Margaret Smith Brogden.

Handbook of organization and method in hospital social service; an outline of policies as practiced at the Johns Hopkins hospital, Baltimore, Md. online

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Handbook of

Organizcttion and Method in

Hospital Social Service



Handbook of

Organizdtion and • Method in

Hospital So'cidl Sewice



An Outline of Policies as practiced at

The Johns Hopkins Hospital

Baltimore, Md.



by



MARGARET S. BROGDEN

Chief of Social Service

The Johns Hopkins Hospital

Baltimore, Md.



THE NORMAN, REMINGTON CO.

PUBLISHERS,
BALTIMORE, MD.



-RA^



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GIFT PAOIFIC COAST JOURNAL
OF NUBdING to HYG£1NE- DEPT.,



Copyright, 1922, by
The Norman, Remington Co.



Published June, 1922



Printed in the United States of America at the Press of G. A. Peters Co., Baltimore.



IN THE HOSPITAL

The doctor smiled, and said, "You may go home

Tomorrow;" and he looked surprised when I

Returned no answering smile. How should he know

The sudden shrinking of my tortured flesh

From all that ''going Home" implies to me?

I am so tired — so tired ! And when I think

Of taking up the burdens that I dropped

When sickness bought for me a breathing space —

The grimy, odorous clothes, so hard to rub

To whiteness as I bend above the suds;

The food that must be bought, prepared, and cooked;

The constant struggle to keep up the rent,

So that our poor, cheap sticks of furniture

May not be set out in the public street,

(Ah, God! that fear looms chief of all my fears!) —

Then is it strange that I should weakly cling

To this white cot, this atmosphere of rest.

Where I may sleep, afar from vendors' cries,

And noisy brawlings from the flat next door?

I almost hoped this pain would end all pain;

But no; the verdict's ''Life!" I must "go home!"

— Florence Van Cleve.



7435 1 8



INTRODUCTION



Monrovia, California,
May 17, 1922.

"Miss Margaret S. Brogden,
Social Service Department,
The Johns Hopkins Hospital,
Baltimore, Maryland.

My dear Miss Brogden:

Your letter was forwarded to me here, where I
am spending the summer.

I used your Policy Book as reference material
for those students in my course in record keeping who
were interested particularly in hospital social service,
and to that group I feel that it had real value in
making clear the relationship of records to hospital
administration, and of showing case records in their
administrative setting, a thing which the new worker
always needs to learn.

Of course, it is understood that adaptations
would be needed in applying this or any other plan
to another institution, but it seems to me that any
hospital social service worker would be helped by the
suggestions in this book.

Sincerely yours
(Signed) GEORGIA G. RALPH."

(Of the New York School of Social Work).



PREFACE

With the growth and development of the social
service department, the need of a reference book
setting forth clearly the routine and policies of the
department, accessible to all the workers, became
apparent.

To meet such need this book was compiled.

In addition to our own routine and policies I have
incorporated into it helpful material and sugges-
tions from the Boston Dispensary and the Massachu-
setts General Hospital Social Service Departments,
the writings of Miss Mary E. Richmond, Dr. Richard
C. Cabot and others, to whom I am much indebted
for their co-operation and courtesy.

This book was compiled with no idea of publica-
tion. It is being published now in response to numer-
ous requests from visitors to our department. The
original is in the form of a loose-leaf ledger, and has
been revised from time to time to meet changes in the
social service department or dispensary routine. I
regret that at this late date I can not give due recog-
nition to those who have generously helped me with
their suggestions and material.

M. S. B.



TABLE OF CONTENTS



Page

Diagram facing 13

Organization of the Hospital 13

Report of Committee on the Function of Hospi-
tal Social Work 18

Approach to Doctors and Nurses 19

Case Analysis 21-

Case Work 22

Records:

Attitude toward Records 30

The Danger of Becoming Mechanical in Work 30
The Need of Accuracy and Completeness of

Information 31

The Need of Getting Results 32

Records Should Show 32

Types of Records 33

Statistical Records 33

Intensive and Short Service Case Records 33

Yellow Sheet 34

Old Histories 34

Letters 35

Making Corrections in Typewritten Work 35

Folders 35

Care of Records 35

Outline for Writing Histories 37

Outline for Yellow Sheet 40

Forms 41

Use of Medical Records 49

Registration of Cases 51

Cards 51



Statistics: Page

Monthly Sheets 55

Transferred Cases 55

Closed Cases 55

Forms 56

Confidential Exchange of Information:

Principles of Confidential Exchange of Infor-
mation 60

Registration of Cases 60

Form 61

Giving Information to Outside Agencies and

Individuals 62

Steering Blanks 62

Bills, Orders and Money:

Ledger Cards 63

Orders 64

Instalments:

Method of Payments 66

Method of Closing Cases 67

Requests for Free Treatment 67

Miscellaneous Forms:

Refemng Patients to Social Service :... 68

Discharge Notice to Social Service 68

Form given by Interne to Patients upon

Discharge 69

Supplies:

General Office 69

Departments 70

Repairs 70

Outside Requisitions 70



Office Rules: Page

Volunteer 72

Telephone 72

Telegrams 74

Filing 74

Keys 74

In and Out Board 74

Office Resources 74

Use of the Social Service Ford 75

Clothing required by the Patients entering
THE State Tuberculosis ;JSanatorium 76

Key to Abbreviations 77



THE JOHNS HOPKINS HOSPITAL

Orfianization of the Social Service Department




ORGANIZATION AND METHOD IN SOCIAL SERVICE 13



SOCIAL SERVICE DEPARTMENT

ORGANIZATION OF THE HOSPITAL

The Johns Hopkins is a general hospital of 625 beds.

The service includes:

Medicine, with sub-divisions,

Surgery, with sub-divisions.

Gynecology, with sub-divisions.

Obstetrics,

Pediatrics,

Psychiatry,

Pathology,

X-Ray,

Social Service,

Out-Patient Department.

There is a daily dispensary service, with nineteen
departments, and an average attendance of 475
patients a day.

Each hospital service has a chief of service, with
resident and visiting staff.



14 ORGANIZATION AND METHOD IN SOCIAL SERVICE

There is a Training School for Nurses, with 48
officers and 240 pupils. The course is three years.

Social Service is an integral department of the
hospital, supported by hospital funds. The staff
comprises a department chief and sixteen associates.
The department chief is responsible to the trustees
through the director of the hospital. Social Service
is in operation in the following services:

Department of Medicine,
Surgery,
Pediatrics,
Psychiatry,
Tuberculosis,
Syphology,
Ophthalmology,
Orthopedics,
General.

The social workers are assigned to a definite service
and cases are referred by the physicians on that ser-
vice from both the hospital wards and out-patient
department.

A weekly staff meeting is held on Thursday, 9-10
A.M.

The function of the social worker is to aid in medi-
cal treatment and prevention of disease through in-
vestigation, reporting to the physician and adjustment
of problems, both personal and environmental, that



ORGANIZATION AND METHOD IN SOCIAL SERVICE 15

hinder or retard the process of recovery. If I may
define our function in the terms of the American Hos-
pital Association's Survey :

** Discovery and reporting to the physician facts
regarding the patient's personaUty and environment
which relate to his physical condition.

Overcoming obstacles to successful treatment,
such as may exist or arise in his home or work.

Assisting the physicians by arranging for supple-
mentary care when required.

Educating the patient in regard to his physical
condition in order that he may co-operate to the best
advantage with the doctor's program for the cure of
the illness, or the promotion of health."

Through the Social Service, interpreters are secured
for foreign-speaking patients. Aid in management of
clinic is supplied by volunteer staff. Medical infor-
mation and advice regarding medical sources is fur-
nished outside agencies. Such services as arranging
for transportation and escorting patients who are
unable to perform these offices for themselves, either
because of illness or ignorance, are rendered. All
cases are referred by the physicians with definite
recommendations.

The Johns Hopkins is a private hospital dependent
for support upon its endowment, voluntary contribu-
tions and fees from patients. Both private and
public ward patients are received. During the year
from February 1, 1920, to February 1, 1921 7,793
patients were treated in the hospital wards, and



16 ORGANIZATION AND METHOD IN SOCIAL SERVICE

142,532 visits were made to the out-patient depart-
ment. 2,882, or 37.1% of the house patients, re-
ceived free treatment, and 2,791, or 35.8%, were
treated at a reduced rate.

The Johns Hopkins is essentially a teaching hos-
pital, closely allied with the Johns Hopkins Univer-
sity and Medical School. The members of the Hos-
pital Staff hold corresponding positions in the Medical
School; for example the Professor of Medicine is the
Physician-in-Chief to the hospital and the head of
the Medical Service.

Courses in psychiatric and medical social service
are given in collaboration with the Johns Hopkins
University, to a limited number of students who have
completed the first year's work in the course in Social
Economics at the Johns Hopkins University, or a
school of social work of equal requirements.



^



REPORT OF COMMITTEE
ON THE FUNCTIONS OF HOSPITAL SOCIAL

WORK cx-^

Presented at the Annual Meeting of The American
Association of Hospital Social Workers, June, 1921.

Permanent Functions

1. Case work; by the method of social case work
to care for ward patients and out-patients whose
medical and social condition indicate need of adjust-
ment in order to render their medical treatment
effective and restore them to health and sound social
condition.

2. Research; to study social causes of health con-
ditions and behavior.

3. Education;

a. To co-operate with schools of social work in
the training of students for hospital social work.

b. To give to students from training school for
nurses, medical schools and from schools of socio-
logy and psychology insight into the social environ-
mental conditions of patients, through lectures,
required reading and field work.

c. To interpret the hospital to the community
by posters, charts, public speaking and other
means, and to help to make the resources of the
institution available to persons in the community.

d. To educate the public by the same means in
hygiene and to teach the relation between social
conditions and health.



18 ORGANIZATION AND METHOD IN SOCIAL SERVICE

e. To co-operate with such outside agencies,
institutions and interested individuals as may
serve to enlarge the functions of the hospital, and
to render its care of patients more effective.

Temporary Functions

In organizing a department, it may be necessary
to undertake, for a time, certain duties that are not
essentially the function of hospital social work, such
as those of clinical clerk, admitting clerk, financial
investigator for the hospital or messenger, which may
be performed for a time with the intention of helping
the hospital to fulfill its obligations toward the com-
munity as well as to the patients. In undertaking
these temporary and supplementary duties it is im-
portant not to lose sight of the fact that the primary
function of hospital social work is social case work,
and that the best contribution of such work both to
the hospital and the community is to perform this
function.



"APPROACH TO DOCTORS AND NURSES"

"Find out the names of doctors and nurses on duty
in the dinic before going to it.

"On entering a clinic to take a patient to a doctor,
or to make inquiry, be careful each time to give your
name and state your connection with the dispensary,
to wit: "of the social service department."

"DO NOT OMIT the formality unless you are sure
that your name and connection are well known,
remembering that you are but one of many going on
similar errands and that it is not easy for the doctors
to place each personality quickly.

"In referring a patient to a doctor, only give the
symptoms which led you to seek medical advice. Do
not make a diagnosis. For example: never say,
'I have brought John to see you about his adenoids,
but say, 'As John can not breathe through his nose, I
want him to have an examination.' The making of
a diagnosis by a layman is very irritating to a physi-
cian, and therefore extremely bad etiquette. Doctors
themselves in seeking a consultant are very cautious
about doing so.

"Give the physician sufficient information in regard
to your errand to gain his interest, but do so in as few
words as possible.

"When a doctor refers a patient to a social worker,
or makes inquiry of a social worker in regard to a
patient, if the particular patient in question is present,
or other patients, do not discuss the case in their
presence. Make an excuse for seeing the doctor in
another room or at another time.



20 ORGANIZATION AND METHOD IN SOCIAL SERVICE

"Before leaving the clinic make a definite arrange-
ment at the doctor's convenience for securing a report
in regard to the examination of the patient. For
example, either plan to return to the clinic at a certain
time or to see the doctor in the social service depart-
ment on his way out of the dispensary. If there is a
social worker in the clinic it is best to have all ar-
rangements go through her."



CASE ANALYSIS



"In order to understand a hospital patient's disease
we should know:



a. Physicallylg^l^f ^^^ functions



1. The
individual



b. Mentally



2. His

environment



a. Physically



b. Mentally



Habits

Habits

Interests

Abilities

Fears, worries, etc.

Food and clothes
Housing

Work conditions
School conditions
Income and outgo

Family and friends

Workmates

Schoolmates

Recreation

^Religion"



The above quotation is taken from a paper by Dr.
Cabot published in the ''Modern Hospital," March,
1916. If we agree with Dr. Cabot (I think few will
question his statement) that the physician must know
his patient both from the physical and the environ-
mental side, and since the physician's time is com-
pletely filled with the study of the physical, it is
evident that information concerning the environ-
mental must be supplied to him through the medium
of social service.



22 ORGANIZATION AND METHOD IN SOCIAL SERVICE
CASE WORK

A. Patients:

I. How referred:

a. Inside the hospital, (admitting officers, doctors,
nurses, social workers.)

b. Outside the hospital (social agencies).

II. Why referred and methods of handling:

a. Home adjustment; visits to home, to relatives,
friends, employer and clergyman.

b. Work adjustment: investigation of character
and place of employment; interview with
employer.

c. School adjustment: visit to school, interview
with teacher, withdrawal from school, or trans-
fer to special class.

■ (For special classes see directory, S.S.D. office)

d. Hospital care.

(1) Pay Patients:

(a) Applying for admission to JHH should
be referred directly to Admitting officer.

(b) If no room in JHH, phone other hospital
for admission (see telephone directory).

(2) Free Patients:

(a) If there is no room in JHH, and patient
has resided in Baltimore for one year,
phone Plaza 2000, Clerk of the Super-
visors of City Charities office, 329
Courtland St.,f or bed in another hospital.



ORGANIZATION AND METHOD IN SOCIAL SERVICE 23

Or if patient has chronic disease, a recom-
mendation blank may be filled by the
doctor's order and the patient sent to
above office for admission to Bay View
Hospital.

(b) Should the patient be too ill to make
personal application, a relative or friend
may take recommendation and secure
admission slip from the Clerk of Super-
visors of City Charities. If ambulance
case, special permission may be asked
to send patient without admission slip.
Information can be given by phone to
the Clerk who will transmit same to the
hospital and secure the use of the City
ambulance. The JHH recommenda-
tion must be mailed immediately to the
Supervisor's office. It is possible to
secure use of the JHH ambulance
through the admitting officer if the City
ambulance is not available.

The Social Service Ford may be requi-
sitioned in the Social Service office.

(c) If there is no room in the JHH, and
patients reside in Maryland but not in
Baltimore, phone to the Secretary, State
Board Aids and Charities, 405-6 Union
Trust Bldg. (Plaza 2680), for care in a
hospital providing beds for state pat-
tients, or communicate with the com-
missioners of the county from which
they come.



24 ORGANIZATION AND METHOD IN SOCIAL SERVICE

(d) Should the patient Hve out of Maryland
and be too ill to travel, phone office of
the Supervisor of City Charities (see
paragraph (a) ), stating details of the
case, and ask advice or assistance. In
some instances it is possible for the
Supervisor to provide temporary care
at the BVH pending arrangements to
send the patient home.

(3) A U. S. sailor may be referred to United
States Public Health Service, Custom
House, Gay & Lombard Streets (phone.
Plaza 4220). A foreign sailor may be re-
ferred to the consul representing his
country.

(4) Contagious disease diagnosed by a member
of the JHH staff or by a doctor sent by
the Health Department, is handled by the
latter office.

If the patient has advanced pulmonary
tuberculosis and has been a resident of
Baltimore for one year, effort should be
m.ade to secure immediate admission to
the Municipal Tuberculosis Hospital.
If this is impossible, the patient is sent
home and the Tuberculosis Division of
the Health Department is notified. By
this means the patient is placed on the
waiting list for the MTH or sanatorium,
and is given nursing care pending admis-
sion.



ORGANIZATION AND METHOD IN SOCIAL SERVICE 25

e. Institutional Care.

(1) A man or woman, white or black, without
home or funds and not in need of hospital
care, can be sent to The Friendly Inn,
309-11 S. Sharp Street (phone. Plaza 278).

(2) Un-co-operative patients living in the
city, in the primary or secondary stages of
syphilis or gonorrhoea, may be referred to
the Health Department (Plaza 320) to
enforce treatments. Un-co-operative pa-
tients living in Maryland outside of Balti-
more may be referred to the State Board
of Health, 16 W. Saratoga St. (Plaza
4810). Soldiers and sailors are sent to
the United States Public Health Service.

(3) Should it seem likely that the patient will
need care for an indefinite period, the Bay
View Hospital commitment can be ar-
ranged through the Clerk of the Super-
visors of City Charities, provided the
patient has been a resident of Baltimore
for one year. Out-of-city patients with-
out home or funds can be sent to The
Friendly Inn pending investigation of the
patient's statement as to his social situa-
tion.

(4) Patients with mental disorder who are
residents of Maiyland, after being certi-
fied by two physicians who are residents
of Maryland and have practiced for 5
years, should be referred to the Secretary
of the Supervisors of City Charities, Court



26 ORGANIZATION AND METHOD IN SOCIAL SERVICE

House (phone, Plaza 2000); blank certi-
ficates can be secured from the HPPC.
Arrangement must be made with the Sec-
retary of the Supervisors of City Charities
by the nearest relative. Non-residents v/ith-
out resources may be referred to the Sec-
retary of the Supervisors of City Charities
pending return to their own state.
f. Medical attention, nursing and convalescent
care.

(1) If a patient residing in the City needs
medical attention at home and is unable
to pay for same, notify the Instinctive
Visiting Nurse Association, 1123 Madison
Ave. (phone, Vernon 469).

(2) Patients over three years of age, residents
of the City, in need of nursing care can be
provided with it as follows:

(a) If the patient has non-contagious disease
notify the Instructive Visiting Nurse
Association.

(b) If the patient has contagious disease,
notify the Nurses Division of Health
Department, 311 Courtland St. (phone.
Plaza 230).

(c) If the patient has pulmonary tubercu-
losis, notify the Nurses Division of the
Health Department, 311 Courtland St.
(phone. Plaza 230)

(d) Infectious venereal cases receiving treat-
ment at the dispensary are reported to
the City Health Department if they can
not be induced to come regularly for
treatment.



ORGANIZATION AND METHOD IN SOCIAL SERVICE 27

(3) Patients three years of age and under,
residents of the City, in need of nursing
care can be provided with it as follows:

(a) If the patient has non-contagious dis-
ease, notify the Babies Milk Fund As-
sociation, 130 S. Calvert St. (phone.
Plaza 3271).

(b) See paragraph (2) (b).

(c) See paragraph (2) (c).

(d) Children needing surgical dressings
should be referred to the Instructive
Visiting Nurse Association (phone, Ver-
non 469).

(4) Mothers of children needing country care
during the summer can be sent to The
Fresh Air Farm, through the Children's
Fresh Air Society, 35 Knickerbocker Bldg.,
Lexington and North Sts., (phone. Plaza
1268).

g. Surgical Appliance dental plates, diet and
material relief:

(1) Patients residing in Baltimore who claim
inability to provide any of the above, can
be referred to the Family Welfare Associa-
tion's district office (see phone book for
addresses).

(2) Hebrew patients should be referred to the
Hebrew Benevolent Society, 411 W. Fay-
ette St. (phone, Calvert 3280.)

(3) Roman Catholic patients should be refer-
red to the St. Vincent de Paul Society,
222 St. Paul Street, (phone, Plaza 4216).



28 ORGANIZATION AND METHOD IN SOCIAL SERVICE

(4) Abdominal binders recommended in the
JHH dispensary will be furnished at re-
duced prices by Miss Foard, maker, 711
N. Carey St. (phone, Madison 81). Miss
Foard is in the dispensary on Tuesdays
11 a. m.-12 m. to take orders and measure
patients.

(5) Should the patient live out of the city,
effort should be made with the patient's
permission to secure assistance from the
relatives, friends, church, employer or
relief-giving agency in his place of resi-
dence.

h. Free treatment, lunch and car-tickets.

(1) 24-hour pass can be given without investi-
gation, permanent free treatment should
be given only after investigation. See
form on page 67.

(2) Lunch can be provided, when the patient
is unable to pay for it and must remain
for afternoon clinic.

(3) Car-tickets can be given for emergency
use. (Money for lunches and car-tickets
may be obtained from the secretaiy. Social
Service ofhce.) See form on page 65.

i. Steering.

(1) To another clinic for examination.

(2) To admitting office at front.

(3) Out-^of-towm patients to a boarding-house,
j. Emergency or accident cases.

(1) To accompany patient home.



ORGANIZATION AND METHOD IN SOCIAL SERVICE 29

(2) To call an automobile to take the patient
home. The Stewart taxi-Service Co.,
7 W. Eager St., for white and colored
patients. Patients not ambulance cases
may be sent home or called for in the social
service Ford car if necessary; write requisi-
tion in the register in central office.

(3) To notify patient's relatives, friends or
employer of illness either in person or by
telephone.

k. Return visits.

Efforts should be made by letter or visit
to secure return of patients to the clinic,
if further treatment is advised.

1. Reports.

Diagnosis and recommendation as to treat-
ment may be given to other medical or
social agencies or to responsible individuals,
(i. e., friend, relative or employer.) See
page 62.



30 ORGANIZATION AND METHOD IN SOCIAL SERVICE

RECORDS

ATTITUDE TOWARD RECORDS.

"There is a certain natural tendency in most of us
to exalt the record as an end in itself, a tendency to
feel that something has actually been accomplished
in the disposition of a case when a statement appears
in black and white. We are a little too inclined to
feel, perhaps, that the aim of asking questions of the
persons we are interviewing is to get material to fill
the blank spaces on a yellow card. A record, how-
ever, is only a tool to be made keen and kept avail-
able for use. Only that should go into a record which
will help the agency whose tool it is, in the working


1 3

Online LibraryMargaret Smith BrogdenHandbook of organization and method in hospital social service; an outline of policies as practiced at the Johns Hopkins hospital, Baltimore, Md. → online text (page 1 of 3)