UBC Remaining Compassionate & Professional in Social Work Practice Discussion Discussion: Remaining Compassionate and Professional As a social worker, you

UBC Remaining Compassionate & Professional in Social Work Practice Discussion Discussion: Remaining Compassionate and Professional As a social worker, you interact with
individuals who are at various stages of change in their lives. This may
become frustrating for you when clients are struggling to achieve their
goals. Thus, it is important for you to develop strategies to process
your experiences so that you can maintain your compassion and
professionalism. As you consider the strategies you have developed to
address these issues, also consider how you might help other social
workers to develop such strategies. Perhaps you consulted with your
supervisors when you had difficulty processing your emotions in
particular situations. As you consider assuming a supervisory role, how
might you apply your learning from those experiences to helping those
whom you supervise?For this Discussion,
review the Levy case study in this week’s video. Consider how you, as a
social worker, might address the challenge of remaining engaged with a
client while not letting your emotions affect the interaction. Also,
consider how you, as a supervisor, might discuss this topic with a
social worker whom you supervise.By Day 3Post a strategy that you, as
the social work supervisor in the Levy case study video, might use to
debrief the social worker after the session described in the video. The Clinical Supervisor
ISSN: 0732-5223 (Print) 1545-231X (Online) Journal homepage: https://www.tandfonline.com/loi/wcsu20
Models and Methods in Hospital Social Work
Supervision
Goldie Kadushin , Candyce Berger , Carlean Gilbert & Mark de St. Aubin
To cite this article: Goldie Kadushin , Candyce Berger , Carlean Gilbert & Mark de St. Aubin
(2009) Models and Methods in Hospital Social Work Supervision, The Clinical Supervisor, 28:2,
180-199, DOI: 10.1080/07325220903324660
To link to this article: https://doi.org/10.1080/07325220903324660
Published online: 10 Nov 2009.
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The Clinical Supervisor, 28:180–199, 2009
Copyright # Taylor & Francis Group, LLC
ISSN: 0732-5223 print=1545-231X online
DOI: 10.1080/07325220903324660
Models and Methods in Hospital
Social Work Supervision
GOLDIE KADUSHIN
University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States
CANDYCE BERGER
University of Texas at El Paso, El Paso, Texas, United States
CARLEAN GILBERT
Loyola University School of Social Work, Chicago, Illinois, United States
MARK DE ST. AUBIN
University of Utah, Salt Lake City, Utah, United States
This is the first qualitative study of the perceptions of hospital-based
social work supervisees regarding their hospital supervision.
Seventeen social workers were recruited using a national listserv
and snowball sampling techniques. According to the perception
of the clinical social workers participating in the study, hospital
social work supervision is organizationally driven rather than
worker-focused. Implications for social work education and
research are discussed.
KEYWORDS hospital, managed care, models of supervision,
organizational re-structuring
INTRODUCTION
Social work supervision has played an important but changing role in the
development of the profession. Supervisors are agency managers who
have been delegated authority to maintain the job performance of supervisees.
In assuming this responsibility, the supervisor performs educational, administrative, and supportive functions in a positive relationship with the supervisee.
Address correspondence to Goldie Kadushin, Professor, Helen Bader School of Social
Work, University of Wisconsin-Milwaukee, PO Box 786, Milwaukee, WI 53201. E-mail:
Kadushin@uwm.edu
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Hospital Social Work Supervision
181
The long-term objective of supervision is to prepare the supervisee to deliver
effective, efficient services to clients, consistent with the agency’s mandate and
professional practice standards (Kadushin & Harkness, 2002; Tsui, 2005). The
administrative function of supervision is to organize the work of the supervisees to achieve agency objectives. This is the basic supervisory function. Educational or clinical supervision improves the knowledge and skills of workers
within the mandate of the agency. Supportive supervision reduces job-related
stress and fosters worker self-awareness to cope with stress (Bogo & McKnight,
2005; Kadushin & Harkness, 2002; Tsui, 2005). These functions apply to any
supervisor in any social work agency.
This paper focuses on social work supervision in hospitals. The
sustainability of supervision in hospital settings is threatened by the elimination of middle management and supervisory positions in favor of leaner,
cost-effective structures. This reorganization reflects the influence of managed care and capitated methods of financing that are reducing the hospitals’
access to revenue (Berger & Mizrahi, 2001; Globerman, McKenzie-Davies, &
Walsh, 1996; Weissman & Rosenberg, 2002; Schmid, 2002). Consistent
with these findings, a recent survey of licensed health care social workers
reported increased job stress in the context of reduced access to supervision
(Center for Health Workforce Studies, 2006).
The influence of managed care and capitated financing systems on hospital supervision has not been examined by social work researchers since
1996, the last year of data collection in a longitudinal study conducted by Berger and her colleagues (Berger, Robbins, Lewis, Mizrahi, & Fleit, 2003; Berger
& Mizrahi, 2001; Berger et al., 1996.) The existing research is also limited by an
exclusive focus on the perceptions of supervisors. No research has examined
hospital supervision from the perspective of the supervisee. An understanding
of the supervisee’s views is necessary to inform the profession of unmet
worker needs for oversight, support, and education in the social work health
care labor force (Center for Health Workforce Studies, 2006). To begin to
address this gap in the literature, a pilot study was conducted to answer the
following question: What are the perceptions of supervisees about the current
models and functions of social work supervision in hospitals? The hospital
agency was the setting for this pilot study because previous research on supervision in health care has been hospital-based, providing a knowledge base for
the development of the study questions and instruments.
LITERATURE REVIEW
Hospital Reorganization: Impact on Social Work
Hospital Supervision
Many theories explain the relationship between the hospital and the environment (Netting, Kettner, & McMurtry, 2004) or those ‘‘external conditions
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that may affect the organization’’ (Schmid, 2002, p. 133). The merits of different
theories are still debated, but all theories assume environmental circumstances
influence organizational processes (Schmid, 2002). In particular, the immediate
or task environment is assumed to affect organizational strategies and structures (Schmid, 2002; Netting et al., 2004). The task environment includes
patient populations, revenues, in-kind resources, competitive institutions,
and federal and state regulators (Netting et al., 2004; Schmid, 2002).
In the early 1980s, health care delivery and funding underwent a radical
change in the United States with the introduction of a Medicare capitated
payment system for hospital care. Capitated payment is a form of managed
care. Managed care can be defined as a payment and health care delivery system that regulates, monitors, and coordinates resources to contain costs and
increase efficiency. Introduced into the United States to reduce spiraling
health care spending in the early 1980s, managed care is now the dominant
arrangement in both public and private sectors.
Because a capitated payment system transfers risk from payer to provider, the Medicare prospective payment system reduced hospital revenues.
Aware of the risk of cost-shifting, private and public third-party payers also
adopted managed care payment and delivery procedures. Hospitals were
confronted with an unstable, rapidly changing environment in which fierce
competition for scarce resources and patients existed. In this context, theories predict that organizations will revise strategies and structures to reassert
control over actors in the task environment (Schmid, 2002).
Hospitals responded by developing alliances with multi-hospital systems, merging with competitive institutions, and separating functions into
independent, decentralized programs or teams (Lee & Alexander, 1999;
Bazzoli, Dynan, Burns, & Yap, 2004; Weil, 2003). The effect of hospital reorganization was to reduce operating costs by consolidating management and
duplicative services. However, this strategy also eliminated the positions of
middle managers and social work directors who provided supervision,
decreasing institutional resources to support this function (Kadushin &
Harkness, 2002; Weissman & Rosenberg, 2002).
A government-mandated managed care program implemented in the
1990s in Canadian hospitals is suggestive of the effect of hospital restructuring
on social work supervision. The introduction of managed care was the impetus
for the dismantling of Canada’s hospital social work departments. Social work
supervision decreased in the absence of an administrative structure (e.g., social
work directors and supervisors). Canadian hospital workers organized peer
groups to provide clinical and supportive consultation but they had no
access to formal supervision (Globerman et al., 1996; Globerman, White, &
McDonald, 2002; Globerman, White, Mullings, & McKenzie-Davies, 2003;
Michalski, Creighton, & Jackson, 1999). While this research is specific to the
Canadian health care system, it is suggestive of the potential impact of managed care and hospital restructuring on worker access to formal supervision.
Hospital Social Work Supervision
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Kadushin and Harkness (2002) hypothesize that clinical and supportive
supervision, which are resource-intensive, non-revenue-generating functions,
may be assigned a low priority by hospitals impacted by managed care. They
suggest, however, that because administrative supervision directly benefits
the organization, it may be the sole form of supervision recognized by hospitals within an environment of cost containment (Kadushin & Harkness, 2002).
Models of Social Work Supervision
Models of social work supervision can be differentiated by levels of agency
control. At one extreme is the ‘‘casework model’’ or scheduled one-on-one
individual social work supervision, which is based on high levels of administrative accountability. At the other extreme is the autonomous practice
model, which is characterized by professional autonomy of the supervisee.
Between these extremes on the continuum of administrative accountability
are group, team, and peer supervision models (Bogo & McKnight, 2005;
Kadushin & Harkness, 2002; Tsui, 2005).
Individual supervision is the most widely used model of supervision,
particularly for unlicensed or inexperienced (less than two to six years of
practice in the same setting) workers (Kadushin & Harkness, 2002). It is
delivered in a one-on-one tutorial session scheduled weekly for at least an
hour. The demands of time and effort required by this model may be challenging to hospital-based social work supervisors who have corporate or wideranging administrative responsibilities.
Group supervision is the second most widely adopted model of
supervision. It is characterized by the presence of a formal social work
supervisor who performs the functions of supervision—administrative,
educational, and supportive—in a group format. Group supervision is a
supplement to, not a substitute for, casework supervision.
The introduction of group supervision is ideally preceded by worker
preparation for the change and agreement by the staff. The advantages of
the group modality are conservation of time and resources; lateral peer learning; and sharing and normalization of job-related stress (Bogo & McKnight,
2005; Kadushin & Harkness, 2002; Sulman, Savage, Vrooman, & McGillivray,
2004; Tsui, 2005).
Peer supervision is supervision led by a peer group; in this situation, no
supervisory oversight or authority exists. All participants hold equal status in
terms of accountability and responsibility for their own practice. The purpose
of peer group supervision is to provide educational=clinical supervision
through case conferences and the exchange of clinical expertise and guidance.
Peer supervision is a supplement to, or a substitute for, educational=
clinical supervision (Brashears, 1995; Barretta-Herman, 1993; Hardcastle,
1991; Kadushin & Harkness, 2002; Sulman et al., 2004; Tsui, 2005). Team
supervision is led by a team leader who may or may not be a social worker.
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In team supervision, intradisciplinary workers may exercise autonomy,
collectively make decisions about work assignments, case dispositions, performance checks, and professional development, providing educational=clinical
guidance and oversight and allocating work assignments. The supervisor is a
team member but retains administrative accountability for team performance
(Kadushin & Harkness, 2002; Tsui, 2005). On interdisciplinary teams, the leader
may be a physician, nurse, or other medical professional who assumes supervisory authority over the other team members (Kadushin & Harkness, 2002).
The question of the prevalence of supervision models in hospital-based
social work has generally been ignored by social work research. Berger and
Mizrahi (2001) examined supervision from the perspective of supervisors in a
national sample of hospitals in 1992, 1994, and 1996. They found that in the early
to late 1990s, individual and group supervision were the most frequent models
(these models were collapsed into the category ‘‘formal supervision’’). Peer
supervision (consultation) was the second-most frequent model. The use of
non-social work supervision significantly increased over all time periods.
Health care social workers speculate that as hospitals restructure and
eliminate social work managers and departments, the resources to support
the traditional individual supervision model will decline. Workers will have
to take the initiative in finding support for supervision outside the hospital
or by creating group or peer models that use collective resources efficiently.
The caution is the need for thoughtful planning, implementation, and a
mechanism for training and evaluation to accumulate research to inform
the profession regarding the efficacy of innovative supervision models
(Berger & Mizrahi, 2001; Kadushin & Harkness, 2002).
METHODOLOGY
This qualitative study was implemented using telephone focus group
interviews. Focus groups have been widely used as a data collection method
in qualitative research, and growing evidence supports the efficacy of
telephone focus groups or ‘‘telegroups’’ as an alternative to face-to-face focus
groups (Cooper, Jorgensen, & Merritt, 2003; Appleton, Fry, Rees, Rush, &
Cull, 2000). Using the Society for Social Work Leadership in Health Care
membership as a sampling frame, researchers employed purposive and
snowball sampling techniques. Social work directors=managers were
contacted by electronic mail using the organization’s listserv. The e-mail
explained the purpose and method of the study and encouraged social work
directors=managers to share the attached flyer with their staffs. Inclusion=
exclusion criteria were as follows: graduate-level social work staff (i.e.,
MSW, PhD, DSW); 50% currently employed in an inpatient or outpatient
hospital setting; one or more year working in clinical practice; at least one
year of experience in the current setting; and English-speaking.
Hospital Social Work Supervision
185
Eligible staff members e-mailed the Principal Investigator (PI) to indicate
their willingness to participate. The PI responded to the e-mail and screened
the subject for eligibility. If he or she qualified for the study, the PI sent an
electronic version of the consent form that was approved by the institutional
review boards (IRBs) of every member of the research team. A waiver of
signature for consent was obtained from the IRBs in order to ensure anonymity of the participants. In developing the focus groups, every attempt was
made to ensure that subjects from the same setting did not participate in
the same focus group to prevent voice identification.
The PI contacted the individuals by phone to discuss the study, answer
questions, and confirm their willingness to participate. Subjects were also
encouraged to share information about the study with their colleagues within
their own and other health care settings. Given the use of the listserv and the
snowball sampling technique, it was not possible to calculate how many
social work clinicians in health care settings were informed of the study to
produce a response rate.
The subjects were made aware of scheduled times for the focus groups
and selected a group. The subjects were asked to adopt fictitious names to
be used during the telegroup; these same names are also used in the data
presentation that follows. The intention in using fabricated names was not only
to increase the level of confidentiality, but also to ensure that each person in
the telegroup session had a distinguishable name. An e-mail was subsequently
sent to the participants confirming the time of the telegroup, the phone number that the participants called to access the focus group, the conference call
identification number to be used, and the fictitious name that they selected
for use during the telegroup and additional flyers advertising the study to share
with colleagues. This e-mail also contained the fictitious names of the other
participants and the focus group leader. A similar e-mail was sent to the group
facilitators. Focus group facilitators were aware only of the fictitious names and
geographic location of the participants; they were not given any other identifying information about the participants in their groups. The day before the telegroup, the PI sent an e-mail reminder to each participant with the same
information contained in the previous e-mail.
Once this reminder e-mail was sent, the PI erased any electronic
information required in setting up the conference calls in order to ensure
anonymity within the actual focus groups. If a participant did not call the
access number for the telegroup, it was impossible to contact him or her
since all identifying information was erased. However, most of the participants who were not able to attend their assigned focus group did contact
the PI to reschedule another time to participate. A private teleconferencing
company was used to set up the conference calls for the focus groups.
The members of the research team served as the facilitators of the focus
groups; the focus groups took about 60 minutes. Telegroup members were
instructed to use only their fictitious names in identifying themselves.
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A semi-structured interview schedule was finalized following a literature
review and the consensus of the four researchers who contributed both
academic knowledge and practice experience in supervision. The interview
schedule consisted of a series of six open-ended questions and accompanying
probes related to the following topics:
1.
2.
3.
4.
5.
6.
access to individual educational=clinical supervision;
access to different models of supervision (e.g., group, peer);
supervisors’ professional discipline;
administrative supervision and accountability for job performance;
use of outside supervisors; and
organizational changes affecting supervision.
This semi-structured interview schedule was followed in each focus
group to ensure some comparability. Major topic questions were presented
to each group separately to maintain a focus on the topic, but group leaders
had the flexibility to explore issues raised that did not coincide with the topic
questions. The topic questions were read aloud by the facilitator, who then
prompted the group for responses. Once discussion was underway, the facilitators intervened only as necessary to guide, probe, or provide support. This
procedure aided in conducting groups that were focused, without excessive
and counterproductive constraints on their interaction.
All interviews were audio-recorded and then transcribed by members of
the research team or by the teleconferencing company. The focus group
sessions began with an assignment of a study identification number. Only
the study identification numbers appeared on the transcripts. Any identifying
information on the tape (e.g., names of individuals, institutions, and locations
used in the discussion) were deleted from the transcript. Once the transcript
was checked for accuracy, the audiotapes were destroyed.
Using a grounded theory approach to data analysis, the narrative data was
pre-coded into conceptual categories. Content was then grouped into broad
categories to detect patterns and relationships. Through further co…
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