negotiating this interaction are more likely a function of structural/systemic factors than they are a matter of idiosyncraticipersonal considerations. Abramson and Mizrahi (1986) further suggest that collaboration between the professions "will be enhanced by the identification of social work as a resource for the physician." They argue that by elevating the status of social work with physicians, social work influence over patient care will likewise increase. Roberts (1989) extends the discussion of social work-physician relations by using a value framework, suggesting that conflicts emerge from the differing values regarding quality of life, patient autonomy, the use of data, responses to emotional problems and differing perspectives on interdisciplinary team roles. Abramson (1984) considers interdisciplinary conflict from a

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moral-ethical perspective in her discussion of the meaning of collective responsibility among health care providers. She examines the question from the viewpoint of collective interdisciplinary decision making, and from the perspective of an individual professional within that collective. Among her recommendations with direct organizational implications is the development of regular procedures for analyzing complex ethical dilemmas. Organizational power for women in the health care field is examined by Chernesky and Tirrito (1987). They argue that if power is understood and used to the advantage of colleagues in pursuit of the organizational mission, gender and gender imbalances will be a lesser factor in decision making. They note that positions which affect length of stay and occupancy are sources of power in hospitals since these variables are of importance to the organization. Single Site Studies Several single site studies highlight interprofessional and interorganizational issues. Ritvo (1987) conducted a one year study on efforts to link discharged inpatients to community support services. He concludes that passive referrals will not accomplish aftercare expectations, and recommends an aggressive program of interorganizational and interpersonal discharge planning to maintain continuity of care. Clarke et al. (1986) provide a case study analysis of the development of social work roles and functions in a newly established primary medical group practice. The social workers' clinical role emerged from the primary care goal of the group practice: minimizing specialty referrals and thereby reducing the fragmentation of care. While this is a self report, thereby raising questions of the validity and reliability of the information, it nonetheless is a valuable documentation of the development of organizational roles and responsibilities. Vincent and Davis (1987) studied nurse-social work collaboration in managing complex interagency problems for the clients of a home health agency. Using two sources of data, nursing staff reports of client social problems and daily activity logs of social service staff, they traced the quantity and quality of cases referred by nurses to social service staff. They found a sporadic pattern of refer-

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rals and communication betwecn the two, and noted that "the social workers and nurses did not demonstrate an awareness of the agency's expectations of social workers."

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Multi-Site Research lntcragency cooperation and referral patterns is a critical componcnt of social work practice. The question is, what are the determinants of interaction? These organizational functions have been studied from both an institutional and an individual perspective. Prager (1986) compared the simulated referral patterns of two comparable welfarc agency offices, to determine if differenccs in organizational structure correlate with differences in refcrral patterns. One of the agencies had an Older Persons Unit which providcd more personalized and professionally specialized attention than the other agency, which refcrrcd clients from its general pool of workers. Prager classified the first as a pcople changing organization, and the second as a people processing organization (Hasenfield, 1983). He found that workers in the first agency were less likely to refcr thc client to an institutional setting, were morc likely to use community-based services, and were more inquisitive about the background and needs of the client. The study makes a good case for the importance of organizational context in influencing the practice patterns of social workers. Kurtz (1985) also examined multi-site practice patterns, finding that ideological agreement of professionals corresponds to interorganizational cooperation. She surveyed members of Alcoholics Anonymous (AA) and professionals in nearby treatment centers to asscss cooperation and rivalry among them. Though their domains of practice and intervention did overlap, this potential competition was not perceived by the respondents to decrease cooperation. Those professionals clarified as non-cooperating, so labelled because of their attitudes toward AA, scored significantly differently than coopcrating professionals on a six item value scale and a four item treatment approach scale. Kurtz et al. (1987) surveyed mental hcalth social workers working in agencies in close proximity to mutual-aid groups that offered closely parallel services. These social workers were selected be-

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cause of their importance as the "linking person" in promoting interorganizational relationships. It was found that while 84 percent made referrals to mutual-aid groups of various kinds, only 56 percent referred to the mental health mutual-aid group, and only 26 percent performed linking activities other than referrals. The data suggest that social workers are more likely to refer clients to experts rather than peer-led forms of continuing care. SERVTCE DELIVERY

The Mqjor Issues The matter of organizational influence on service delivery patterns is perhaps at the far reaches of what can be included in the literature on health care social work organization. This question is at the fine line between what is practice method and organizational context. This section reviews a sampling of research which sheds light on both organizational design and service delivery. Perhaps no social work practice responsibility is more 'organizational' than discharge planning. James (1987) applies an "ecological" approach to her conceptualization of discharge planning, including interprofessional, client-organization and interorganizational activity to describe the interaction of people within and outside of the organization. She recommends that "the needs of both in developing strucclient and organization require attention tures which facilitate collaboration rather than conflict between participating professional, organizational and client systems." Blumenfeld and Rosenberg (1988) present a model of "social health care management" which is responsive to the reimbursement and regulatory constraints affecting hospitalization. This model is intended to replace "discharge planning" as an operative definition for preparing the patient to leave the hospital. Their network of social health care services includes attention to patient needs before admission; consultations to physician and patient prior to hospitalization, either in the hospital or in the physician's office; preadmission screening programs; case management services for the elderly and disabled and development of health education and health pro-

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motion programs. Coulton (1988) emphasizes the importance of interorganizational collaboration to accomplish quality assurance of post hospital care. Because social workeis are positioned at transition points along the continuum of care, they can assume a leadership role in dcvcloping these quality assurance mechanisms. Rosscn and Coulton (1985) outline a research agenda for discharge planning, to provide support for organizational design based on scientific rcsearch. Among their recommendations are usc of control groups to compare different approaches, tests of models which formally assign discharge planning to a single coordinator, and collection of follow-up data to adjust patient care, reduce avoidable costs, and build new alternative health programs. In addition to the intra- and interinstitutional organizational activities typified by discharge planning, health care social work has also taken the initiative to create new organizations and programs for target populations requiring innovative services. Black et al. (1986) propose a multidisciplinary, multi-institutional model for developing health promotion services for the chronically ill. They contend that "voluntary health agencies constitute a most advantageous, yet under utilized, organizational setting for the delivery of services for the chronically ill." Gummer (1988) traces the evolution of the hospice as an "alternative" organization, a reference to the kinds of services offered and the organizational structures for their provision. His discussion identifies issues facing hospice organizations, such as negotiating with funding sources which may not share hospice values, and the resulting staff tensions fostered by necessary compromises. He offers a set of strategies for action, so that hospices can preservc their unique approach to serving the dying and their families. Rusnack et al. (1987) conceptualize the social work role in the hospice setting as encouraging "safe passage," facilitating a nurturing environment for the person-in-transition. Poole and Carlton (1986) outline a model for analyzing utilization of the matcrnal and child health services which can address the high infant mortality rate in this country. They conclude that ". . . (h)ealth systems factors detcrmine . . . the kinds of organizational strategies implemented to reduce barriers to health care utilization and creatc

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greater consumer demand for needed services." Each of these innovative programs and organizational designs provide the framework for research and evaluation that will test their effectiveness in addressing service population needs.

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Single Site Studies

A number of single site follow-up studies have been conducted which evaluate, in part, the intra- and interorganizational effectiveness of providing a continuous availability of services to patients following hospital discharge. Evans et al. (1989) compared two groups of medical patients with matched diagnoses for lengths of stay. The study group was seen by social work, while the control group was not. The timing of social work involvement with the patient was monitored. Confirming their hypothesis, the study group had a longer length of stay than the control group. They also found that earlier consultations given the study group accounted for a significant amount of variance in that group, and that the earlier the consultation, the shorter the length of stay. Semke et al. (1989) examined social work coordinated discharges at a 387-bed tertiary hospital, finding that system factors contributed to 77 percent of delayed discharges, the most frequently noted system delay being the lack of post hospital beds. Solomon and Gordon (1987) report on a follow-up study of 114 patients who appeared at a psychiatric emergency room. Eighty one percent were referred to a community agency from the emergency room. The research project collected data on all subsequent visits to those agencies in the three months following the initial ER visit, to find that only 48 percent actually made contact. The authors conclude that this finding may signal the need for a more aggressive referral policy, in particular for those who have a substance abuse problem. Wolock et al. (1987) followed sixty-nine patients hospitalized for a serious illness and discharged to their own or a relative's home. They found that while service provision was limited, the social worker had a critical role in linking the patient to community services. Cheder and Barbarin (1984) examined the often conflictual relationship between parents of children with cancer and medical staff, commenting that "the research . . . suggests that . . .

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social workers should perform a mediating function that addresses the relationship between the family and the medical staff."

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Multi-Site Research Given the many circumstantial differences in service delivery and discharge planning among hospitals, multi-site research provides the most generalizable and applicable information. Abramson (1988) conducted a study of participation of elderly patients in discharge planning at seven acute care facilitics, collecting data from 57 social workers on 148 discharges. Using a nine item participation scale completed by the social worker, a participation score was determined for each patient. Among the findings, the greater the amount of time spent by the social worker with the families, the lower was the patient participation score. Kruzich (1986) studied 63 patient discharges from mental hospitals to 28 different intcrmediate and skilled nursing facilities in Washington state. The purpose of the study was to determine the relationship bctween institutional variables and the integration of the patient-into the larger community. Integration was measured as involvement by the patient in a set of mutually exclusive activities. The most important predictor of residents' involvement in the larger community was the rigidity of routine within the facility. Another significant indicator was the perccption of the usefulness of social selvices: a higher regard for social services correlated with greater integration of patients into a community. While interesting, the small sample size distributed among so many institutions limits the statistical significance of the findings. CONCLUSION

A rich body of knowledge spans organizational topics relevant to the practice, conceptual development and planning of social work health care services. At a time when health care organizations are experiencing major changes in their structure and financing, this organizational research informs both the system adjustments and leadership which social work can offer the health care field. In many cases, social work has bolstered its organizational position by

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offering effective responses to these larger changes, manifested as discharge planning, linkage programs with the community and service accountability systems. The organizational research reviewed in this article provides the opportunity to test, support and legitimate these social work innovations. There is a good deal more work needed to further advance the field and its potential contributions. Greater attention should be given to methodological rigor in designing and implementing research projects. Many of the studies reviewed here did not discuss the reliability or validity of their data collection instruments or scales. Few studies incorporated a control group or a sample size that was statistically significant. And even when studies used multisite comparisons, there was often scant attention to the comparability of the sites. Elevating the standards of the research will not only improve its quality, but will also enhance its generalizability and practical application to organizational change. The use of experimental and quasi-experimental design will offer further support to research conclusions and organizational innovations. Especially in large acute care facilities where there are numerous separate units and a rapid turnover of patients, different organizational and service delivery strategies can be tested and compared. This method can be useful in trials of interdisciplinary collaboration efforts, discharge planning systems and management innovations. The current focal interests in the field of health services research are "outcomes7' and "effectiveness." Health care social work research has much to offer those efforts which assess outcomes and effectiveness of various organizational designs and service delivery strategies. By adopting research standards and topics which conform to general trends in the field, social work research can play an even greater role in shaping changes in health care organization, service delivery and financing. REFERENCES Abramson, 1. (1988) "Participation of Elderly Patients in Discharge Planning: Is Self-Determination a Reality?" Social Work, 33:443-451. Abramson, J. & Mizrahi, T. (1986) "Strategies for Enhancing Collaboration Between Social Workers and Physicians." Social Work in Health Care, 12:1, 122.

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Abramson, M. (1984) "Collective Responsibility in Interdisciplinary Collaboration: An Ethical Perspective for Social Workers." Social Work in Health Care. 10:1, 35-44. Berkman, B.; Kemler, B., Marcus, L.; & Silverman, P. (1985) "Course Content for Social Work Practice in Health Care." Journalof Social Work Education. 21:3, 43-51. Berkman, B.; Bonander, E.; Kemler, B.; Marcus, L.; Rubinger, M. J.; Rutchik, I.; & Silverman, P. (1988) Social Work in Health Care: A Review of the Literature. Chicago: Society for Hospital Work Directors, American Hospital Association. Black, R.; Dornan, D. & Allegrante, J. (1986) "Challenges in Developing Health Promotion Services for the Chronically Ill." Social Work. 31:287-293. Blumenfield, S. & Rosenberg, G. (1988) "Towards a Network of Social Health Services: Redefining Discharge Planning and Expanding the Social Work Domain." Social Work in Health Care, 13:31-48. Chernesky, R. & Tirrito, T. (1987) "Sources of Organizational Power for Women in the Health Care Field." Social Work in Health Care, 12:4, 93-102. Chcsler, M. & Barbarin, 0. (1984) "Relating to the Medical Staff: How Parents of Children with Cancer See the Issues." Health and Social Work, 9:49-65. Clarke, S.; Neuwirth, L.; & Bcrnstein, R. (1986) "An Expanded Social Work Role in a University Hospital-Based Group Practice: Service Provider, Physician Educator and Organizational Consultant." Social Work in Health Care, 11:4, 1-18. Coulton, C. (1988) "Prospective Payment Requires Increased Attention to Quality Post-Hospital Care." Social Work in Health Care, 13:19-30. Coulton, C.; Keller, S.; & Boone, C. (1985) "Predicting Social Workers' Expenditure of Time with Hospital Patients." Health and Social Work, 10:35-45. Dincrrnan, M.; Seaton, R.; & Schlesinger, E. (1986) "Surviving DRG's: New Jersey's Social Work Experience with Prospective Payments." Social Work in Health Care, 12:1, 103-113. Edinburg, G. (1988) "Social Work in Teaching Hospitals and Expansion of ForProfit Health Corporations." Health and Social Work, 13:122-129. Evans, R.; Hendricks, R.; Lawrence-Umlauf, K.; & Bishop, D. (1989) "Timing of Social Work Intervention and Medical Patients' Length of Stay." Health Care and Social Work, 14:277-282. Germain, C. (1984) Social Work Practice in Health Care: An Ecological Perspective. New York: The Free Press. Germain, C. & Gitterman, A. (1980) The Life Model of Social Work Practice. New York: Columbia University Press. Gumrner, 8.(1988) "The Hospice in Transition: Organizational and Administrative Perspectives." Administration in Social Work, 12:2, 31-43. Gummer, B. & Edwards, R. (1985) "A Social Worker's Guide to Organizational Politics." Adnrinistration in Social Work, 9:1, 13-22. Haber-Scharf, M. (1985) "Costing Social Work Services in a Hospital Setting." Social Work in Health Core, 11:1, 113-129.

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Hasenfeld, Y. (1983) Human Service Orgonizatiom. Englewood Cliffs: PrenticeHall, Inc. Holloway, S. & Breger, G. (1985) "Implicit Negotiations and Organizational Practice." Administration in Social Work, 9:2, 15-24. James, C. (1987) "An Ecological Approach to Defining Discharge Planning in Social Work." Social Work in Health Care, 12:4,47-60. Jensson, B. & Simmons, J. (1985) "The Ecology of Social Work Departments: Empirical Findings and Strategy Implications." Social Work in Health Care, 11:2, 1-16. Jensson, B. & Simmons, J. (1986) "The Survival of Social Work Units in Host Organizations." Social Work, 31:339-343. Krell, G. & Rosenberg, G. (1983) "Predicting Patterns of Social Work Staffing in Hospital Settings." Social Work in Health Care, 9:2, 61-80. Kruzich, J. (1986) "The Chronically Mentally I11 in Nursing Homes: Issues in Policy and Practice." Health Care and Social Work, 11:5-14. Kurtz, L. (1985) "Cooperation and Rivalry Between Helping Professionals and Members of AA." Health Care and Social Work, 10:104-112. Kurtz, L., Mann, K. & Chambon, A. (1987) "Linking Between Social Workers and Mental Health Mutual-Aid Groups." Social Work in Health Care, 13:6978. Marcus, L. (1987) "Discharge Planning: An Organizational Perspective." Health and Social Work, 12:39-46. Meenaghan, T. & Gmber, M. (1986) "Social Policy and Clinical Social Work Education: Clinicians as Social Policy Practitioners." Journal of Social Work Education, 22:2, 38-45. Mizrahi, T. & Abramson, J. (1985) "Sources of Strain Between Physicians and Social Workers: Implications for Social Workers in Health Care Settings." Social Work in Health Care, 10:3, 33-52. Ortiz, E. & Bassoff, B. (1988) "Proprietary Hospital Social Work." Health and Social Work, 13:114-121. Patti, R. & Ezell, M. (1987) Performance Priorities and Administrative Practice in Hospital Social Work Departments." Social Work in Health Care, 13:7390. Poole, D. & Carlton, T. (1986) "A Model for Analyzing Utilization of Maternal and Child Health Services." Health and Social Work, 11:209-222. Prager, E. (1986) "Bureaucracy's Impact on Decision Making in Long-Term Care." Health and Social Work, 11:275-285. Rehr, H. (1985) "Medical Care Organization and the Social Service Connection." Health and Social Work, 10:245-257. Ritvo, R. (1987) "Coordinating In-Patient and Out-Patient Services: The Need for Action." Social Work in Health Care, 13:39-50. Roberts, C. (1989) "Conflicting Professional Values in Social Work and Medicine." Health and Social Work, 14:211-218. Rosenberg, G. & Clarke, S. (1987) "Findings and Implications." Social Work in Health Care, 12:3, 143-159.

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Rossen, S. & Coulton, C. (1985) "Research Agenda for Discharge Planning." Social Work in Health Care, 10:4, 55-62. Rusnack, B.; Schaefer, S.; & Moxley, D. (1987) "'Safe Passage': Social Work Roles and Functions in Hospice Care." Social Work in Health Care, 13:3-20. Schill~ng,R. & Schilling, R. (1987) "Social Work and Medicine: Shared Interests." Social Work, 32:231-234. Semke, J.; VanDerWeele, T. & Weatherley, R. (1989) "Delayed Discharges for Medical and Surgical Patients in an Acute Care Hospital." Social Work in Heahh Care, 14:15-32. Sheridan, M. (1988) "Time Management in Health Care Social Work." Social Work in Health Care, 13:3, 91-99. Solomon, P. & Gordon, B. (1987) "Follow-up of Outpatient Referrals from a Psychiatric Emergency Room," Social Work in Health Care, 1357-68. Speno, R. & Lund, S. (1986) "Productivity and Performance: Keys to Survival for a Hospital-Based Social Work Department." Social Work in Heallh Care, 11:3, 25-40. Stoess, D. (1986) "Corporate Health Care and Social Welfare." Health and Social Work, 11:165-172. Vincent, P. & Davis, J. (1987) "Functions of Social Workers in a Home Health Agency." Health and Social Work, 12:213-219. Walsh, A. (1987) "Impact of DRG Reimbursement: Implications for Intervention." Social Work in Health Care, 13:lS-24. Wolock, 1. et al. (1987) "The Post-hospital Needs and Care of Patients: Implications for Discharge Planning." Social Work in Health Care, 12:4, 61-76.

Research on organizational issues in health care social work.

A rich body of knowledge spans organizational topics relevant to the practice, conceptual development and planning of social work health care services...
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