expert power, which is gained by possessing special skills and knowledge important to agency function-for example, the knowledge of community resources and continuum of insurance-covered services available to a client necessary to develop a discharge plan, which in turn would decrease patient length of stay.ģ. resource power, which is gained by having control over a critical resource that is essential to the functioning of the organization, is in short supply, or cannot be substituted-for example, providing utilization review for third-party payer reimbursement.Ģ. Kenney (1990) described three types of power that social workers can attain in organizations:ġ. To remain essential to their agencies, she stated, medical social workers needed to develop power. Kenney (1990) suggested that a shift from "hospital social work" to "social work in health care" was necessary for continued integration in health care settings. The integration of social work practice into these settings is essential to the survival of health care social work because medical care is increasingly provided in these environments. By looking at successful models and identifying factors that foster continued integration, these models can be extended to community-based health care agencies such as primary care settings and managed care organizations. Social workers have much to learn from studying departments that have achieved continued integration and growth within hospital organizations despite threats to their survival. Some departments have responded creatively, developing critical roles in their facilities. ![]() Because hospital-based social work typically has not been income generating, social work departments have been vulnerable to downsizing and elimination. ![]() Hospitals are downsizing as lengths of stay decrease and pressures to maximize health care dollars increase. The growth of managed care and the "corporatization" of health care have had major implications for hospitals, nursing homes, and home care agencies. During the past decade, social work in health care has undergone major changes.
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