Services integration, professional autonomy and standardization. Representations of standardization among case managers in the case of integrated service networks implementations (original) (raw)
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2015
Standardization represents an important concept for developing closer integration within the healthcare sector. While prior research has examined standards from the perspective of technological interoperability and business processes, there is limited research examining interface design standards for a healthcare information system (IS). This research in progress addresses this gap by empirically investigating the nature of such standards and their implications for a healthcare organization. The study adopted an interpretive case approach and collected data collected from a leading hospital in Saudi Arabia. Preliminary results indicate that IS facilitates collaborative work practices within a healthcare organization by inscribing in itself the standards for such collaboration. Further such standards are instantiated in terms of a configuration of functional information technology (IT) affordances, which can represent design standards. The research also identifies a preliminary set o...
Social Work as Laboratory for Normative Professionalisation
Social work and society, 2005
The problem-situation In most Western countries, the professional status of social workers is instable and insecure. Of course, most Western countries are themselves instable, ridden with feelings of insecurity and in search of reassurance and promises of control. But social work hardly lends itself as a projection screen for visions of professional control and efficiency in the face of insecurity. On the contrary: within the present cultural and political climate, social work connotes primarily with unpopular social problems, with people unable to cope adequately with the competitiveness and the rate of change of post-industrial societies, that is to say: it connotes more with dependency and helplessness then with autonomy and control. Moreover, whereas public discourse in most Western country is dominated by a neo-liberal perspective and the intricate network of economic, managerial, consumerist and military metaphors connected with it, social work still carries with it a legacy of 'progressive politics' increasingly labeled as outdated and inadequate. Although the values of solidarity and social justice connected with this 'progressive heritage' certainly have not faded away completely, the loudest and most popular voices on the level of public discourse keep underscoring the necessity to adapt to the 'realities' of present-day postindustrial societies and their dependence on economic growth, technological innovation and the dynamics of an ever more competitive worldmarket. This 'unavoidable' adaptation involves both the 'modernization' and progressive diminishment of 'costly' welfare-state arrangements and a radical reorientation of social work as a profession. Instead of furthering the dependency of clients in the name of solidarity, social workers should stimulate them to face their own responsibilities and help them to function more adequately in a world where individual autonomy and economic progress are dominant values. This shift has far-reaching consequences for the organization of the work itself. Efficiency and transparency are the new code words, professional autonomy is dramatically limited and interventions of social workers are increasingly bound to 'objective' standards of success and cost-effectiveness. At first sight, this situation does not provide a very promising horizon for those theorists, researchers and social workers still adhering to the 'progressive' legacy of social work and its central values: solidarity, social justice and empowerment. The notion of historical progress connected with these values seems to have lost its visionary and unifying power, to be replaced by and large by a quite different, neo-liberal view of 'a better future', dominated by the idea of ever increasing consumptive possibilities for autonomous individuals on the basis of unlimited economic growth and technological innovation. This neo-liberal vision of a better future is underpinned by its own version of a just society, wherein every man (!) gets what he deserves on the basis of his own efforts. This vision accomplishes the remarkable feat of trivializing blatant forms of social inequality and exclusion, not only by picturing them as an unavoidable price to be paid 'in the short run' for a better future for all 'in the long run', but also by stressing the individual responsibility of those who are unwilling or unable to face
Integrating or disintegrating effects of customised care: The role of professions beyond NPM
Journal of Health, Organisation and Management, 2011
Purpose -This paper aims to describe the integrating and disintegrating effects of professional actions in customised care. Design/methodology/approach -Using a qualitative case study, the authors examine the work practices and cultures of three Swedish child and adolescent psychiatric care units (CAP) charged with providing customised care in collaboration with other organisations. The authors conducted 62 interviews, made 11 half-day observations, and shadowed employees for two days. Findings -The social embeddedness of action is crucial to understanding the professions' integrating/disintegrating activities. In the internal social context of CAP, the professions adapt to productivity-enhancing new public management (NPM) principles, resulting in integrating effects between the different professions and administrative management in the CAP units. However, CAP exercises professional dominance over the cooperating organisations. Thus, in the external social context, CAP's resistance to customised care principles exacerbates the disintegration problems among the different organisations. Practical implications -The study concludes that, contrary to findings in many other studies, neither the professional logic nor NPM/customised care reforms determine the actions of professionals. In this case, the institutionalisation of some NPM methods blocks the adoption of customised care practices. Originality/value -Contrary to the widely accepted idea that resource restriction is a main source of conflict between management and the professions, the professions accept and adapt to resource restrictions, even at the expense of de-emphasising the practices of customised care. Thus, since professionals choose different operational strategies depending on the social context, the success of a normative reform measure may depend in part on its social context.
Thinking about practice in integrated services
Integrated service delivery in the early childhood education and care sector is burgeoning as a direct result of government agendas in Australia that privilege services for young children and families, especially those considered most vulnerable and at risk. In many cases this means reviewing and revising current practice to work more collaboratively with other professionals. This paper reports the findings of one aspect of a larger Australian study entitled: 'Developing and sustaining pedagogical leadership in early childhood education and care professionals'. The focus of this paper is the understandings and practices of professionals in both Queensland and Victoria working in integrated Children's Services across the education, care, community and health sectors. The notion of transdisciplinary practice is also explored as a way to sustain practice. Qualitative data collection methods, including the 'Circles of Change' process, the 'Significant Change' method and semi-structured interviews were used. The findings indicate concerns around professional identity, feeling valued, role confusion and the boundaries imposed by funding regulations. Working in a transdisciplinary way was generally considered a useful way to move practice forward in these settings, although the ramifications for leadership that this approach brings requires further consideration.
Nordic Social Work Research, 2020
Social work practice and related documentation are being challenged by the consumerist-managerialist discourse, which simultaneously emphasizes the aims of a client orientation and the demand for economical and efficient activity that reflects a system orientation. This article explores the structuration processes of social work practice in the context of case-based social work with disabled people in Finland. The theoretical framework is provided by Anthony Giddens' structuration theory. By applying qualitative multiple case study research and analysing client documents from seven individual cases, two combined cases are reconstructed: a client-oriented case and a systemoriented case. Based on the analysis, the prevailing structure of social work practice is structured between the two dimensions, reflecting intersections of client orientation and system orientation. The findings show, that structuration of client-oriented social work practice throughout a case requires social work to increase its critical consciousness and reflection on the client's need in addition to have various resources. The structuration of client-oriented social work practice should also be visible in client documents. The article concludes that every encounter between organizational structures, the social worker and the client represents a new opportunity to structure clientoriented social work practice.
Managed care and social work: Practice implications in an era of change
J. Soc. & Soc. Welfare, 2001
DIVISION OF SOCIAL WORK The purpose of this article is to explore the role of the clinical social worker in a time of unprecedented change. The events of the last decade have transformed health care delivery as well as professional performance expectations. To facilitate understanding, the environmental considerations that surround these changes are traced and discussed. A direct linkage is made to clinical social work practice and suggestions for the future survival of the profession is discussed. These suggestions include: (1) a greater focus on behaviorally-based outcomes that result in cost-beneficial service provision; (2) increased marketing of social work services to health care providers; (3) promotion of social work services as an integral part of the success of the interdisciplinary team, (4) incorporate a macro perspective into micro or clinical practice approaches; and, (5) explore non-traditional roles for social work professionals to expand their current practice arena. Managed Care: The Beginning In the later part of the 1980s it became clear that the cost of health care delivery had reached a national crisis. Although, there may have been multiple reasons for this major contributions included: (1) the results of better health care with many people living longer; (2) increased technological advances and the costs associated with it; (3) the use of heroic measures to maintain life beyond its traditional boundaries; (4) the lack of health care approaches formulated and implemented on a national level that
2014
The main topic of this meta-analysis is the disclosure of the process of social work becoming a profession in Lithuania under complicated conditions of society transformation. When we speak about the process of any activity becoming a profession we speak about professionalization. The aims of this meta-analysis are: 1) to analyse social work professionalization in Lithuania in the light of constructivist and systemic theoretical perspectives. 2) to extract and elaborate the main factors creating the conditions for professional social work development in Lithuania over the period of 1992-2013. 3) to answer to the main research question of the meta-analysis – how did Lithuanian social work professionalize? The code of society transformation becomes an ultimate assumption for modelling the construction of social work professionalization, highlighting its manifestation. In Lithuania, there is a lack of a detailed work, which would sum up the results of twenty years of social work develo...
Organizational Professionalism: Social Workers Negotiating Tools of NPM
Professions and Professionalism, 2018
This article examines how social workers and managers perceive meaningful work and expertise in six care and treatment facilities in Denmark. Based on 29 interviews with social workers (n=22) and managers (n=7), the article shows how New Public Management-inspired tools such as scoring schemas align with social work values such as “client-centeredness” and working with the individual welfare recipient face-to-face. The article finds that fitting social work into organizational schemas changes the work practices of social workers and also the way members of this profession define meaningful work and expertise. In addition, the article also finds that scoring schemas cause conflicts among social workers regarding the character of expertise when values of social work (to meet a welfare recipient’s need) must be aligned with NPM-inspired values of organizations (to meet managers’ demand for documentation).