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The professional staff in five hospital social work departments participated in an exploratory study to assess the impact of organizational reengineering on job satisfaction, professional identity and other work related attitudes. A survey was used to explore how job functions had changed; whether or not staff felt adequately prepared to perform the new tasks; and whether the changes were consistent with their professional identities and academic preparation. Follow up focus group interviews were held to enrich the quantitative findings. The results of the study indicate that reengineering has a negative effect on job satisfaction and results in role changes that are experienced as inconsistent with the professional identity and academic preparation of social work staff. In addition to describing the results of the study, this paper provides a brief overview of reengineering, describes models of reengineering for hospital social work departments and suggests strategies for lessening the negative effect on staff.

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This study explored the perceptions of health care providers across the continuum of care as to how effective advance directive arrangements were in assuring compliance with the patients' wishes, as well as their overall satisfaction levels with the process. The health care providers who responded to the survey indicated high levels of overall satisfaction with advance directives, despite low patient completion rates and, most significantly, low confidence levels that surrogate decision making accurately reflected the patient's wishes. A secondary analysis compared the perceptions of health care providers with consumers' reasons for failing to complete advance directives. The need for further education was perceived as a primary need by the health care professionals but not by the consumers. Recommendations for policy initiatives and further research are then presented.

Practice-based evaluation integrates research skills and techniques into the clinical process in order to correlate clinical interventions with treatment outcomes. Although most clinicians recognize the importance of some form of practice evaluation, barriers including lack of time, resources, expertise, and organizational support may deter such evaluation efforts. However, there are numerous advantages for clinicians and agencies to develop a culture that values and integrates practice evaluation into its daily work-life; these include opportunities for teamwork, collaboration, mentoring, and innovation. This paper defines practice evaluation research, identifies strategies for its implementation, and describes a framework for creating a "research friendly" culture. It further describes the implementation of such an innovative program in both a hospital and a mental health agency setting.