Hospital restructuring in North America has involved re-engineering, downsizing, reorganizing, and remodeling of traditional hierarchical functional organizations into multisite programmatic conglomerates. The implications for professional disciplines have been dramatic in that departments such as social work have been dismantled and social work practice has come under the domain of program managers representing multiple disciplines. In this study 12 hospitals in Ontario, Canada, that were studied in the early stages of restructuring in 1995 expanded to 22 sites by 1999. The effect of the mergers and moves to program management on the social work profession was examined. The key findings are that social work line positions were not lost, but accountability and recruitment were no longer in the hands of the discipline. These findings suggest that it is more critical now than ever for social workers to champion their contributions to health.

The shifts in hospitals from single-site functionally organized university and community hospitals to multilayered, mega institutions have had dramatic effects on social work practice. Through this longitudinal research we examine, using a strengths perspective and qualitative interviews, the strategies social workers in 22 hospitals across Ontario, Canada, utilized to survive and thrive. The findings identify the importance of clearly articulating one's value to the organization, staying current, and being flexible.