Theory, Practice, and Research: Mapping the Future of Social Work Leadership in Healthcare

Background and Purpose: The health sector is a growing area of specialization in social work, with the fields of health and mental health projected to grow faster than other segments of the profession over the next 10 years. Leadership within the organizations employing these social workers often rely on individuals from other disciplines, such as nursing and psychology, to manage, direct, and lead clinical social workers. This study sought to explore the existing literature around social work leadership in healthcare, identify leadership competencies for social workers, and examine barriers to social work leadership.

Methods: This study utilized the 5-step method outlined by Arksey & O’Malley (2005) to conduct a scoping review of the existing literature. Exclusion criteria eliminated literature that was not empirically grounded, studies that did not address the healthcare sector, and studies that did not explore leadership beyond clinical supervision. We chose to include mental health and substance abuse social work in the healthcare sector for this study. Additionally, we opted to include dissertations with an empirical foundation.

Results: Following abstract and full text review, 51 studies were selected for inclusion in the study. Approximately 37% were dissertations. Dissertations were more likely to rely on a foundational leadership theory than peer-reviewed articles. Most (67%) were conducted in the United States, more (45%) utilized qualitative or mixed methods study design over quantitative (35%), and only 23% centered on the mental health or substance abuse clinical setting. In reviewing the study results, four themes emerged: effective social work leadership skills, social work engagement in leadership activities, social work leadership in the context of change, and barriers to social work leadership. Over 20 unique leadership theories or frameworks were identified across the included studies. Transformational Leadership Theory is the only theory or framework that appeared in more than one study and is identified as the predominant framework for successful social work leadership. Social workers are trained as systems thinkers and should position themselves to be leaders during times of organizational change or shifting policy landscapes.

Conclusions and Implications: Despite our profession’s commitment to social change, governing bodies such as CSWE and NASW do not overtly define leadership qualities or prioritize the training of social workers as leaders. Without such guidance, there is little framework for identifying, supporting, nurturing, or mentoring social work leaders. In fact, leadership in the traditional workplace context, may seem antithetical to the values and principles that shape social work practice. In the healthcare sector, research is a driving force for maintaining best practice among all allied health professionals. Social work departments in healthcare settings rarely promote or encourage participation in research or intervention development. Creating a role for social work researchers within health sector organizations may facilitate improved standing for social work leadership in healthcare. Future studies will benefit from a consistent use of leadership theory and may prefer to segregate mental health/substance abuse from medical healthcare settings.