Hospital restructuring has had a dramatic impact on social work practice and field education. In a qualitative focus group study of nine educational coordinators responsible for educational programs in teaching hospitals with 25 to 100 social workers each, four main themes emerged: (1) difficulty managing field education when the actual change experienced in restructuring hospitals was far less progressive and systemic than the hospital missions espoused; (2) a struggle to maintain stable student programs when change was unpredictable; (3) the importance of support, reciprocity, and advocacy from the university; and (4) the need to be creative in delivering the educational program while undergoing organizational change.
social work students
Hospital restructuring has had a dramatic impact on social work practice (Rehr, Rosenberg, & Blumenfield, 1998). Driven by economic imperatives (Chan, DeGroote, & Ho, 1997; Tidikis & Strasen, 1994) framed as philosophical shifts (Chains & Tewksbury, 1993; Moore & Kelly, 1996), the changes in the hospital industry in North America have resulted in much soul-searching for professional disciplines in health (Berger, Cayner, Jensen, Mizrahi, & Scesny, 1996; Lowe, 1997). Restructuring has primarily centered around two phenomena: external reorganizing such as mergers and amalgamations; and internal reengineering, primarily a shift from functional bureaucratic systems to programmatic organizations (Browne, Smith, Ewalt, & Walker, 1996; Edwards, Cooke, & Reid, 1996; Herbert & Levin, 1996).
In Canada program management models in hospitals refer to the organization of hospitals by which programs (for example, heart, kidney transplant, brain injury) are responsible for a range of functions, from financial management to staff hiring and supervision. All centrally located functions are devolved from the central hospital administration to the programs. Because hospitals are publicly administered and funded primarily through provincial and federal government transfer grants, managed care has not been the primary force or model for health care delivery in Canada. Organizations using program management have had as their rationale that the "patient-focused" model is more efficacious than the traditional functionally organized model. However, with reduced funding from the government, the same principles of efficiency and effectiveness associated with managed care currently drive program management.
Social work in hospitals was traditionally organized with silo-type hierarchical functional departments, headed by "directors" and managed by "supervisors." Decisions about the assignment of social workers in the hospital, workload, professional education, recruitment, performance appraisals, and student education were all centrally located. How social workers negotiated their roles and practices within their teams were local activities. However, workers could consult with the social work director who provided central leadership in the hospital organization. The director also could address individual and systemic issues. With the move to programmatic operational structures and the elimination of discipline-specific leaders, all profession-related activities, including recruitment, performance appraisals, accountability, and in many cases, the actual work of the social workers, were placed under the direction of program managers who were rarely social workers (Globerman, McDonald, & White, in press). In pure programmatic organizations where all discipline-specific functions are eliminated and the hierarchy is flattened (Chains & Tewksbury, 1993), social workers are not collectively organized, have no formal reporting or accountability relationships to other social work colleagues, and have little authority within the hospital organization. …