Talk to the Tablet: Medical Social Workers' Interactions with Technology during Covid-19

Background. A 50% increase in telehealth visits in the first quarter of 2020 demonstrates the massive shift in health care delivery due to the Covid-19 pandemic. Existing research has explored telehealth, which became a lifeline between patients and providers, but little is known about medical social workers’ (MedSWs) experiences with technology during the pandemic. This study is led by two research questions: (1) What were MedSWs’ experiences of technology use during Covid-19? (2) How did technology impact MedSWs during Covid-19? MedSWs reflect on when their hands-on profession was forced to rely on screens and remote empathy, and they make recommendations for future health care practice and policy.

Methods. Fifty-four semi-structured interviews were completed by two interviewers via Zoom in Summer 2020 with MedSWs from across the U.S. Informed by Saldaña’s (2015) qualitative coding manual, qualitative thematic analysis was performed using first and second cycle coding methods. Full transcripts were reviewed twice to build familiarity before engaging in first cycle topic coding using eleven technology search keywords (e.g., “tech”, “computer”, “virtual”, “phone”, “tele”). Second cycle pattern coding was used to identify the major themes in the data. Code mapping and weaving strategies were used to build theoretical ideas, which were then checked through a focused coding sweep with MaxQDA software to ensure the themes and theoretical ideas accurately represented the data.

Results. Qualitative thematic analysis revealed three thematic tensions experienced by MedSWs resulting from technology use during Covid-19. First, MedSWs were apt to reflect and critique the provision of virtual social work care, which they found “stressful” although necessary, “I couldn’t do my job without [technology] right now.” Second, MedSWs were confronted by access and equity issues exacerbated by the turn toward technology. Third, MedSWs faced new technology-based ethics, safety, and privacy concerns. This study posits that these tensions contribute to professional dissonance due to a discrepancy between MedSW values and the virtual delivery method of their job tasks. Dissonance seemed to grow when MedSWs had to rely on many different types of technology (e.g., cellphones, tablets, HIPAA-compliant apps, computers) to connect with patients. Their practice was impacted by the pandemic expansion of telehealth for virtual family visits, goals of care discussions, and staff meetings. Due to this change in technology interaction, MedSWs requested increased education on technology-enabled social work delivery as well as education on the policies guiding their virtual practice.

Conclusions and Implications. Findings suggest that equipping MedSWs with appropriate technology and education for virtual care could decrease feelings of professional dissonance by building clinicians’ capacity and confidence. Further, these actions may be protective factors against burnout. Future research should evaluate virtual social work best practices and inform modern policy for the Digital Age. While current work amidst Covid-19 is more normalized, the time is now to build competence around evidence-based virtual practice methods, which includes educating MedSWs and enacting policy that safeguards clinicians and patients through the ever-changing health care landscape.