Understanding organizational reengineering in health care: strategies for social work's survival.

Confronted with decreasing reimbursement and managed care, hospitals across the country have been "reengineering" in an effort to streamline processes and enhance revenue. Because of the financial implications of discharge planning, hospital social workers and their departments are typically examined and realigned in some way during a reengineering process. To survive in this environment, social workers must understand the principles of reengineering; its hoped for and actual impact; be able to identify opportunities to contribute; and have the capacity to cope with an evolving professional role. This paper presents a general overview of reengineering and its adaptation to the health care environment. Specific challenges for medical social workers are described along with strategies for surviving in a reengineered health care system.