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

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.’