Abstract
The COVID-19 pandemic is only the most recent challenge for healthcare professionals. Critical change processes, synthesized in the terms neoliberalization, globalization, and digitalization, have affected institutional settings and workplaces and altered work practices and working conditions in this professional area. Such processes have also influenced how professionals perceive their roles and interact with managers, peers, and users, calling into question professional identities. This chapter focuses on healthcare social workers – namely, social workers who work in healthcare facilities and collaborate with other professionals to address complex situations – arguing that they have been severely hit by the above changes and are further threatened by the COVID-19 pandemic. Based on a literature review, the analysis shows that neoliberalization is the fil rouge that connects social, institutional, and professional change and identifies new public management as a factor that significantly modified social work practice in healthcare. Street-level bureaucracy literature, though, revealed ambiguous effects on social workers’ discretionary autonomy. Then, while it is clear that the pandemic crisis has affected work organization and working conditions, its impact on identity dynamics is nebulous.
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References
Asquith S, Clark C, Waterhouse L (2006) The role of the social worker in the 21st century – A literature review. Scottish Executive Education, Edinburgh
Baines D (2004) Pro-market, non-market: the dual nature of organizational change in social services delivery. Crit Soc Policy 24(1):5–29. https://doi.org/10.1177/0261018304039679
Baines D, Charlesworth S, Turner D, O’neill L (2014) Lean social care and worker identity: the role of outcomes, supervision and mission. Crit Soc Policy 34:433–453. https://doi.org/10.1177/0261018314538799
Beddoe L (2011) Health social work: professional identity and knowledge. Qual Soc Work 12(1):24–40. https://doi.org/10.1177/1473325011415455
Bellini A, Maestripieri L (2018) Professions within, between and beyond. Varieties of professionalism in a globalising world. Cambio Rivista Sulle Trasformazioni Sociali 8(16):5–14. https://doi.org/10.13128/cambio-24947
Ben Shlomo S, Levin-Keini N (2021) Once in a hundred years: does COVID-19 present an opportunity to restructure the professional image of the social worker in Israel? Br J Soc Work 51:1568–1584. https://doi.org/10.1093/bjsw/bcab055
Berg E, Barry J, Chandler J (2008) New public management and social work in Sweden and England. Challenges and opportunities for staff in predominantly female organizations. Int J Sociol Soc Policy 28(3/4):114–128. https://doi.org/10.1108/01443330810862188
Boas TC, Gans-More J (2009) Neoliberalism: from new liberal philosophy to anti-liberal slogan. Stud Comp Int Dev 44(2):137–161. https://doi.org/10.1007/s12116-009-9040-5
Bolton S, Muzio D (2008) The paradoxical processes of feminization in the professions: the case of established, aspiring and semi-professions. Work Employ Soc 22(2):281–299. https://doi.org/10.1177/0950017008089105
Bourgeault IL, Wrede SH, Benoit C, Neiterman E (2016) Professions and the migration of expert labour: towards an intersectional analysis of transnational mobility patterns and integration pathways of health professionals. In: Dent M, Bourgeault IL, Denis J-L, Kuhlmann E (eds) The Routledge companion to the professions and professionalism. Routledge, London, pp 295–312
Brodkin EZ (2011) Policy work: street-level organizations under new managerialism. J Public Adm Res Theory 21(suppl2):i253–i277. https://doi.org/10.1093/jopart/muq093
Brown C, Johnstone M, Ross N, Doll K (2022) Challenging the constraints of neoliberalism and biomedicalism: repositioning social work in mental health. Qual Health Res 32(5):771–787. https://doi.org/10.1177/10497323211069681
Busch PA, Henriksen HZ (2018) Digital discretion: a systematic literature review of ICT and street-level discretion. Inf Polity 23(1):3–28. https://doi.org/10.3233/IP-170050
Carey M (2015) The fragmentation of social work and social care: some ramifications and a critique. Br J Soc Work 45(8):2406–2422. https://doi.org/10.1093/bjsw/bcu088
Cohen N, Benish A, Shamriz-Ilouz A (2016) When the clients can choose: dilemmas of street-level workers in choice-based social services. Soc Serv Rev 90(4):620–646. https://doi.org/10.1086/689621
Currin-McCulloch J, Qi C, Kaushik S, Sparks D, Jones B (2022) The courage to continue: healthcare social worker’s resilience during COVID-19. J Soc Work End Life Palliat Care 18(2):177–192. https://doi.org/10.1080/15524256.2022.2070330
Davidovitz M, Cohen N (2021) “I have learned my lesson:” How clients’ trust betrayals shape the future ways in which street-level bureaucrats cope with their clients. Public Adm 1–15. https://doi.org/10.1111/padm.12769
de Boer N, Raaphorst N (2021) Automation and discretion: explaining the effect of automatization on how street-level bureaucrats enforce. Public Manag Rev 1–19. https://doi.org/10.1080/14719037.2021.1937684
Dent M, Whitehead S (2002) Introduction: configuring the “new” professional. In: Dent M, Whitehead S (eds) Managing professional identities: knowledge, performativity and the “new” professionalism. Routledge, London, pp 1–16
Dubar C (2010) La crise des identités. L’interprétation d’une mutation. Presses Universitaires de France, Paris
Dubois V (2010) The bureaucrat and the poor: encounters in French welfare offices. Ashgate, Farnham
Du Y-Z, Chan TMS (2021) Professional identity of Wuhan and Hong Kong social workers: COVID-19 challenges and implications. Qual Soc Work 20(1–2):297–304. https://doi.org/10.1177/1473325020973339
Ebert N (2012) Individualisation at work: the self between freedom and social pathologies. Ashgate, Farnham
Evans T (2009) Managing to be professional? Team managers and practitioners in social services. In: Harris J, White V (eds) Modernising social work: critical considerations. Policy Press, Bristol, pp 145–163
Evans T (2011) Professionals, managers and discretion: critiquing street-level bureaucracy. Br J Soc Work 41(2):368–386. https://doi.org/10.1093/bjsw/bcq074
Evans T, Harris J (2004) Street-level bureaucracy, social work and the (exaggerated) death of discretion. Br J Soc Work 34:871–895. https://doi.org/10.1093/bjsw/bch106
Franceschini D, Grabowski J, Sefilyan E, Moro TT, Ewald B (2021) COVID-19: a critical time for cross-sector social work care management. Soc Work Health Care 60(2):197–207. https://doi.org/10.1080/00981389.2021.1904319
Gallie D (ed) (2013) Economic crisis, quality of work and social integration. Oxford University Press, Oxford
Gillen P, Neill RD, Manthorpe J, Mallett J, Schroder H, Nicholl P, Currie D, Moriarty J, Ravalier J, McGrory S, McFadden P (2022) Decreasing wellbeing and increasing use of negative coping strategies: the effect of the COVID-19 pandemic on the UK health and social care workforce. Epidemiologia 3(1):26–39. https://doi.org/10.3390/epidemiologia3010003
Harlow E (2003) New managerialism, social services departments and social work practice today. Practice 15(2):29–44. https://doi.org/10.1080/09503150308416917
Harlow E, Berg E, Barry J, Chandler J (2013) Neoliberalism, managerialism and the reconfiguring of social work in Sweden and the United Kingdom. Organization 20:534–550. https://doi.org/10.1177/1350508412448222
Harris J (1998) Scientific management, bureau-professionalism, new managerialism: the labour process of state social work. Br J Soc Work 28(6):839–862. https://doi.org/10.1093/oxfordjournals.bjsw.a011404
Harvey D (2005) A brief history of neoliberalism. Oxford University Press, Oxford
Hill M, Hupe P (2020) Discretion in the policy process. In: Evans T, Hupe P (eds) Discretion and the quest for controlled freedom. Palgrave Macmillan, Cham, pp 237–258
Hood C (1991) A public management for all seasons? Public Adm 69(1):3–19. https://doi.org/10.1111/j.1467-9299.1991.tb00779.x
Hupe P (2013) Dimensions of discretion: specifying the object of street-level bureaucracy research. Der Moderne Staat 6(2):425–440
Ibarra H (1999) Provisional selves: experimenting with image and identity in professional adaptation. Adm Sci Q 44(4):764–791. https://doi.org/10.2307/2667055
Judd RG, Sheffield S (2010) Hospital social work: contemporary roles and professional activities. Soc Work Health Care 49(9):856–871. https://doi.org/10.1080/00981389.2010.499825
Klenk T, Pavolini E (eds) (2015) Restructuring welfare governance: marketization, managerialism, and welfare state professionalism. Edward Elgar, Cheltenham
Larsen F, Caswell D (2022) Co-creation in an era of welfare conditionality—lessons from Denmark. J Soc Policy 51(1):58–76. https://doi.org/10.1017/S0047279420000665
Lawler J (2000) The rise of managerialism in social work. In: Harlow E, Lawler J (eds) Management, social work and change. Ashgate, London, pp 33–55
Lawler J (2007) Leadership in social work: a case of caveat emptor? Br J Soc Work 37(1):123–141. https://doi.org/10.1093/bjsw/bch404
Lévesque M, Negura L (2021) Organizational context and healthcare reforms: what effect on the professional distress of Canadian social workers and social service provision? Front Sociol 6:651240. https://doi.org/10.3389/fsoc.2021.651240
Lévesque M, Negura L, Gaucher C, Molgat M (2019) Social representation of social work in the Canadian healthcare setting: negotiating a professional identity. Br J Soc Work 49(8):2245–2265. https://doi.org/10.1093/bjsw/bcz005
Lewiskin J, Abramovitz M, Zelnick J (2021) On the front lines: the impact of managerialism on the New York City addiction treatment workforce. New Solut 31(3):259–270. https://doi.org/10.1177/10482911211041615
Lipsky M (2010[1980]) Street-level bureaucracy: dilemmas of the individual in public services. Russel Sage, New York
Lotta G, Pires R, Ostergaard Møller M (2021) Recontextualizing street-level bureaucracy in the developing world. Public Adm Dev 42(1):3–10. https://doi.org/10.1002/pad.1968
Martínez-López JÁ, Lázaro-Pérez C, Gómez-Galán J (2021) Predictors of burnout in social workers: the COVID-19 pandemic as a scenario for analysis. Int J Environ Res Public Health 18(10):5416. https://doi.org/10.3390/ijerph18105416
Miller JJ, Reddin Cassar J (2021) Self-care among healthcare social workers: the impact of COVID-19. Soc Work Health Care 60(1):30–48. https://doi.org/10.1080/00981389.2021.1885560
Mojica Méndez D, Michelsen Gómez S, Cadena Camargo Y (2021) Healthcare workers during the COVID-19 pandemic from a street-level bureaucracy perspective – A narrative review of literature. Univ Med 62(4):135–150. https://doi.org/10.11144/javeriana.umed62-4.call
Monaghesh E, Hajizadeh A (2020) The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health 20(1):1193–1202. https://doi.org/10.1186/s12889-020-09301-4
Moore ST (1998) Social welfare in a managerial society. Health Mark Q 15(4):75–87. https://doi.org/10.1300/J026v15n04_05
Morilla-Luchena A, Muñoz-Moreno R, Chaves-Montero A, Vázquez-Aguado O (2021) Telework and social services in Spain during the COVID-19 pandemic. Int J Environ Res Public Health 18(2):725. https://doi.org/10.3390/ijerph18020725
Muzio D, Brock DM, Suddaby R (2013) Professions and institutional change: towards an institutionalist sociology of the professions. J Manag Stud 50(5):699–721. https://doi.org/10.1111/joms.12030
Negura L, Lévesque M (2021) Understanding professional distress through social representations: investigating the shared experience of healthcare social workers in Canada. Int Soc Work 1–17. https://doi.org/10.1177/0020872820967428
Noordegraaf M (2007) From “pure” to “hybrid” professionalism: present-day professionalism in ambiguous public domains. Adm Soc 39(6):761–781. https://doi.org/10.1177/0095399707304434
Osborne D, Gaebler T (1992) Reinventing government: how the entrepreneurial spirit is transforming the public sector. Addison Wesley, Reading
Parry N, Parry J (1979) Social work, professionalism and the state. In: Parry N, Rustin M, Satyamurti C (eds) Social work, welfare and the state. Edward Arnold, London, pp 21–47
Pollitt C (1993) Managerialism and the public services: cuts or cultural change in the 1990s? Blackwell, Oxford
Powell WW, Colyvas JA (2008) Microfoundations of institutional theory. In: Greenwood R, Oliver C, Suddaby R, Sahlin K (eds) The Sage handbook of organizational institutionalism. Sage, London, pp 276–298
Preston-Shoot M (2001) Regulating the road of good intentions: observations on the relationship between policy, regulations and practice in social work. Practice 13(4):5–20. https://doi.org/10.1080/09503150108411523
Raaphorst N (2018) How to prove how to interpret and what to do? Uncertainty experiences of street-level tax officials. Pub Man Rev 20(4):485–502. https://doi.org/10.1080/14719037.2017.1299199
Ross AM, Schneider S, Muneton-Castano YF, Caldas AA, Boskey ER (2021) “You never stop being a social worker:” experiences of pediatric hospital social workers during the acute phase of the COVID-19 pandemic. Soc Work Health Care 60(1):8–29. https://doi.org/10.1080/00981389.2021.1885565
Ruhs M, Anderson B (2010) Who needs migrant workers? Labour shortages, immigration and public policy. Oxford University Press, Oxford
Sawyer A-M (2009) Mental health workers negotiating risk on the frontline. Aust Soc Work 62:441–459. https://doi.org/10.1080/03124070903265724
Schiff M, Shinan-Altman S, Rosenne H (2021) Israeli health care social workers’ personal and professional concerns during the COVID-19 pandemic crisis: the work-family role conflict. Br J Soc Work 51(5):1858–1878. https://doi.org/10.1093/bjsw/bcab114
Shanks E, Lundstrom T, Wiklund S (2015) Middle managers in social work: professional identity and management in a marketised welfare state. Br J Soc Work 45:1871–1887. https://doi.org/10.1093/bjsw/bcu061
Thomann E, Hupe P, Sager F (2018a) Serving many masters: public accountability in private policy implementation. Governance 31(2):299–319. https://doi.org/10.1111/gove.12297
Thomann E, van Engen N, Tummers L (2018b) The necessity of discretion: a behavioral evaluation of bottom-up implementation theory. J Public Adm Res Theory 28(4):583–601. https://doi.org/10.1093/jopart/muy024
Tummers L, Bekkers V, Steijn B (2012a) Explaining the willingness of public professionals to implement public policies: content, context and personality characteristics. Public Adm 90(3):716–736. https://doi.org/10.1111/j.1467-9299.2011.02016.x
Tummers L, Vermeeren B, Steijn B, Bekkers V (2012b) Public professionals and policy implementation. Public Manag Rev 14(8):1041–1059. https://doi.org/10.1080/14719037.2012.662443
Tummers L, Bekkers V, Vink E, Musheno M (2015) Coping during public service delivery: a conceptualization and systematic review of the literature. J Public Adm Res Theory 25(4):1099–1126. https://doi.org/10.1093/jopart/muu056
Van Berkel R, Caswell D, Kupka P, Larsen F (eds) (2017) Frontline delivery of welfare-to-work policies in Europe: activating the unemployed. Routledge, New York
Viens AM (2019) Neo-liberalism, austerity and the political determinants of health. Health Care Anal 27:147–152. https://doi.org/10.1007/s10728-019-00377-7
Webb SA (2001) Some considerations on the validity of evidence-based practice in social work. Br J Soc Work 31(1):57–79. https://doi.org/10.1093/bjsw/31.1.57
Webb SA (2006) Social work in a risk society: social and political perspectives. Palgrave Macmillan, Houndmills, Basingstoke
Webb SA (2017) Matters of professional identity and social work. In: Webb SA (ed) Professional identity and social work. Routledge, London, pp 1–18
Zacka B (2017) When the state meets the street: public service and moral agency. Belknap Press, Cambridge
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Bellini, A., Raspanti, D. (2023). Institutional Change and Healthcare Social Workers’ Identity: An Analysis from the Street-Level Perspective. In: Liamputtong, P. (eds) Handbook of Social Sciences and Global Public Health. Springer, Cham. https://doi.org/10.1007/978-3-030-96778-9_34-1
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