What social work can learn from the teaching hospitals model

The renewed focus on social work practice leadership is welcome and long overdue. And there is much to learn from other disciplines.

The teaching hospital model offers innovative ideas for how social work leadership could be modelled and developed. Teaching hospitals promote a distinct focus on education, research, clinical innovation and patient care, often focusing on specialist treatment.

Simply put, complicated conditions or specialist treatments benefit from practice (clinical) informed research, alongside clinical skills and highly trained staff. More junior clinicians benefit from this focus on clinical expertise delivered by senior staff.

Teaching and learning is built into the architecture of the organisation, with senior leadership mentoring and teaching others. Assessment and case analysis is often a team endeavour in teaching hospitals and this offers a consultative approach to patient care.

This is significantly different to a dyad model of physician-patient (or social worker – manager). Benefits include experienced and novice practitioners sharing in practice learning, with debate and challenge in clinical work woven into the day to day working culture. In essence this is practice leadership, credibility and gravitas based on a deep understanding of professional research and an engagement with the evidence base. We must not just accept research on what works but take a critical and rigorous approach.

Outcomes

While much hospital based research has focused on clinical outcomes, there is little empirical research about the actual model. In one important study, Ayanian and Weissman (2002) argue that teaching hospitals are well regarded in the public eye, and attract and retain a high calibre of staff.

They note outcomes for specialist care are better in teaching hospitals. Teaching hospitals in the United States are significantly more expensive to operate, because they offer specialist services, so equipment costs and highly experienced specialist clinicians are needed. Balancing this investment, career development opportunities attract a high calibre of clinicians who want to be field experts, and staff retention is higher than in non-teaching hospitals.

Ayanian et al (2002) found substantially better quality of care in teaching hospitals over non-teaching hospitals. They found clinical notes and case recording at a higher standard than non-teaching hospitals. What is not clear is why clinical note recording is at a higher standard. One hypothesis is that senior clinicians review notes and so junior staff work is engaged with in real time. A culture of high standards then is part of practice and organisational culture.

What is not clear from the literature is the difference organisation cultures in teaching hospitals to non-teaching hospitals have on staff and therefore patient care and experience. However, there is substantial evidence in the literature that organisational cultures do affect professional practice in social work.

Social work needs to be brave

The design of the system and how social work services are delivered has become increasingly scrutinised through the lens of government, our regulators and more importantly the children, young people and their families and carers we serve. We need to be brave and tenacious to try new ways of working, challenge what has gone before us and pioneer new models through co design and innovation.

Teaching hospitals are noted to be professionally attractive; with brand prominence and public perceptions improved. Unlike teaching hospitals, there is no onus on senior managers in social care to be active in practice, research engaged or up to date in knowledge about our discipline – social work and family support are poorer because of this. Would we accept this from surgeons or pilots?

The best senior leaders and assistant directors are engaged in practice, and draw upon an extensive research informed paradigm.  It is also pertinent to reflect and indeed lament on the different professional bodies social work has been associated with through the years. This has not provided a secure base on which to grow. Within a teaching hospital the professional bodies are mature, own their profession and campaign for their status. The new social work regulator, Social Work England will be in a prime position to drive this forward.

To date, the focus inside local authorities has been on qualifying practice or first year in practice, the assisted and supported year in practice, with some investment to frontline mangers. There is little if any investment to middle or senior managers in practice leadership by experience. Rather, an emphasis on managerial knowledge and skill dominates. Principal social workers and chief social work officers are recent developments (see Stanley and Russell’s 2014 paper on the development of the PSW role in England).

Senior leaders need a skill set fit for purpose

The role of assistant directors and principal social workers, rebranded as ‘practice leaders’, will help influence professionalism, and this is being promoted by both national chief social workers. Proposals for accreditation at the practice leader level have been recently been developed by the chief social workers. However, our current workplace learning and practice architecture will need reform if we are to offer a culture of practice leadership premised on knowledge skills, research and practice leadership across the tiers or management.

Social Work in 2017 demands stronger leadership, with a move away from the linear model of expert by experience. Senior leaders need a skill set that is fit for purpose we need to grow our talent, nurture and support future leaders to be systems leaders who can build a coalition.

The current local authority system and culture does not expect or encourage the most senior decision makers, managers or leaders to be current in practice or discipline theory, method, knowledge or skill. The best leaders do this, and indeed model this in their day to day practice, they know and understand the conditions for practice and what works.

The teaching hospital model is premised on exactly that. High quality practice, an improved positive public perception, and attracting the brightest and best practitioners and leaders are gains for teaching hospitals. A start could be assistant directors and heads of service being more active in practice, research or teaching – mentoring and coaching others, undertaking assessments, observing casework, or co-working complicated cases.

This is expected and promoted everyday culture for practice leadership in teaching hospitals. The West-Midlands teaching partnership is learning from this experience, and involves nine local authorities with the University of Birmingham. We are researching and locating ways to facilitate leadership as a central tenet from the novice student and beginning to the DCS.

We can aim higher for social work, through aspirational leaders who have practice depth and breadth, and a rich engagement with the underpinning research and evidence base for social work, our profession deserves this, but more importantly our children, young people and adults who receive services should demand this.

Other disciplines have much for us to learn from.

Dr Tony Stanley is Birmingham’s chief social work officer in Birmingham – tony.stanley@birmingham.gov.uk

Lee Pardy-McLaughlin is Coventry’s principal social worker for children and families – Lee.Pardy-McLaughlin@coventry.gov.uk