social work profession was founded on identifica- for the values our profession represents, or be-

tion of strengths, and it is our fundamental obli-
gation to support the original values.
Thank you for publishing “new breath!”
Ann Jackson Wadsworth
Hastings-on-Hudson, NY
Response to Effect of a Changing Health
Care Environment on Social Work Leaders
cause their institutions have not yet been visited
by outside consultants who exclusively address the
bottom line. The struggle to preserve humanistic
values is exhausting.
We look forward to seeing how the authors’
follow-up data hold up as social workers report to
nurses, as we focus on the “dispo” rather than
psychosocial assessment and intervention in
health emergencies, as young staff defect in the

W e owe Mizrahi and Berger (“Effect of a

Changing Health Care Environment on So-
cial Work Leaders,” April 2001, pp. 170–182) a
absence of a viable career ladder, as we induct
young staff into a frenzied environment without
roots in professional identify and stifle their pro-
tremendous debt for organizing an outstanding fessional growth, as we listen to consumer feed-
longitudinal study to monitor the effect of a back about quality, and as exceptional leaders are
changing health care climate on hospital social replaced with managers. Will it support optimism
work. As a casualty of such reengineering, I espe- about our professional influence on program,
cially applaud them for distinguishing between policy, and research in health care? There will al-
social work management and leadership. Current ways be social work jobs. This should not be con-
staff (as opposed to those in my former depart- fused, however, with professional influence on
ment) are “managed” in terms of productivity how institutions care for their patients or what we
and paperwork compliance. Tasks prevail over contribute as a profession to health management
clinical functions, and supervision is spotty. Al- and prevention.
though we agree that organizations should expect Sue Matorin
staff to step to the plate when hired and function New York, NY
with skill, administrative support and mentoring
for staff to refine skills and develop professionally
are needed as well, as are opportunities to partici-
pate in collaborative research projects. The em-
phasis on volume has resulted in considerable
turnover as staff members are asked to sacrifice
and do more with less. Budgets dominate hiring
so that seasoned clinicians are replaced with new
clinicians, despite increasing case complexity and
high risk clients. Managers identify with business
values and minimize concerns about breaches of
confidentiality and ethical dilemmas. In the ab-
sence of professional leadership, there is no arena
to explore the impact on quality. However, our
clients articulate it well. For example, a young fa-
ther of a 15-month-old daughter participates in a
treatment program to recover from a major sui-
cide attempt; the social worker had no time to
speak with his overwhelmed, terrified wife for a
week.
We do not experience these sea changes in iso-
lation. My psychiatrist colleagues share the same
concerns. Ironically, the cost savings promised by
managed care have failed to materialize, and in
fact health care costs continue to soar.
My survivor colleagues graciously acknowledge
that they exist because of administrative support
Social Work / Volume 46, Number 4 / October 2001

376