Pursuing quality improvement: a social work perspective

The multidisciplinary approach to the treatment of patients with chronic renal failure has existed since the inception of the Medicare end-stage renal disease (ESRD) Program. Social workers as team members in the various renal outpatient treatment settings have contributed to the planning and assessment of patient needs with the goal of achieving the optimal quality of life available to each individual. Nephrology social workers have also participated in the evolution of quality management through their professional organization. The eight clinical indicators jointly developed by the Council of Nephrology Social Workers and the National Association of Social Workers provide a basis for the implementation of continuous quality improvement concepts. The Health Care Financing Administration, the administrative agency of the ESRD Program, has shifted its quality management approach from quality assurance to the broader concepts of continuous quality improvement. The Health Care Quality Improvement Program provides the structure for all professionals to develop a facility-based system for quality management. By using strategies of quality control and quality improvement, social workers will be able to demonstrate the positive benefit of social service intervention. Identification of useful psychological and functional assessment tools must be incorporated into social work practice to measure outcome. Social workers have the necessary expertise in conflict resolution and group dynamics, which are skills needed for team facilitators used within the conceptual framework of continuous quality improvement. The challenge is to learn these concepts and incorporate them into the daily operation of social work practice.