Takayama Eriko

The purpose of this article is to consider the influence of the health care-related social policy on social work practice in hospitals. First, references to social workers in documents such as the medical service fees and medical service law ware reviewed. Through this, what social workers was expected was considered. Changes in the social workers were analyzed as follows: (1) the trend of the number of social workers in the health care field; (2) changes to the assigned department of social workers in hospitals; and (3) changes in the ratio of discharge supports. It appeared that the number of social workers has increased. Furthermore, the percentage of social workers belonging to regional medical care coordination departments and the percentage of social work tasks involring discharge supports have become high. Finally, I concluded that the ratio of discharge supports shows the scale of the social work duties and that here is a relationship between the health care-related social policy and social work practice.

Discharge planning is becoming one of the most important tasks for social worker in hospital, although there has not been any statistical analysis about it. The purpose of this paper is to study the establishment of discharge planning as a new task for social worker in a large hospital of highly specialized status. It clarifies the elements affecting the number of the cases, and discusses what makes possible adequate referral by hospital doctors to social workers. Tasks of social workers are categorized in four- (A) support for hospital utilization, (B) discharge planning, (C) solving economic problem, and (D) others. As for the elements affecting it, two factors are picked up : (a) medical care policy of the government toward specialization of hospitals, and (b) formation of "team as framework". As for discharge planning, establishment of the task is affected by medical care policy, whereas "team as framework" affects adequate referral. On the other hand, as for support for hospital utilization, "team as framework" affects both, establishment of the task and adequate referral. It is concluded that medical care policy affects mainly the establishment of discharge planning, whereas "team as framework" affects support for hospital utilization and the establishment of discharge planning through adequate referral.

In social work studies, various concepts of team have been suggested. One of the most important aspects of team is that team members participate in assessment of patients and decide more adequate care planning for patients. However, in Japanese hospitals, it is normally doctors who assess patients' needs and prescribe treatments to be done by other professionals. This paper suggests the concept "team as a framework", in which all professional members belonging to independent sections, participate in assessment process and have chance to exchange free opinions. "Team as framework" is important in two ways. One, team members are encouraged to discuss all the patients concerned. Two, team members are expected to change their roles according to the needs of patients. The analysis of a large hospital of a high specialization status seems to suggest that the "weekly going round" of all patients' beds and "weekly conference" in wards and sections contribute to form the concept "team as framework", where two points are identified as important factors. One, "weekly round" and "weekly conference" clarify the patients as a team's concern, giving chances of discussing their overall conditions as a group. Two, they divide the members and non-members of a team, which work team as a "small group".