From ideological to competency-based: the rebranding and maintaining of medical social work's identity.

Despite a history rich in patient care, case management, and knowledge-building, medical social work has limped through the past decade. Although there are still the occasional success stories about true heroes who have managed to not only persevere, but also thrive, their efforts have not been easily replicated by the masses. The medical social work community might benefit from taking an honest look at itself and the challenges the future holds. Presently we remain employees of host agencies that have been besieged by increasing expenses, nursing shortages, and third-party payers who continue to strangle reimbursements. Berger et al. (2003) reported that an increasing number of social work professionals are managed and supervised by nursing and other health care practitioners. To further exacerbate this challenge, social work's surface-level values are often perceived to be in juxtaposition with that of hospitals struggling to correct declining financial status. TWENTY-FIRST CENTURY CHALLENGES The challenges facing medical social work can be differentiated into three areas: the work environment, the traditional branding of the social work profession, and a resistance toward change. The Environment Many hospital-based social workers face the challenge of professionally residing in an ecosystem that does not naturally support social work life. First, it has long been noted that the medical social work department, even in its heyday, resided in a host agency. Although this was never meant to convey second-class citizenship, the responsibility lies with social work to evolve and align with the changing face of our hosts. Second, many social work managers run into the same gender bias and glass ceilings faced by other administrators. Furthermore, the social work manager (regardless of gender) is typically outside the loop of any naturally occurring "good old boys network." Perhaps not a group of which we are desirous of membership, it is still critical to note that there is a lack of institutional-based, natural mentors for social work leaders in health care. The literature often sites mentorship as an important predictor of career advancement (Goleman, 1998). For example, nursing has a well-developed career ladder and preceptorship program at most hospitals. This is not the case for social work. Typically, there are few incumbents at senior and executive levels of management who speak social work's language. Although social work interventions activities often drive patient satisfaction and cost savings, balance sheets are not set up to capture these contributions. Therefore, hearing our voice and translating our contributions are not instinctive. The Traditional Social Work Brand Typically, social workers are not inherently motivated by cookbook compliance with policy and procedure, but thrive on the ownership and ambiguity involved in the management of one's own case. As with most professions, social work candidates are likely guided toward the profession by talents, desires, and a goodness of fit (Buckingham & Coffman, 1999). However, efforts to market the profession have failed to convey an accurate image to the marketplace. From the serious media to television sit-corns, we are often portrayed as left-wing undereducated, do-gooders, lacking business and financial acuity. The profession reacts to the undereducated piece, but we seem to wear the counterculture label as a badge of honor. This is noble, but not necessarily strategic. Social work must protect against presenting itself along narrow, steadfast, ideological and political lines, with little regard for the diverse cultures and environments inhabited by its practitioners. This often results in a disconnect among academia, our host organizations, and practice realities. From a macro, organizational development prospective, we fail to align our talent, skill, and knowledge with the current needs of our employers. …