Social work in medical practices

Both the federal and cantonal governments are in favour of greater interprofessional collaboration in the healthcare system. The rise in chronic illnesses and comorbidities and a lack of skilled workers mean new and innovative forms of interprofessional collaboration are required. Growing awareness of the social factors that affect illness and the common social issues faced by patients indicates that experts in the ‘social safety net’ could be a useful addition to interprofessional teams. Early detection of social issues helps stabilise budgets, finance medical treatments and care, retain jobs and preserve the social safety net.

To ease the burden on healthcare systems caused by chronic illnesses and multimorbidity, the World Health Organisation (WHO) recommends that all countries invest an additional percentage of their GDP in primary care. Strong primary care not only enhances equal health opportunities and public health but also reduces unnecessary hospitalisations and healthcare spending. Social work in primary care can be useful in many ways. It helps patients access and navigate the healthcare system, promotes social integration, obtains social case histories and relieves the burden on medical staff – for instance, by dealing with issues concerning carers, child and adult welfare, and social security.

Although social work in medical practices (primary care social work) is successfully established in various other countries, the services on offer in Switzerland pale in comparison. They have emerged in recent years from the need for holistic and patient-oriented primary care and were created and expanded by committed doctors and social workers. This research project was conducted in conjunction with four such social work services in medical practices.

Objectives

As part of the Innosuisse-backed research project, the BFH set two goals. The first was to research the specialist and organisational foundations of social work in medical practices. Knowledge of different models for social work in medical practices and social work for medical practices should act as a foundation on which specialist practice staff and decision-makers can develop services. A comprehensive benefit and impact assessment was also conducted. The aim was to learn more about social-work clients; the social, mental and physical changes they experience as a result of social work; and the benefits for medical professionals.

A report on the ‘introduction and principles’ of social work in medical practices and a ‘research report’ were produced as project objectives. A short description in the form of a brochure and specialist articles on the subject were also produced to complete the project.

Approach

An extensive literature review was performed for the principles and research reports. The results of the principles report are additionally based on expert interviews, expert workshops and the experiences of practice partners. The findings of the research report are further informed by a longitudinal patient study, a doctor survey and expert interviews. 

The principles report’s findings regarding theoretical foundations and practical implementation show that social work can be implemented in medical practices without too much extra co-operative effort. Referring patients to social workers is just as easy for doctors as referring them to medical specialists:

‘Whether I send someone to the gastroenterologist or the social worker, it’s all more or less the same to me.’ A participating doctor
 

Findings from the research into interprofessional collaboration demonstrate first of all that intensive forms of cooperation are possible. For complex psychosocial matters affecting patients, which cut across different professional categories and capabilities, joint case reviews, team meetings and close communication within the practice can be advantageous. Secondly, the results show that external social work services based outside the medical practice are equally promising. In future, these external services, which can also work with outpatient services or retirement and nursing homes, will require greater attention.

The following statements from doctors who took part in the study demonstrate the benefits for medical professionals:

‘And I learn from the social worker, of course, in the same way the social worker can learn certain aspects from me. So it’s a highly satisfactory situation, as we’re constantly learning and obtaining new skills, without having to master a whole new area of expertise.’ A participating doctor

‘[Patients] keep coming to me with the same lawyer’s letter or missive from their landlord. They come to me with all their issues and expect advice or a solution. I can’t just tell them that’s not my job and to go away. That makes people feel offended. (…) But I simply don’t have time for it. That was one motivation for having a professional on hand to advise these people.’ A participating doctor

The results of the research report demonstrate that social work in medical practices is hugely beneficial to patients and doctors alike. Patients benefit from improved mental health, increased autonomy and enhanced well-being overall. For their part, doctors report having more time to deal with medical matters when seeing patients, an improved standard of care and increased satisfaction at work.

Summary

Social work in medical practices is hugely beneficial to patients and doctors alike. In the context of patient-focused and holistic primary care as set out in WHO guidelines, social work in medical practices should also become widespread in Switzerland. Its potential for equal-opportunity and efficient healthcare provision is major.

santeneXt 2021

The project participant ‘Gesundheitspunkt Oberägeri’ won the Prix d’excellence santeneXt 2021. The participant ‘Caritas beider Basel’ was another finalist, with its project ‘Social work in medical practices’.