Medical Social Work Issues - Speech or Presentation Example

Abstract

Medical social work is a branch of social work and is also referred to as hospital social work. Professionals in this discipline are termed as medical social workers and usually work in hospitals, community health clinics, outpatient clinics, extended health care facilities and nursing homes. The medical social workers do work with patients and their families through offering psychosocial help. They accomplish this by evaluating the psychological functioning of patients and families offering interventions as needed. The interventions can be in the form of supportive counseling/grief counseling, psychotherapy, networking patients and families with the required resources and support in the community and strengthening the patients’ social support.

The core responsibility of a medical social worker is to restore balance in an individual’s personal, family and social life so as to assist the individual maintain or recover health while helping the patient ability to assimilate back into the society. During their course of work, medical social workers work on an interdisciplinary team with such professionals as doctors, nurses, physicians, occupational therapists and recreational therapists to name but a few.

Case Management

For this presentation I target a medical social worker specializing in Case Management. The patient in this scenario is a white male aged 75 years who has kidney failure. The patient undergoes dialysis, which is the process of removing waste products and excess fluid from the body. For the patient, dialysis is necessary since he is unable to adequately filter the blood. Dialysis allows the patient a chance to live a productive life. In most instances case management is mostly offered by Registered Nurses but there are social workers who also specialize in this field. The medical social worker in this instance is the case manager and facilitates the transition of the patient to the next level of care even as the patient heads home. The medical social worker also provides utilization reviews.

The role of the case Manager

In facilitating the transition of the patient to the next level of care and providing utilization, the case manager will offer a variety of services. The typical interventions that he will provide will be scheduling outpatient treatment for the patient’s dialysis. The particular patient is struggling with chronic health issues including diabetes, hypertension resulting in poor vision, cardiac problems, and neuropathy. The case manager will provide assistance in disability benefit application, resources, counselling, and referrals for the medical care.

It is the duty of the case manager to help the patient comply with their treatment regimen, asses the safety of the patient’s living environment and the assessment of the psychological coping. Referrals to programs that focus on meal services will ensure the patient has adequate nutrition contributing the general well-being of the patient.

The case worker will also order for any equipment needed by the patient, provide information on other services available for private pay that may include caregivers and emergency services. The case manager may also help on the formalities of disability benefits and provide counseling to help the patient cope with the life changing events that he may be experiencing. The case worker will offer services to the members of the patient’s family through the provision of resource information and counseling.

Interdisciplinary team in case management

The Case Management Association of America defines case management as a collaborative process of assessment, planning, facilitating, case-coordination evaluation, and advocacy for options and services to meet an individual’s and family comprehensive health needs through communication available resources to promote quality and cost effective outcomes. Like in any other process or field, collaboration is vital for case management to be effective. A team work approach results in an effective case management and the patient gets the best outcome.

Case management begins with the referral. This is followed by the plan of care of the patient that gives the discharge instructions or specific orders from the physician. Next will be the pre-admission conference that will have in attendance the admission nurse with the intake Registered Nurse. It is during this conference that the referral information is discussed, the expected diagnosis identified, and the necessary services laid out.

The next step is the admission visit that sets out the primary goal of the services and an anticipated discharge date. A comprehensive assessment of the patient’s needs to be performed and other disciplines that are required to meet the goals and needs of the patient, and need to perform the same type of assessment thus ensuring objectivity and the accuracy of the patient outcome.

After the admission visit, the admission nurse, the clinical coordinator and all members of the team do conference to identify issues that had come up regarding the patient’s plan of care. This will be based on the input of the Registered Nurse and the discussion will be on the diagnoses, projected frequency and duration leading to a goal directed care. Collaboration is vital and interdisciplinary communication should occur after each discipline assesses the patient.

Communication is so vital that it should be frequent. Coordination of care communication should focus on the very pertinent information between the entire group, and special meetings should be held when any pertinent changes happen and this should be documented in the patient’s records.

The case manager will establish effective daily interdisciplinary meetings thus participating in a concrete change that will improve performance on the various metrics that will help demonstrate the case manger’s value to the hospitals in which he works. The effective interdisciplinary meetings will allow the care team to be proactive in the planning, communication, and interventions with the patient and his family.

Once the care team is well informed on the patient’s needs, communication with the patient and family is consistent. The involvement of the patient in his plan of care while he is in the hospital will help in promoting high care quality and satisfaction with the care experience. The overall purpose of convening these interdisciplinary meeting is to improve the team’s ability to continuously deliver high quality care.

Collaboration with other members of the health care team

Improved communication between the physician, nurse, the case manager and other members of the team that are involved in the patient’s care that may include speech, physical and occupational therapists, chaplain and the pharmacist. There should be enhanced communication and coordination with the patient and the patient’s family members. This has the spiritual effect of improved satisfaction of the care being given.

There is need for the provision of a forum in which house staff can learn and also demonstrate Accreditation Council for Graduate Medical Education (ACGME) competencies. This is through developing and carrying out patient management plans, team work, and demonstrate experience in their work. Enhancing staff satisfaction and staff retention is also important.

It is good to establish a common understanding of the follow-up step in advancing the plan of care each day. Identify the hindrances encountered to care and the accountability for timely follow-up. Also identify and work towards an appropriate discharge goal date for each patient and improve the communication of bed availability so as to support the overall house management and assist in the placement of patients ensuring the caregivers expertise matches with the patient.

Essential values of members of an interdisciplinary health team

Team members must be disciplined and should carry out their duties and responsibilities even in circumstances that may make them feel inconvenienced. They should seek out and share information with the sole purpose of improving the individual and team functions, even when doing so may be uncomfortable. Such discipline allows the team to develop and abide by their standards/protocol.

Honesty is key since the team members should place a high value on effective communication within the team which includes; transparency about aims, decisions, uncertainty and even the mistakes that may occur. Honesty is an important value in continued improvement and maintenance of the mutual trust necessary for a high functioning team.

Humility is very vital. This is achieved through team members recognizing that they have differences in training but they do believe that one form of training is uniformly superior to the training of the others. There is the recognition that any member can make a mistake hence the need to work as a team since members can rely on each other to help recognize and advert failures without regarding the member’s position in the team.

Team members need to be creative. The curiosity to tackle new and emerging problems, errors, and unanticipated bad outcomes are taken as potential opportunities to learn and improve.

Curiosity is a great value among members of the team, since members tend to be dedicated to reflecting upon what they have learnt during the execution of their daily activities and use the new knowledge acquired to continuously improve their own work as well as the productivity of the team.

Challenges working in interdisciplinary health care team

Professional identity and scope of practice is an example. Interdisciplinary teams require clarity of roles and responsibilities to ensure the team’s optimum productivity. Each member of the team comes to the team with varying degree of understanding concerning the capabilities of other professionals. Case workers often negotiate their role on the interdisciplinary team without consultation with other members of their profession. Case workers at times end up in a position of having to create roles so as to seem relevant.

Power differentials in the interdisciplinary health team can be facilitated or hindered by overt and covert powers. It is necessary to always consider the power dynamics while developing and implementing collaborative models. Covert power differentials do require a level of critical reflection since they are subverted. Interdisciplinary teams focus in communication regarding patients placing the doctor ‘central’ in the team. Issues of power determine to what extent collaboration occurs.

Organization structure plays a key role too. Communication between members of a team can be affected if there is more than one site or when the team members are operating on different floors though in the same building. Structural factors that facilitate collaborative care include collaborative leadership, organizational culture that supports collaboration, effective methods of communication and colocation.

Negative effects of interdisciplinary health care to patients

There is a growing concern over the number of healthcare errors, as well as the interest in the development of care delivery processes that focus on minimizing the potential for error. Several authors have noted that 70 to 80 percentage of health care errors are caused by human factors associated with interpersonal interactions.