Hospital Social Work

Workforce characteristics, hospital role, scope of work

Three sections follow:

1.      Background Material that provides the context for the topic

2.      Suggestions for Practice

3.      A list of References

4. Appendix 1: Aboriginal peoples' experiences of hospitals

Feedback welcome!

Background Material

Introduction

Social workers employed within health services provide direct intervention to patients and their families/carers aiming to minimise the impacts of illness, injury, biopsychosocial severity, complexity and treatment. A social worker's role within health is to enhance biopsychosocial and emotional functioning through targeted evidenced based, patient centred interventions. Social workers are essential members of the multidisciplinary team. As such social workers can significantly influence the patient’s care plan to be more reflective of their needs, directly influencing positive outcomes, reducing the need for health service demand (New South Wales Health, 2023).

Workforce characteristics

Workforce modelling indicates the need to grow the NSW social work workforce by around 20 to 34 new professionals per annum to meet community need in 2040 within the Health (community and hospital) sector.  In NSW Health in 2021 there were 2769 social workers employed for an average of 31 hours per week.  87.6% were female with average age of 43.3 years.  1.5% were Aboriginal people (New South Wales Health, 2023).

There is an increased demand for social workers because of increases in:

• Complex health and social needs, including among older Australians

• People people with histories of psycho-social distress or trauma

• People diagnosed with a disability

• People at risk of violence and harm

• Natural disasters and pandemics that increase psychosocial issues in the community (New South Wales Health, 2023).

Social workers in hospitals

Hospitals are one of the largest employers of social workers in Australia with professional social workers employed in a wide range of hospital settings. Social workers offer a unique contribution to the hospital system in providing services to meet the multidimensional needs of patients and their families/carers.  They provide direct services to patients and their families/carers (including significant others) aiming to minimise the negative impacts of illness and hospitalisation. Social workers intervene in the context of a patient’s social environments and relationships, recognising the effects of the psychological, familial, social, economic and cultural determinants on health and wellbeing. Social workers advocate for the rights of patients and their families/carers against discrimination, exclusion and abuse they can sometimes experience (Cordoba, 2020). With effective assessment and case planning tools and reliable networking with hospital staff, the social worker can advocate on the patient's behalf and help to paint a new picture of what a person's quality of life may look like upon discharge (AASW, 2024).

Scope of practice for hospital social work (Cordoba, 2020; AASW, 2024)

Assessment         In the assessment phase social workers recognise the effects of the psychological, familial, social, economic and cultural determinants of health and wellbeing on the patient.  The social workers' key roles involve mitigating risk factors—child abuse and neglect, family violence, intimate partner violence, elder abuse, sexual abuse and exploitations.

Counselling, mediation and therapeutic intervention      Some of the main approaches social workers might use with patients include systems theory, brief intervention therapy and the solution-orientated approach. Grief and trauma informed practice may assist patients who struggle to adapt to a recent diagnosis or loss.

Crisis intervention           Social workers support vulnerable people in crisis to communicate their needs and wishes. 

Advocacy               It is important that social workers learn to advocate for themselves and the patient, so the medical and allied health team are aware of the patients' broader social and emotional issues. These factors may be impacting on the patient's overall health issues.

Case management, service co-ordination and multidisciplinary work      Social workers must communicate well with the hospital team, from the doctors and nursing staff on the wards to the allied health professionals and volunteers in outpatients. This includes writing concise, factual case notes.  With effective communication in place social workers can develop a clear, concise care plan where all the allied health services goals, interventions and outcomes are documented.  This ensures that patients, families, and staff have a clear plan and are working towards a safe and healthy discharge.

Policy program, design, and research      Social workers can be effective at the organisational level by assisting with the development and implementation of a patient-centred care model.

Specialist clinical experience in addressing psychosocial aspects               Social workers should address psychosocial aspects of care which may include child abuse and neglect, family violence, grief and loss, socio-legal issues and ethical decision making, chronic health conditions, family interventions and support, and developing culturally responsive and inclusive interventions.

Simpson (2026) sees an important role for social workers in hospitals, suggesting they can be involved in both the clinical and social dimensions of care.  Social workers are trained to see and offer support multiple patient issues: trauma history, grief, caregiver dynamics, relationship discord, housing instability, lack of support, and internalized stigma.  Simpson suggests the outcomes of social worker involvement with a patient can include:

• Reduced length of stay.

• Less likely to require inpatient psychiatric hospital care post discharge.

• Leaving the hospital with practical tools, such as cognitive restructuring techniques, mindfulness strategies, and safety planning.

• Increased adherence to psychiatric medication, and more likely to engage in follow-up care upon discharge.

• Educating future physicians around treating mental health with a more comprehensive and patient-focused approach.

Suggestions for Practice

In their commitment to self-determination and respect, hospital social workers ensure that patients, and their families/carers, have access to information and are able to make informed decisions concerning their health and wellbeing.  Social workers contribute by:

• Conducting comprehensive and culturally appropriate psychosocial assessments that greatly inform the decision making of other professionals and the multidisciplinary health team

• Reducing inappropriate health service demand through comprehensive psychosocial assessments and intervention including linkages and referrals to community-based services

• Preventing re-admissions through rigorous discharge planning and by addressing critical psychosocial determinants including the establishment of strong, supportive familial and community networks and access to appropriate resources

• Leadership when working in multidisciplinary team around response planning for issues of risk, abuse and trauma

• Providing professional development for other health professionals on psychosocial issues relevant to recovery (Cordoba, 2020).

Case Study: From Surviving to Healing

Patient X is a 45-year-old individual who has survived a self-inflicted gunshot wound to the head. A social worker meets patient X right where they are—medically compromised, emotionally overwhelmed with sadness, anxiety, and fear. Patient X’s story is heard and valued at a detailed level—the emotional weight behind the attempt and the stressors that led to it. Together, worker and patient begin to build a crisis management plan that is grounded in patient X’s own values. Almost daily visits include evidence-based practices of cognitive restructuring, emotional regulation skills, and meaning making conversations that help patient X reconnect with a sense of purpose and hope. Over time, these visits start to become a place where patient X is looking forward to talking, reminded they are not alone, and able to become an active participant in intentional healing—knowing healing is possible.  With each visit, Patient X begins to build a toolbox of skills to carry into life after discharge. These are strategies they can use during moments of distress or uncertainty. The discharge plan extends beyond finding placement. It also includes follow-up care for therapy and psychiatry services. Their support system is also engaged in the discharge planning process. In this new model, Patient X doesn’t just survive their injury at the hospital, but they begin the work of healing, with mental health support integrated into their recovery from the start (Simpson, 2026).

References

AASW: Australian Association of Social Workers.  (2024). Social workers role in the hospital - Bridge to the social world.  https://my.aasw.asn.au/s/article/Social-workers-role-in-the-hospital-bridge-to-the-social-world

Cordoba, P. (2020). Scope of social work practice: Hospitals.  https://www.researchgate.net/publication374809857_Scope_of_Social_Work_Practice_Hospitals  doi: 10.13140/RG.2.2.33619.55842

Crook C, Kalucy D, Nixon J, Sherriff S, Winch S, Bailey S. (2025). Exploring Aboriginal people's experiences of hospital care. NSW Ministry of Health. Sax Institute.  https://www.health.nsw.gov.au/aboriginal/Documents/general-report.pdf 

New South Wales, Australia, Health. (2023). Social work: Workforce modelling factsheet.  https://www.health.nsw.gov.au/workforce/modelling/Pages/social-work.aspx

Simpson, A. (2026, Winter). At the bedside and beyond: Reimaging social workers’ role in hospitals.  Social Work Today, 26(1), 8-9.  https://www.socialworktoday.com/

Appendix 1

Aboriginal peoples' experiences of hospital

Crook C, Kalucy D, Nixon J, Sherriff S, Winch S, Bailey S. (2025). Exploring Aboriginal people's experiences of hospital care. NSW Ministry of Health. Sax Institute.  https://www.health.nsw.gov.au/aboriginal/Documents/general-report.pdf 

From the analysis of the interview data, four themes emerged as the driving factors behind whether Aboriginal patients had positive, culturally safe hospital experiences, described as feeling welcomed, respected, comfortable, supported, and empowered during their hospital stay.

1.  Pre-existing views about hospitals.  The range of views shaped by culture, family and friends, and previous healthcare experiences

Many patients noted that previous negative hospital experiences had resulted in them holding significant fear of hospitals. This included personal experiences, and the experiences of family, friends, and community members. This combination of historical and recent experiences created a lack of trust amongst many participants that their medical concerns would be appropriately dealt with, or that they would be treated with respect and listened to during their stay. This view was particularly common in older patients.

2.  People – what, how and who matters. The key role of Aboriginal staff and communication in providing welcoming, supportive, and respectful, culturally safe care.

What - Covert racism and discrimination still exists            While participants felt there had been systemic improvements in cultural safety over time, they said that covert racism by individuals in the hospital system still existed. This included stereotyping, with assumptions being made regarding the use of drugs or alcohol, not being treated respectfully or not listened to.  Body language, feeling inferior or ignored, and lack of awareness amongst non-Aboriginal hospital staff of Aboriginal culture (including the role of family and community and perceptions and practices around death) and past trauma experienced by Aboriginal people.  Where experiences of racism or discrimination occurred, it impacted participants’ overall stay in hospital and often future health seeking behaviour as well. Most commonly, patients would report an unwillingness to return to the hospital where it occurred, and sometimes hospitals more broadly.

How – The way staff communicate with Aboriginal patients matters           Where staff communicated in a manner that was kind, friendly, and caring, participants reported feeling welcome, comfortable, and respected.  Participants also reported that when staff took the time to explain things well, give clear directions and consultation, patients felt empowered to manage the next steps in their care pathway.  Participants also valued when staff made efforts to check they were comfortable and took the time to sit and chat with them.  Where patients received communication that was perceived to be rushed, uncaring, or not well explained (either not enough information or too much jargon), they felt powerless, undervalued, disrespected, and ashamed to ask questions.

Who – Aboriginal staff are important for cultural safety                    Having Aboriginal staff at the hospitals was considered to be the most important factor in ensuring cultural safety for Aboriginal patients.  Patients also spoke of the important role AHLOs played in supporting them during their time in hospital. AHLOs were perceived as providing culturally specific support which helped overcome fear and loneliness. Patients noted that AHLOs gave them much needed support during and after their hospital stay, through assisting with communication, advocating for their needs and providing logistical support. In some locations post-discharge care was also provided by the AHLOs.

3.  Processes, practices and policies.  How the hospital system contributes to Aboriginal patients feeling comfortable, supported, and empowered as well as the affecting the quality of clinical care provided.

Many participants described situations where they felt that understaffing and limited numbers of beds had resulted in lengthy wait times (e.g. on admission and waiting for discharge), patients feeling unwelcome, including feelings of being shuffled and discharged too early.  Some patients reported that there were insufficient numbers of Aboriginal staff.

Many participants reported that the overall clinical care they received was good, even if they had concerns with other aspects of their stay.

Where the discharge process provided adequate information upon discharge, patients felt empowered to manage their care at home. Follow-up care was highly valued but not always provided.

4.  Places.   The environmental factors that impact how comfortable and supported Aboriginal patients and their families feel in hospital.

Participants expressed the importance of having a cultural room, where family can meet in larger numbers, make food and be present for sick family members. Some participants suggested that Aboriginal artwork in the hospital made them feel more welcome and others mentioned the need for spaces to be warmer (less clinical looking).

Conclusion

Participants in this study reported feeling that Aboriginal people’s experiences of hospital care have generally improved overall in recent years. Aboriginal people admitted in NSW hospitals, however, still reported many negative experiences of care that had impacts on their health, wellbeing, and future willingness to engage with the health system. Systemic challenges such as covert racism and other factors including long wait times from admission through to discharge, rushed or compromised interactions with staff, a lack of access to Aboriginal staff, and breakdowns in communication with hospital and primary care that impact patient experience and cultural safety were reported. Aboriginal patients described culturally safe care as feeling welcomed, respected, comfortable, supported and empowered.