From the cleaners to the doctors : exploring the dimensions of effective health social work practice in an acute hospital : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Social Work at Massey University, Albany, New Zealand
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Date
2011
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Massey University
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Abstract
My thesis reports that since the earliest days of the social work profession the role of
science and its relationship to practice has been contested. In Aotearoa this debate has often
centred on the relevance of research conducted on distant shores, with populations that
were not our own. Social work, by its very nature is interested in context. The absence of
local research may have left us bereft of the ability to claim and articulate what it is that
does inform us and what it is we aim to achieve in order to legitimately claim our practice
as effective. In an effort to begin to understand what may be claimed as effective practice in
one particular context this mixed methodology study asked the question: “How are the
dimensions of effective health social work practice demonstrated and described within the
multidisciplinary team, in an acute hospital setting in Aotearoa?” Beginning with a fine
grained case study, the dimensions of effective practice were identified, and then tested
across a broader context, with a broader group of participants via an online survey tool.
Whilst accepting that at times clear evidence does exist to support particular health social
work practices, engaging in this type of interpretive research provided an opportunity to
begin to understand the most appropriate practice in this particular circumstance (Plath,
2006). Key stakeholders were clear that the dimensions of effective practice in the acute
hospital context are made up of a combination of professional activities, behaviours,
attitudes and theory-informed practice. The quality of the relationships between the health
social worker, their team, patients and his/her whanau members were found to be at the
very heart of these dimensions, this is reflected in the title of my thesis ‘from the cleaners
to the doctors’. These dimensions are not confined to specific results, although there are
indications that they do support successful outcomes. There is much in the findings to
suggest that the vestiges of many of the discoveries made by empirical studies can be found
in the dimensions of effective practices that emerged from this study. It is not the remnants
of the empirical effectiveness studies that dominate the findings. Rather it appears to be the
successful adaptation to the acute hospital environment made by the Health Social Worker
that was found to be important. In this context the dimensions of effective practice were
identified as those which were best able to support the provision of an efficient, responsive
and timely health social work service in a practice context that heavily favours ‘getting the
job done.’
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Keywords
Medical social work, Social work practice, Acute hospitals, New Zealand