Effect of a Changing Health Care Environment on Social Work Leaders: Obstacles and Opportunities in Hospital Social Work

The health care system is undergoing dramatic change in auspice, structure, and services delivery in response to an emphasis on market-driven, cost-containment strategies. Consequently, many hospital social work directors either have lost some of their administrative responsibilities or have expanded their span of control beyond social work services. This article examines the responses of social work administrators to the breadth of changes occurring throughout their hospitals; the major accomplishments of social work services within their facilities; and the failures, frustrations, and obstacles in the delivery of social work services. As a result of examining the relationship between their actual and anticipated behavior and changes in the hospital and external environment, the authors found that social work leaders in hospitals understand the complexities and challenges of the world around them. Overall, they have exhibited commitment, competence, and confidence in shaping organizational change.