The challenge of change: enhancing social work services at a time of cutback.

Little systematic attention has been paid to the process of cuts in resources in hospital social work departments and to the implications of such events over time. This article describes the activities of a social work department in response to hospitalwide downsizing. It outlines conceptual premises for action, recommends a step-by-step process for analysis and implementation, reviews implications of cutback, and describes outcomes for department and personnel. In this particular case, social work administration was able to make changes in department organization to improve quality, efficiency, and professional control of practice while modeling cutback and reorganization to the larger hospital community.