Discussion: Remaining Compassionate and Professional

Discussion: Remaining Compassionate and Professional ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON 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? Discussion: Remaining Compassionate and Professional 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. Discussion: Remaining Compassionate and Professional BY DAY 3 Post 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. models_and_methods_in_hospital_social_work_supervision.pdf standards_social_work_supervision.pdf teaching_the_use_of_self_through_the_process_of_clinical_supervision.pdf 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. Submit your article to this journal Article views: 3172 View related articles Citing articles: 9 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=wcsu20 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 180 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). Discussion: Remaining Compassionate and Professional 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 182 G. Kadushin et al. that may affect the organization’’ (Schmid, 2002, p. 133). Discussion: Remaining Compassionate and Professional 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 183 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. Discussion: Remaining Compassionate and Professional 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. 184 G. Kadushin et al. 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. Discussion: Remaining Compassionate and Professional 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.Discussion: Remaining Compassionate and Professional 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. 186 G. Kadushin et al. 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. Discussion: Remaining Compassionate and Professional 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 … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10