Social Work in Health Care
ISSN: 0098-1389 (Print) 1541-034X (Online) Journal homepage: http://www.tandfonline.com/loi/wshc20
The Functional Analysis Study Roslyn H. Chernesky MSW & Abraham Lurie PhD To cite this article: Roslyn H. Chernesky MSW & Abraham Lurie PhD (1976) The Functional Analysis Study, Social Work in Health Care, 1:2, 213-223, DOI: 10.1300/J010v01n02_10 To link to this article: http://dx.doi.org/10.1300/J010v01n02_10
Published online: 26 Oct 2008.
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Date: 11 June 2016, At: 16:04
THE FUNCTIONAL ANALYSIS STUDY: A FIRST STEP IN QUALITY ASSURANCE
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Roslyn H. Chernesky, MSW Abraham Lurie, PhD
A B S T R A C T . This article describes a recent study o f h o w social work s t a f f i n a large medical center spend their time-the tasks and activities performed regularly. T h e ualue o f this kind o f study, especially as a first step i n the development o f a comprehensive quality assurance program for a department o f social work seruices, is discussed.
WHY A FUNCTIONAL ANALYSIS STUDY? With the growing need t o assure the quality of care they provide, social workers, along with physicians, nurses, and nonmedical personnel, must develop procedures to evaluate their services. In response to P.L. 92-603, the 1972 federal mandate for the ongoing review of care, social work departments in medical and health settings are establishing programs that will monitor and in some measure account for both the services they deliver and the extent to which these services meet the standards set by the institution and by the profession.' . 2 Among the programs being developed are medical audits, patient services evaluations, and consumer evaluations. In planning for these quality assurance programs, less attention has been given t o the development of procedures that will explain and account for how staff members spend their time. Yet a record of time spent on the tasks and activities performed regularly by social work staff is a key aspect of any departmental effort t o strengthen its accountability to clients, to the institution, to the public, and t o the profession. A systematic procedure by which staff members report how they spend their time can provide information that may contribute t o more effective use of resources t o achieve program goals. Such a record can deepen social workers' understanding of what they are doing, of the range of tasks and activities they perform regularly, and of the factors -
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Ms. Chernesky is Assistant Professor, Columbia University School o f Social W o r k , 622 W e s t 1 1 3 t h Street, N e w Y o r k , N e w Y o r k 10025. Dr. Lurie is Director, Department o f Social W o r k Services, Long Island Jewish-Hillside Medical Center, N e w Y o r k . Social W o r k in Health Care, V o l . 1(2),Winter 1975-76
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that affect patterns and variations in the use of their time.3.4 Moreover, a procedure for recording how staff time is spent serves as a necessary base upon which a more extensive and depth approach to quality assurance can be built. Before one can assess how well staff are doing, one must know and document what staff are doing. As an early phase in the development of a comprehensive quality assurance program, the Department of Social Work Services at Long Island Jewish-Hillside Medical Center conducted a functional analysis study.* It was designed to determine the tasks and activities on which staff members spent their time each day. Several considerations prompted the department's administration to engage in the study. There had been a growing need for objective data about how social work staff time was spent. "Hard" data rather than impressionistic data were needed to plan for the allocation and expansion of personnel. In order to increase the social work staffing complement or to change staffing patterns, it was necessary to have'information on the way staff were being used. In order to justify the need for additional offices or clerical staff, it was necessary to have information on the staff time spent in locating office space and performing clerical tasks. We believed a functional analysis study could provide the data, the statistics, and the graphic pictures necessary for this departmental planning. As important as it was to have data to use with hospital administration, the staff of the department had come to realize that they needed a picture of themselves for themselvesa kind of self-study. The rapid expansion of departmental programs, services, and size, further complicated by a merger and affiliation of four hospitals into one medical center, made it increasingly difficult to know the extent to which departmental efforts were directed toward the primary function of social work. It was unclear whether departmental efforts and goals, as illustrated in the expenditure of staff time, had inadvertently been redirected or displaced. How - much time is invested in staff development and student training? How much worker time is used in recording or in meetings? It was no longer possible to answer these questions with notions and hunches. We decided, therefore, that a functional analysis study was to answer such questions as: 1. How much staff time is spent in each of the department's activities? 2. How is staff time spent within each activity? *The Long Island Jewish-Hillside Medical Center is comprised of four hospital divisions that merged in February 1973: Hillside Hospital, a voluntary psychiatric hospital; Queens Hospital Center, a municipal hospital that has a psychiatric service as well as medical and surgical services; Long Island Jewish, a general hospital; and South Shore, a general hospital. The Department of Social Work Services had a social work staff of 217 at the time of the study.
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Roslyn H. Chernesky and Abraham Lurie
3. How much time is spent in direct patient care? 4. How much time is spent in "processing" tasks, such as case recording? 5. What is the department's contribution in staff time to training of social work graduate and undergraduate students? 6. To what extent do staff participate in staff education and development? 7. To what extent can variations in expenditure of staff time be explained by hospital division, setting (medical or psychiatric), service unit (inpatient, outpatient, etc.), level of worker (supervisor, social worker, social work associate/assistant), or characteristics of workers? Finally, we believed that sound preparation f o r the department's future quality assurance program included a study that highlighted quantitative accounting of workers' activities.
METHOD The Study The Functional Analysis Study was a time study of workers' daily activities. There was a procedure for selecting a sample of workers and for examining some of the factors that affect the way time is ~ p e n t . ' > ~ " ~ study he was conducted for a 3-week period in February 1974. On each of the 15 days of the study, those staff members who were selected to participate recorded how they spent their time. They used a schedule form especially designed for logging the necessary data. Workers accounted for every minute of their day by recording six items of information: the time each task was begun; the time each task was terminated; the total time elapsed for each task; the purpose of the task in terms of the activity center in which it belonged; the numerical code of the task as it was listed in the Activity and Task Manunl; and a brief description, in the worker's own words, of what the task was and the reason why it was performed. All tasks were recorded according t o a classification scheme based upon nine activity centers and precoded job tasks within each activity center that represent the purpose for engaging in a given task.
Activity and Task Manual A manual describing and listing all possible activities and tasks that the social work staff were likely t o perform was developed t o assist in the collection of the data. The manual was an important component of the study. It helped to set the boundaries for the kinds of activities and tasks that were of interest t o the functional analysis review. It also helped t o focus the worker on what constituted a task, how tasks were perceived, and how tasks were both ordered and interrelated. The manual developed was based upon the activity manual of Hill, Ormsby, and ~ c C u r d ~ ,and ' an attempt was made t o adapt the tasks so they would be more relevant to what social workers were doing in hospital settings. Their conceptual framework of functional and supportive service centers was retained. We used nine
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activity centers into which all tasks were grouped: Social Work, Student Training, Community Planning, Staff Development, Work with Volunteers, Public Information and Education, Administration, Research, and Miscellaneous. 1. The Social Work Activity Center included all tasks associated with rendering social work service t o patients. Direct contact, telephone contact, and group interviews with and on behalf of the patients were included. Workers' tasks that included dictating and writing case records, letters, memos, referrals, chart comments, and the like were considered t o belong in this activity center. Similarly, supervision, either giving o r receiving, that was related to specific patients, clients, or cases was part of the Social Work Activity Center. 2. The Student Training Activity Center included all tasks related to the fieldwork training and supervision of students: conferences, meetings, and contacts with school representatives, task supervisors, and students; field trips; and participation in school curriculum or school planning committees. 3. Community Planning and Community Activities included all participation by staff as agency representatives in social planning, social action, and other community activities on a local, state, regional, or national level. 4. Staff Development tasks included those whose general purpose was the development o f social work staff and included those that staff attended as learners or as teachers. They included case consultations or case conferences; classes, seminars, and other educational conferences; supervision and staff meetings where the primary objective was workers' general development; and reading professional and other literature related t o the job during office hours. 5. Work with Volunteers included all tasks concerned with the recruitment, training, and supervision of volunteers for the medical center. 6. The Public Information and Education Activity Center included all tasks in which the primary purpose was t o explain the work, policies, and practices of the medical center and the Department of Social Work t o the public. 7. General Administration included a range of tasks such as board and committee meetings; personnel administration; budgeting and fiscal operations; routine compilation of agency service statistics; training, supervision, and periodic evaluations of clerical staff; repairs, plant maintenance, and housekeeping; drafting, putting into effect, and supervising administrative procedures; program planning; attendance at meetings, conferences, and consultations for administrative purposes. This activity center also included the workers' daily tasks in preparation for their day's work, such as clearing off desks, checking mail, and picking up messages. When staff "helped out," such as answering the phone during lunch hours or Xeroxing materials, these tasks were included under Administration. 8. Research referred t o tasks performed on behalf of the time study itself as well as on any other research projects at the medical center. 9. Miscellaneous tasks included lunch, compensating "time off," illness, and the gamut of those kinds of nonproductive tasks such as visiting the rest room, socializing with colleagues, office parties, and lateness. In each activity center, workers had the opportunity t o record the tasks performed in preparation for or as follow-up t o other tasks. This was helpful in collecting information on the myriad of worker tasks that invariably are vaguely described, nondiscrete, and often of very short duration. Workers also could record in each activity center the time taken t o go t o and from other tasks. This was considered t o be of great value by workers who felt it necessary t o record "wasted time," for example, waiting for elevators, going back and forth to wards, going t o central meeting rooms, and locating interviewing space.
Roslyn H. Chernesky and Abraham Lurie
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The use o f activity centers made it possible to convert all tasks from a description o f what they were to their purpose. Social workers learned at the very beginning that all tasks in which they engaged must be recorded according to the reason for their engaging in it and not just according to what the task was. The purpose o f the tasks would always be one o f the nine activity centers. For example, a worker could not record the task "Attend meeting" unless she knew the purpose for her attendance. Once answering that question, she could record the task in one o f a number o f activity centers-for social work purposes, for staff development, for administrative reasons, and so forth. Use o f the manual also was helpful in that it allowed for the collection o f data in a coded form, thereby eliminating the need to code data after collection. We believe that the Activity and Task Manual was the key t o the s~iccessfulcollection o f data. Although we did not have a perfect manual, it proved invaluable to use one that was only a working document and in the beginning stages o f refinement. A page from the manual follows: SOCIAL WORK (1 00) The Social Work Activities Center should include all activities directly associated with rendering social work service to patient or client. Inperson, individualinterview with patient Any discussion between worker and patient. Specify the purposeintake (admissions, registration) or treatment, etc. Telephone interview with patient Any discussion between worker and patient by phone. Specify purpose, i.e. to arrange, change or cancel appointment, to answer inquiry. Inperson, individual interview about patient Any discussion about a specific patient. Specify with whom-i.e. physician, nurse, psychiatrist, social worker, psychologist, activities therapist, secretary, patient's family or relative or friend, vocational rehabilitation counselor, administrator, director, outside agency, etc. Telephone interview about patient Any discussion by phone about a specific patient. Specify with whom. Group interview with patient Any disc'ussion or meeting between worker and patient and others. Specify purpose o f group interview-i.e. orientation, screening, discharge planning, patient government, family therapy, group therapy, etc. Group interview about patient Any discussion between worker and two or more people, excluding patient. This includes interviews with family members about the patient, group meetings o f several families, meetings among staff (team) or with patients and staff where specific patient is discussed. Specify purpose-family therapy, patient-staff meeting, team meeting, case conference, etc. Supervision This includes the time o f both supervisor and social worker. I t includes only supervisor-worker conferences that are related to specific clients including actual assignment o f cases or particular
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aspects of cases. Supervisor-worker conferences or parts of such conferences not concerned with specific clients as much as with the general professional development of the worker, such as an evaluation conference, should be coded as 403. Dictating and writing case record This includes only the actual dictation o r writing of case records; preparation for dictating case records such as hunting records, assembling notes, etc. should be coded as 110 listed below. Dictating and writing of letters, memos, referrals, etc. related Lo patients If any of these miscellaneous activities are done primarily as preparation for some other activity, as many of them probably will be, code them as 110. Since these miscellaneous activities are not often done in orderly sequence, common sense approximations of the 6mount of time spent on each of them will have to be used. Preparation for or follow-up on other activities in social work This refers to such activities as reviewing a case record for a client interview, looking up referral sources for a client, recording notes on a n inlerview for later dictation, as well as the handling, processing and filing of case records, etc. Out-of-office lravel related to social work activities Tizis includes travel to and from a client's home, an interview or visit with another agency o r case conference coded in this service unit.
Procedures Workers were selected t o participate through - a stratified random sampling design. This design resulted in a sample of social work staff that was representative of the population of social work personnel in the four divisions of the medical center. The use of a sampling plan made it unnecessary for every staff member t o keep daily logs in order t o generalize about the distribution of total staff time among tasks. Those workers selected t o participate were informed of this on the day preceding the study in order t o avoid the rearrangement of workday schedules. Six workers were selected for each day of the study. Most workers were never selected t o participate (at the time of the study the department had 217 social work staff members), and several were chosen more than once. A total of 7 4 different workers participated during the 15-day study period. The recording schedules were sent directly t o the researcher upon completion and were not made available t o the supervisory staff. This was t o ensure the credibility of the study for the staff; that is, data went directly t o the researcher and could not be "evaluated" by the supervisor. The data were punched on IBM cards and analyzed with the use of Crosstabs. The base for analysis was the time spent o n tasks rather than the number of tasks o r the number of individual workers. Thus data will be discussed in terms of the percentage of workers' time spent on tasks and in activity centers. Data were analyzed for the Department of Social Work Services as a whole; for each of the four hospital divisions; and for position-titles.* These three levels of *Four categories of position-titles were used in this analysis: (a) directors, which also included associate or assistant directors of the Department
of Social Work Services; (b) supervisors, which also included those with titles of administrative and assistant supervisors; (c) social workers, those with graduate social work degrees; and ( d ) social work associates or assistants, those without master's degrees.
Roslyn H. Chemesky and Abraham Lurie
analyses provided a general picture of task and activity patterns for the total staff as well as comparisons among hospital divisions and position-titles. Although i t is not referred to in this discussion, a picture of each worker's time and activity pattern was derived as well.
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FINDINGS Our findings will be examined first in terms of the amount of time spent by the total sample of social work staff a t the medical center in the nine activity centers. The findings should be viewed as tentative. The study should be replicated, as only through replication can we be confident of its reliability and validity. Also, it is probable that a different sampling procedure, with data collected even for only 1day, would strengthen the study's validity. Table 1 summarizes these findings and shows that most of the staff's time was spent in the Social Work Activity Center. As the core activity center of a social work department, it was expected that direct service with clients and indirect service on behalf of clients would account for most of the staff's time. Tasks in the Miscellaneous Activity Center comprised 22% of staff time. Although this is slightly more than one-fifth of workers' time, it is not as significant as it seems. The Miscellaneous category includes absences because of illness, vacation, and compensatory time, and at least hours, or 19% of an &hour day, are ordinarily consumed by a lunch period along with a morning and afternoon break. Taking the 19% as an expected average, only 3% of time is spent in nonproductive tasks, that is, 1 4 minutes of each day. Administrative tasks represent 11%of staff time, a small amount when one considers that many routine housekeeping tasks such as
1t
TABLE 1 Percent of All Social Work Staff Time Spent i n Activity Centers'
Activity Center Social Work Miscellaneous Administration Staff Development Research Student Training Work with Volunteers Community Planning Public Information
Percent of r i m e
55 22 11
6 4 2
.3 .3
0
*All staff time is calculated based upon an eight hour working day.
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straightening desks, checking for messages, picking up mail, and the like were included in this center. Six percent of staff time was spent in Staff Development tasks including those in which workers were members as well as leaders of seminars and training sessions. Also included in Staff Development were supervisor-worker contacts for the purpose of the workers' development. Research tasks, which referred primarily to those tasks connected with the Functional Analysis Study, took 4% of staff time, about 20 minutes each day. Only 2% of staff time was spent in tasks in the Student Training category, a very small amount of time considering that the Department of Social Work Services is a major teaching center for social work education. This figure may represent skewed results related to the random sample selected. Since no statistical significance was prepared for the data, all findings are tentative, as noted above. Social work staff spent almost no time in three activity centers: Community Planning, Work with Volunteers, and Public Information. The time the total social work staff spent in each of the activity centers was then compared with the time spent by each of the social work functional levels as illustrated in Figure 1. The comparative patterns of time expenditure are similar in several ways to that expected. Directors spent little time in social work activities; most of their time was spent on administrative tasks. Supervisors engaged in social work activities extensively although less than social workers. One-fifth of supervisors' time was spent in administrative tasks. Social work associates/assistants spent more time in social work activities than did social workers. Directors spent considerable time in staff development tasks. Supervisors spent the least amount of time in staff development (i.e., receiving training), which suggests that little time is spent in helping this level of staff with their supervisory and teaching functions or in preparing them for their job functions. Social work associates/assistants spent slightly more time in formal staff development activities than did social workers. The pattern of staff time expended in the nine activity centers was not the same for each of the hospital divisions. There were differences that may be accounted for by the nature of the hospital (psychiatric, general, voluntary, m ~ i c i p a l )and by characteristics of the social work divisional departments (size, stability, status in the hospital, number of services, staff pattern). Substantial differences were found in the time spent in the Social Work and Miscellaneous activity centers among the four hospital divisions. Despite these variations, it was apparent that what a trained social worker does, in relation to the proportion of time spent in the activity centers, is similar throughout the medical center
Roslyn H. Chernesky and A bmham Lurie
T o t a l Tlme
T o t a l S t a f f Time
Social Work Assocls
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Supervlsr
Scale of A c t l v l t v :enters
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Other V o l u n t e e r s . Publ i c I n f o , Comm. Plannlna S t u d e n t Tralninq Ftesearch S t a f f Development Adrlnlstrstlon Riscellaneous S o c i a l York
FIGURE 1. Percentage of social work staff time in activity centers b y position.
and differs little by hospital division. There is a general consistency in the pattern of time expenditure by social workers that provides a fairly clear picture of how a social worker in the medical center is using his time. There is a less consistent pattern in the use of time among activity centers by associateslassistants when hospital divisions are compared. The wide variations, therefore, make it difficult t o conclude that there is a general similarity in tasks of social work associates/assistants.
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SOCIAL WORK IN HEALTH CARE
We also looked at some of the other key task areas in which staff time is spent: supervision, meetings, and paperwork. Approximately 7% of the time of all social work staff in the medical center was spent in receiving or giving supervision, regardless of the purpose of the supervisory contact. Such use of time was recorded primarily by social workers, whereas associates/assistants recorded spending almost no time in supervision. Eight percent of the time of all social work staff in the medical center was spent in meetings, regardless of their purpose. Almost half of the time spent in meetings was related t o patient care and service such as team meetings and group conferences. Meetings for administrative purposes took as much staff time. Writing case records, chart notations, letters and memos, and keeping statistics (excluding data recording for the Functional Analysis Study) accounted for 12% of the time of all social work staff in the medical center. The amount of time given to writing case records and to the compilation of departmental service statistics varied among hospital divisions, although case recording always consumed substantially more time. DISCUSSION These findings illustrate the kinds of information that can be obtained through a systematic procedure of data collection in a functional analysis study. They provide insight about how social work staff time was spent and about differences in patterns among hospital divisions and position-titles. The Functional Analysis Study also highlighted several areas that call for further and more detailed exploration before conclusions can be drawn. The results, though tentative, raised questions and suggested areas for further consideration by the department's staff. Several of the areas addressed as a result of the study were: 1. The different ways social work associates/assistants are used in the four divisions. 2. The investment in staff development and supervision. 3. The differences in amount and kind of paperwork in the four divisions. 4. The role and function of the social work supervisor. 5. The overextension of some social work staff and what may be the underutilization of others. 6. The administrative tasks that may be more appropriately handled by clerical staff or through better organization of departmental procedures. 7. The amount of time spent in social work activities-55% of an 8-hour day, or 63%of a 7-hour day.
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Roslyn H. Chernesky and Abraham Lurie
The written report of all findings was shared with all members of the staff, and a series of staff meetings were held t o discuss their implications. Staff have deliberated these issues, trying t o account for what was observed and, more importantly, trying t o evaluate what was found. Is the department satisfied with the results? Is there reason to introduce administrative changes on the basis of the findings? For example, the departmental administration decided that it wished t o increase its investment in staff development and, since the study, has devoted greater resources t o this activity. Similarly, the question raised by the study about supervisors' activities stimulated a more thorough examination of their role and function in the department. Thus, our experience suggests that a functional analysis study is both feasible and valuable.' It provides staff members and administrators with a graphic portrayal of how they spend their time. This information is especially needed as social work departments plan for effective and efficient use of resources t o achieve their program goals, as they begin to document the contribution of social work t o the functioning of the medical center, and as they begin their quality assurance programs. REFERENCES 1. Legislative History of Professional Standards Review Organization Provision of the Social Security Amendments. Washington, D.C.: Department of Health, Education, and Welfare, November 1972. 2. Decker, Barry, and Bonner, Paul, eds. PSRO: Organization for Regina1 Peer Review. Cambridge, Mass.: Bollinger, 1973. 3. Shepard, Herman S. "Report of Study of Social Service Departments in Major Hospitals in New York City." Unpublished paper, March 1973. 4. Ullman, Alice; GOSF,Marie E.; e t al. "Activities, Satisfactions, and Problems of Social Workers in H o s ~ i t a lSettines: A Com~arative Studv." Social Service Reuieru 45 (1971): 17-29. 5. Hill, John G.; Ormsby, Ralph; and McCurdy, William B. The Time Analysis Manual. New York: Family Service Society, 1962. 6. Greenwood. Ernest. ed. Time Studies in Social Casework. Los Aneeles: California welfare c d u n c i ~ 1950. , 7. Hill, John G.,and Ormsby, Ralph. Cosl Analysis Method for Casework Agencies. Philadelphia: Family Service Society, 1953. 8. Chernesky, Roslyn H. Functional Analysis Review: Final Reporl. Long Island Jewish-Hillside Medical Center, Department of Social Work Services, May 1974.
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ISSN: 0098-1389 (Print) 1541-034X (Online) Journal homepage: http://www.tandfonline.com/loi/wshc20
The Functional Analysis Study Roslyn H. Chernesky MSW & Abraham Lurie PhD To cite this article: Roslyn H. Chernesky MSW & Abraham Lurie PhD (1976) The Functional Analysis Study, Social Work in Health Care, 1:2, 213-223, DOI: 10.1300/J010v01n02_10 To link to this article: http://dx.doi.org/10.1300/J010v01n02_10
Published online: 26 Oct 2008.
Submit your article to this journal
Article views: 6
View related articles
Citing articles: 2 View citing articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=wshc20 Download by: [Monash University Library]
Date: 11 June 2016, At: 16:04
THE FUNCTIONAL ANALYSIS STUDY: A FIRST STEP IN QUALITY ASSURANCE
Downloaded by [Monash University Library] at 16:04 11 June 2016
Roslyn H. Chernesky, MSW Abraham Lurie, PhD
A B S T R A C T . This article describes a recent study o f h o w social work s t a f f i n a large medical center spend their time-the tasks and activities performed regularly. T h e ualue o f this kind o f study, especially as a first step i n the development o f a comprehensive quality assurance program for a department o f social work seruices, is discussed.
WHY A FUNCTIONAL ANALYSIS STUDY? With the growing need t o assure the quality of care they provide, social workers, along with physicians, nurses, and nonmedical personnel, must develop procedures to evaluate their services. In response to P.L. 92-603, the 1972 federal mandate for the ongoing review of care, social work departments in medical and health settings are establishing programs that will monitor and in some measure account for both the services they deliver and the extent to which these services meet the standards set by the institution and by the profession.' . 2 Among the programs being developed are medical audits, patient services evaluations, and consumer evaluations. In planning for these quality assurance programs, less attention has been given t o the development of procedures that will explain and account for how staff members spend their time. Yet a record of time spent on the tasks and activities performed regularly by social work staff is a key aspect of any departmental effort t o strengthen its accountability to clients, to the institution, to the public, and t o the profession. A systematic procedure by which staff members report how they spend their time can provide information that may contribute t o more effective use of resources t o achieve program goals. Such a record can deepen social workers' understanding of what they are doing, of the range of tasks and activities they perform regularly, and of the factors -
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Ms. Chernesky is Assistant Professor, Columbia University School o f Social W o r k , 622 W e s t 1 1 3 t h Street, N e w Y o r k , N e w Y o r k 10025. Dr. Lurie is Director, Department o f Social W o r k Services, Long Island Jewish-Hillside Medical Center, N e w Y o r k . Social W o r k in Health Care, V o l . 1(2),Winter 1975-76
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that affect patterns and variations in the use of their time.3.4 Moreover, a procedure for recording how staff time is spent serves as a necessary base upon which a more extensive and depth approach to quality assurance can be built. Before one can assess how well staff are doing, one must know and document what staff are doing. As an early phase in the development of a comprehensive quality assurance program, the Department of Social Work Services at Long Island Jewish-Hillside Medical Center conducted a functional analysis study.* It was designed to determine the tasks and activities on which staff members spent their time each day. Several considerations prompted the department's administration to engage in the study. There had been a growing need for objective data about how social work staff time was spent. "Hard" data rather than impressionistic data were needed to plan for the allocation and expansion of personnel. In order to increase the social work staffing complement or to change staffing patterns, it was necessary to have'information on the way staff were being used. In order to justify the need for additional offices or clerical staff, it was necessary to have information on the staff time spent in locating office space and performing clerical tasks. We believed a functional analysis study could provide the data, the statistics, and the graphic pictures necessary for this departmental planning. As important as it was to have data to use with hospital administration, the staff of the department had come to realize that they needed a picture of themselves for themselvesa kind of self-study. The rapid expansion of departmental programs, services, and size, further complicated by a merger and affiliation of four hospitals into one medical center, made it increasingly difficult to know the extent to which departmental efforts were directed toward the primary function of social work. It was unclear whether departmental efforts and goals, as illustrated in the expenditure of staff time, had inadvertently been redirected or displaced. How - much time is invested in staff development and student training? How much worker time is used in recording or in meetings? It was no longer possible to answer these questions with notions and hunches. We decided, therefore, that a functional analysis study was to answer such questions as: 1. How much staff time is spent in each of the department's activities? 2. How is staff time spent within each activity? *The Long Island Jewish-Hillside Medical Center is comprised of four hospital divisions that merged in February 1973: Hillside Hospital, a voluntary psychiatric hospital; Queens Hospital Center, a municipal hospital that has a psychiatric service as well as medical and surgical services; Long Island Jewish, a general hospital; and South Shore, a general hospital. The Department of Social Work Services had a social work staff of 217 at the time of the study.
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Roslyn H. Chernesky and Abraham Lurie
3. How much time is spent in direct patient care? 4. How much time is spent in "processing" tasks, such as case recording? 5. What is the department's contribution in staff time to training of social work graduate and undergraduate students? 6. To what extent do staff participate in staff education and development? 7. To what extent can variations in expenditure of staff time be explained by hospital division, setting (medical or psychiatric), service unit (inpatient, outpatient, etc.), level of worker (supervisor, social worker, social work associate/assistant), or characteristics of workers? Finally, we believed that sound preparation f o r the department's future quality assurance program included a study that highlighted quantitative accounting of workers' activities.
METHOD The Study The Functional Analysis Study was a time study of workers' daily activities. There was a procedure for selecting a sample of workers and for examining some of the factors that affect the way time is ~ p e n t . ' > ~ " ~ study he was conducted for a 3-week period in February 1974. On each of the 15 days of the study, those staff members who were selected to participate recorded how they spent their time. They used a schedule form especially designed for logging the necessary data. Workers accounted for every minute of their day by recording six items of information: the time each task was begun; the time each task was terminated; the total time elapsed for each task; the purpose of the task in terms of the activity center in which it belonged; the numerical code of the task as it was listed in the Activity and Task Manunl; and a brief description, in the worker's own words, of what the task was and the reason why it was performed. All tasks were recorded according t o a classification scheme based upon nine activity centers and precoded job tasks within each activity center that represent the purpose for engaging in a given task.
Activity and Task Manual A manual describing and listing all possible activities and tasks that the social work staff were likely t o perform was developed t o assist in the collection of the data. The manual was an important component of the study. It helped to set the boundaries for the kinds of activities and tasks that were of interest t o the functional analysis review. It also helped t o focus the worker on what constituted a task, how tasks were perceived, and how tasks were both ordered and interrelated. The manual developed was based upon the activity manual of Hill, Ormsby, and ~ c C u r d ~ ,and ' an attempt was made t o adapt the tasks so they would be more relevant to what social workers were doing in hospital settings. Their conceptual framework of functional and supportive service centers was retained. We used nine
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activity centers into which all tasks were grouped: Social Work, Student Training, Community Planning, Staff Development, Work with Volunteers, Public Information and Education, Administration, Research, and Miscellaneous. 1. The Social Work Activity Center included all tasks associated with rendering social work service t o patients. Direct contact, telephone contact, and group interviews with and on behalf of the patients were included. Workers' tasks that included dictating and writing case records, letters, memos, referrals, chart comments, and the like were considered t o belong in this activity center. Similarly, supervision, either giving o r receiving, that was related to specific patients, clients, or cases was part of the Social Work Activity Center. 2. The Student Training Activity Center included all tasks related to the fieldwork training and supervision of students: conferences, meetings, and contacts with school representatives, task supervisors, and students; field trips; and participation in school curriculum or school planning committees. 3. Community Planning and Community Activities included all participation by staff as agency representatives in social planning, social action, and other community activities on a local, state, regional, or national level. 4. Staff Development tasks included those whose general purpose was the development o f social work staff and included those that staff attended as learners or as teachers. They included case consultations or case conferences; classes, seminars, and other educational conferences; supervision and staff meetings where the primary objective was workers' general development; and reading professional and other literature related t o the job during office hours. 5. Work with Volunteers included all tasks concerned with the recruitment, training, and supervision of volunteers for the medical center. 6. The Public Information and Education Activity Center included all tasks in which the primary purpose was t o explain the work, policies, and practices of the medical center and the Department of Social Work t o the public. 7. General Administration included a range of tasks such as board and committee meetings; personnel administration; budgeting and fiscal operations; routine compilation of agency service statistics; training, supervision, and periodic evaluations of clerical staff; repairs, plant maintenance, and housekeeping; drafting, putting into effect, and supervising administrative procedures; program planning; attendance at meetings, conferences, and consultations for administrative purposes. This activity center also included the workers' daily tasks in preparation for their day's work, such as clearing off desks, checking mail, and picking up messages. When staff "helped out," such as answering the phone during lunch hours or Xeroxing materials, these tasks were included under Administration. 8. Research referred t o tasks performed on behalf of the time study itself as well as on any other research projects at the medical center. 9. Miscellaneous tasks included lunch, compensating "time off," illness, and the gamut of those kinds of nonproductive tasks such as visiting the rest room, socializing with colleagues, office parties, and lateness. In each activity center, workers had the opportunity t o record the tasks performed in preparation for or as follow-up t o other tasks. This was helpful in collecting information on the myriad of worker tasks that invariably are vaguely described, nondiscrete, and often of very short duration. Workers also could record in each activity center the time taken t o go t o and from other tasks. This was considered t o be of great value by workers who felt it necessary t o record "wasted time," for example, waiting for elevators, going back and forth to wards, going t o central meeting rooms, and locating interviewing space.
Roslyn H. Chernesky and Abraham Lurie
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The use o f activity centers made it possible to convert all tasks from a description o f what they were to their purpose. Social workers learned at the very beginning that all tasks in which they engaged must be recorded according to the reason for their engaging in it and not just according to what the task was. The purpose o f the tasks would always be one o f the nine activity centers. For example, a worker could not record the task "Attend meeting" unless she knew the purpose for her attendance. Once answering that question, she could record the task in one o f a number o f activity centers-for social work purposes, for staff development, for administrative reasons, and so forth. Use o f the manual also was helpful in that it allowed for the collection o f data in a coded form, thereby eliminating the need to code data after collection. We believe that the Activity and Task Manual was the key t o the s~iccessfulcollection o f data. Although we did not have a perfect manual, it proved invaluable to use one that was only a working document and in the beginning stages o f refinement. A page from the manual follows: SOCIAL WORK (1 00) The Social Work Activities Center should include all activities directly associated with rendering social work service to patient or client. Inperson, individualinterview with patient Any discussion between worker and patient. Specify the purposeintake (admissions, registration) or treatment, etc. Telephone interview with patient Any discussion between worker and patient by phone. Specify purpose, i.e. to arrange, change or cancel appointment, to answer inquiry. Inperson, individual interview about patient Any discussion about a specific patient. Specify with whom-i.e. physician, nurse, psychiatrist, social worker, psychologist, activities therapist, secretary, patient's family or relative or friend, vocational rehabilitation counselor, administrator, director, outside agency, etc. Telephone interview about patient Any discussion by phone about a specific patient. Specify with whom. Group interview with patient Any disc'ussion or meeting between worker and patient and others. Specify purpose o f group interview-i.e. orientation, screening, discharge planning, patient government, family therapy, group therapy, etc. Group interview about patient Any discussion between worker and two or more people, excluding patient. This includes interviews with family members about the patient, group meetings o f several families, meetings among staff (team) or with patients and staff where specific patient is discussed. Specify purpose-family therapy, patient-staff meeting, team meeting, case conference, etc. Supervision This includes the time o f both supervisor and social worker. I t includes only supervisor-worker conferences that are related to specific clients including actual assignment o f cases or particular
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aspects of cases. Supervisor-worker conferences or parts of such conferences not concerned with specific clients as much as with the general professional development of the worker, such as an evaluation conference, should be coded as 403. Dictating and writing case record This includes only the actual dictation o r writing of case records; preparation for dictating case records such as hunting records, assembling notes, etc. should be coded as 110 listed below. Dictating and writing of letters, memos, referrals, etc. related Lo patients If any of these miscellaneous activities are done primarily as preparation for some other activity, as many of them probably will be, code them as 110. Since these miscellaneous activities are not often done in orderly sequence, common sense approximations of the 6mount of time spent on each of them will have to be used. Preparation for or follow-up on other activities in social work This refers to such activities as reviewing a case record for a client interview, looking up referral sources for a client, recording notes on a n inlerview for later dictation, as well as the handling, processing and filing of case records, etc. Out-of-office lravel related to social work activities Tizis includes travel to and from a client's home, an interview or visit with another agency o r case conference coded in this service unit.
Procedures Workers were selected t o participate through - a stratified random sampling design. This design resulted in a sample of social work staff that was representative of the population of social work personnel in the four divisions of the medical center. The use of a sampling plan made it unnecessary for every staff member t o keep daily logs in order t o generalize about the distribution of total staff time among tasks. Those workers selected t o participate were informed of this on the day preceding the study in order t o avoid the rearrangement of workday schedules. Six workers were selected for each day of the study. Most workers were never selected t o participate (at the time of the study the department had 217 social work staff members), and several were chosen more than once. A total of 7 4 different workers participated during the 15-day study period. The recording schedules were sent directly t o the researcher upon completion and were not made available t o the supervisory staff. This was t o ensure the credibility of the study for the staff; that is, data went directly t o the researcher and could not be "evaluated" by the supervisor. The data were punched on IBM cards and analyzed with the use of Crosstabs. The base for analysis was the time spent o n tasks rather than the number of tasks o r the number of individual workers. Thus data will be discussed in terms of the percentage of workers' time spent on tasks and in activity centers. Data were analyzed for the Department of Social Work Services as a whole; for each of the four hospital divisions; and for position-titles.* These three levels of *Four categories of position-titles were used in this analysis: (a) directors, which also included associate or assistant directors of the Department
of Social Work Services; (b) supervisors, which also included those with titles of administrative and assistant supervisors; (c) social workers, those with graduate social work degrees; and ( d ) social work associates or assistants, those without master's degrees.
Roslyn H. Chemesky and Abraham Lurie
analyses provided a general picture of task and activity patterns for the total staff as well as comparisons among hospital divisions and position-titles. Although i t is not referred to in this discussion, a picture of each worker's time and activity pattern was derived as well.
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FINDINGS Our findings will be examined first in terms of the amount of time spent by the total sample of social work staff a t the medical center in the nine activity centers. The findings should be viewed as tentative. The study should be replicated, as only through replication can we be confident of its reliability and validity. Also, it is probable that a different sampling procedure, with data collected even for only 1day, would strengthen the study's validity. Table 1 summarizes these findings and shows that most of the staff's time was spent in the Social Work Activity Center. As the core activity center of a social work department, it was expected that direct service with clients and indirect service on behalf of clients would account for most of the staff's time. Tasks in the Miscellaneous Activity Center comprised 22% of staff time. Although this is slightly more than one-fifth of workers' time, it is not as significant as it seems. The Miscellaneous category includes absences because of illness, vacation, and compensatory time, and at least hours, or 19% of an &hour day, are ordinarily consumed by a lunch period along with a morning and afternoon break. Taking the 19% as an expected average, only 3% of time is spent in nonproductive tasks, that is, 1 4 minutes of each day. Administrative tasks represent 11%of staff time, a small amount when one considers that many routine housekeeping tasks such as
1t
TABLE 1 Percent of All Social Work Staff Time Spent i n Activity Centers'
Activity Center Social Work Miscellaneous Administration Staff Development Research Student Training Work with Volunteers Community Planning Public Information
Percent of r i m e
55 22 11
6 4 2
.3 .3
0
*All staff time is calculated based upon an eight hour working day.
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straightening desks, checking for messages, picking up mail, and the like were included in this center. Six percent of staff time was spent in Staff Development tasks including those in which workers were members as well as leaders of seminars and training sessions. Also included in Staff Development were supervisor-worker contacts for the purpose of the workers' development. Research tasks, which referred primarily to those tasks connected with the Functional Analysis Study, took 4% of staff time, about 20 minutes each day. Only 2% of staff time was spent in tasks in the Student Training category, a very small amount of time considering that the Department of Social Work Services is a major teaching center for social work education. This figure may represent skewed results related to the random sample selected. Since no statistical significance was prepared for the data, all findings are tentative, as noted above. Social work staff spent almost no time in three activity centers: Community Planning, Work with Volunteers, and Public Information. The time the total social work staff spent in each of the activity centers was then compared with the time spent by each of the social work functional levels as illustrated in Figure 1. The comparative patterns of time expenditure are similar in several ways to that expected. Directors spent little time in social work activities; most of their time was spent on administrative tasks. Supervisors engaged in social work activities extensively although less than social workers. One-fifth of supervisors' time was spent in administrative tasks. Social work associates/assistants spent more time in social work activities than did social workers. Directors spent considerable time in staff development tasks. Supervisors spent the least amount of time in staff development (i.e., receiving training), which suggests that little time is spent in helping this level of staff with their supervisory and teaching functions or in preparing them for their job functions. Social work associates/assistants spent slightly more time in formal staff development activities than did social workers. The pattern of staff time expended in the nine activity centers was not the same for each of the hospital divisions. There were differences that may be accounted for by the nature of the hospital (psychiatric, general, voluntary, m ~ i c i p a l )and by characteristics of the social work divisional departments (size, stability, status in the hospital, number of services, staff pattern). Substantial differences were found in the time spent in the Social Work and Miscellaneous activity centers among the four hospital divisions. Despite these variations, it was apparent that what a trained social worker does, in relation to the proportion of time spent in the activity centers, is similar throughout the medical center
Roslyn H. Chernesky and A bmham Lurie
T o t a l Tlme
T o t a l S t a f f Time
Social Work Assocls
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Supervlsr
Scale of A c t l v l t v :enters
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Other V o l u n t e e r s . Publ i c I n f o , Comm. Plannlna S t u d e n t Tralninq Ftesearch S t a f f Development Adrlnlstrstlon Riscellaneous S o c i a l York
FIGURE 1. Percentage of social work staff time in activity centers b y position.
and differs little by hospital division. There is a general consistency in the pattern of time expenditure by social workers that provides a fairly clear picture of how a social worker in the medical center is using his time. There is a less consistent pattern in the use of time among activity centers by associateslassistants when hospital divisions are compared. The wide variations, therefore, make it difficult t o conclude that there is a general similarity in tasks of social work associates/assistants.
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We also looked at some of the other key task areas in which staff time is spent: supervision, meetings, and paperwork. Approximately 7% of the time of all social work staff in the medical center was spent in receiving or giving supervision, regardless of the purpose of the supervisory contact. Such use of time was recorded primarily by social workers, whereas associates/assistants recorded spending almost no time in supervision. Eight percent of the time of all social work staff in the medical center was spent in meetings, regardless of their purpose. Almost half of the time spent in meetings was related t o patient care and service such as team meetings and group conferences. Meetings for administrative purposes took as much staff time. Writing case records, chart notations, letters and memos, and keeping statistics (excluding data recording for the Functional Analysis Study) accounted for 12% of the time of all social work staff in the medical center. The amount of time given to writing case records and to the compilation of departmental service statistics varied among hospital divisions, although case recording always consumed substantially more time. DISCUSSION These findings illustrate the kinds of information that can be obtained through a systematic procedure of data collection in a functional analysis study. They provide insight about how social work staff time was spent and about differences in patterns among hospital divisions and position-titles. The Functional Analysis Study also highlighted several areas that call for further and more detailed exploration before conclusions can be drawn. The results, though tentative, raised questions and suggested areas for further consideration by the department's staff. Several of the areas addressed as a result of the study were: 1. The different ways social work associates/assistants are used in the four divisions. 2. The investment in staff development and supervision. 3. The differences in amount and kind of paperwork in the four divisions. 4. The role and function of the social work supervisor. 5. The overextension of some social work staff and what may be the underutilization of others. 6. The administrative tasks that may be more appropriately handled by clerical staff or through better organization of departmental procedures. 7. The amount of time spent in social work activities-55% of an 8-hour day, or 63%of a 7-hour day.
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Roslyn H. Chernesky and Abraham Lurie
The written report of all findings was shared with all members of the staff, and a series of staff meetings were held t o discuss their implications. Staff have deliberated these issues, trying t o account for what was observed and, more importantly, trying t o evaluate what was found. Is the department satisfied with the results? Is there reason to introduce administrative changes on the basis of the findings? For example, the departmental administration decided that it wished t o increase its investment in staff development and, since the study, has devoted greater resources t o this activity. Similarly, the question raised by the study about supervisors' activities stimulated a more thorough examination of their role and function in the department. Thus, our experience suggests that a functional analysis study is both feasible and valuable.' It provides staff members and administrators with a graphic portrayal of how they spend their time. This information is especially needed as social work departments plan for effective and efficient use of resources t o achieve their program goals, as they begin to document the contribution of social work t o the functioning of the medical center, and as they begin their quality assurance programs. REFERENCES 1. Legislative History of Professional Standards Review Organization Provision of the Social Security Amendments. Washington, D.C.: Department of Health, Education, and Welfare, November 1972. 2. Decker, Barry, and Bonner, Paul, eds. PSRO: Organization for Regina1 Peer Review. Cambridge, Mass.: Bollinger, 1973. 3. Shepard, Herman S. "Report of Study of Social Service Departments in Major Hospitals in New York City." Unpublished paper, March 1973. 4. Ullman, Alice; GOSF,Marie E.; e t al. "Activities, Satisfactions, and Problems of Social Workers in H o s ~ i t a lSettines: A Com~arative Studv." Social Service Reuieru 45 (1971): 17-29. 5. Hill, John G.; Ormsby, Ralph; and McCurdy, William B. The Time Analysis Manual. New York: Family Service Society, 1962. 6. Greenwood. Ernest. ed. Time Studies in Social Casework. Los Aneeles: California welfare c d u n c i ~ 1950. , 7. Hill, John G.,and Ormsby, Ralph. Cosl Analysis Method for Casework Agencies. Philadelphia: Family Service Society, 1953. 8. Chernesky, Roslyn H. Functional Analysis Review: Final Reporl. Long Island Jewish-Hillside Medical Center, Department of Social Work Services, May 1974.
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