This article examines the responses of social work administrators to the changes occurring throughout their hospitals over three time periods in the 1990s; the major accomplishments of social work services in their facilities; and the failures, frustrations, and obstacles in the delivery of social work services. It compares the reports of social work director cohorts on the changes they experienced over an eight-year period with what they had expected in their settings. It also analyzes their perceptions over time of obstacles and opportunities for hospital social work administrators in response to these changes. The authors present the ways in which social work administrators understand and address the complexities they face.
As hospitals attempt to decrease their costs to survive in today's health care market, they are implementing resizing strategies that promise greater efficiency. A by-product has been the elimination of many management and supervisory positions. A self-administered questionnaire was sent to a stratified random sample of 750 hospitals (yielding a 46% return rate) to study the types of supervisory models being utilized and the factors associated with their differential use. While concern is expressed about the erosion of clinical supervision, the data suggests that the majority of social workers are receiving supervision from a social worker.
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