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Strategies for Research Development in Hospital Social Work : A Case Study

Ted McNeill and David Bruce Nicholas Research on Social Work Practice 2012 22: 672 originally published online 19 June 2012 DOI: 10.1177/1049731512450214 The online version of this article can be found at: http://rsw.sagepub.com/content/22/6/672

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Research Article
Research on Social Work Practice 22(6) 672-679 The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/1049731512450214 http://rsw.sagepub.com

Strategies for Research Development in Hospital Social Work: A Case Study

Ted McNeill1 and David Bruce Nicholas2

Abstract Objectives: This article identifies salient components in the advancement of social work research leadership within health care. Method: Using tenets of a modified retrospective case study approach, processes and outcomes of social work research progression at a pediatric hospital are reviewed. Results: Capacity-building processes were implemented. These processes generally corresponded with clinical, research, and administrative priorities and strategically aligned with social work aims of evidencebased practice and research leadership. Elements contributing to improved capacity include clarity of vision, palatable funding models, and the infusion of PhD-trained researchers within the clinical setting. Conclusions: This case study argues for social work to be proactive knowledge leaders. Such an aim, however, inherently requires deliberate shepherding, including strategies to advance the profession. Keywords social work, research, clinical and academic development

Introduction
Developing the capacity to conduct research to inform practice is a goal to which many social work departments aspire. However, in an era of diminishing resources, dismantled social work departments in many hospitals and a blurring of boundaries within an interprofessional discourse, the advancement of social work knowledge to inform practice is increasingly challenging. This case study identifies key features and processes in the advancement of social work academic and research leadership within a traditional clinical health care environment, that being a Canadian childrens hospital. Through a case study approach, the evolution of social work scholarship in clinical practice over a 20-year period is explored, along with implications for the delivery and administration of social work.

Background
Research advancing social work practice has been a historic priority (Bern-Klug, Kramer, & Linder, 2005); however, a notable surge has occurred over the last four decades (Wakefield & Kirk, 1996). Chan and Ng (2004) argue that just as academics in medicine integrate clinical roles along with teaching and research, it is incumbent upon social workers to do the same. Unfortunately, a focus on direct practice is not rewarded in academia (Chan & Ng, 2004), and conversely within a clinical context, a focus on social work research often is distinctly secondary to clinical practice issues. Yet, alternative models exist in other professions. For instance, within medicine, the development of clinician scientist models highlights the complementarity of clinical and academic

roles (Hede, 2008). Within nursing, the role of the Advanced Practice Nurse (APN) has facilitated the development of nursing knowledge and the ultimate advancement of the profession (Kilpatrick, 2008), with the domains of APN practice encompassing clinical and research leadership, teaching, and collaboration (Brown 1998; Pauly et al., 2004; Sidani & Irvine, 1999). In contrast to this growing trend to advance research and clinical leadership roles in fields such as nursing and medicine, the social work literature has debated the functionality and productivity of an integration of practice and research (Epstein, 1996a, 1996b; Johnson, 1997). Kondrat (1992), for instance, argues historically that the researcher and practitioner bring, functionally different relationships to the practice arena and, therefore, differing cognitive interests for their involvement in that arena. These differing interests, in turn, result in characteristically distinct forms of rationality and discourse (p. 241). Johnson (1997) argues, in turn, that the integration of research by practitioners is impractical, particularly, given the typical lack of research training and knowledge by social work practitioners.

Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada Faculty of Social Work, University of Calgary and Research Institute, Edmonton, Canada
2

Corresponding Author: Ted McNeill, FactorInwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, Canada M5S 1V4 Email: ted.mcneill@utoronto.ca

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McNeill and Nicholas These perspectives, while thought-provoking, do not speak to the development of knowledge advancement and practice in social work. Accordingly, there is increasing need within social work for models that advance scholarly knowledge through dialogue and collaboration of researchers and practitioners (Hess & Mullen, 1995; Wakefield & Kirk, 1996) in order to engender the production and translation of research findings in social work practice (Grasso & Epstein, 1992; Rubin & Rosenblatt, 1979; Wakefield & Kirk, 1996). Mendenhall (2007) identifies a traditional social work divide between BSW/MSW-trained practitioners focus on practice versus PhD-trained social workers focus on research. This dichotomy reportedly results in role discontinuity and division between social work practice and research, which is viewed to be counterproductive to the advancement of the profession. Nevertheless, Wakefield and Kirk (1996) acknowledge that clinicians who substantially lack research acumen are likely not the ideal candidates for conducting social work research. More recently, McMillen, Lenze, Hawley, and Osborne, (2009) argue for the integration of research within natural practice settings for the production of practice-based social work research. Toward such aims, McMillan and colleagues present the merits of an integrated academic and clinical role, with apparent relevance for social work. They argue that research in the clinical setting offers a pool of participants for studies and naturally infuses practice experience, wisdom, and needs within research design and implementation. Such an integrated research model encourages an in vivo practice-informed research agenda which heightens the capacity for research priority setting, production (McMillen et al., 2009), knowledge translation and impact. Within the consequent need for, and development of, new models for social work research and practice, a corollary argument calls for PhD-trained social work researchers mandated to scholarly advancement within the clinical setting. Within such an arrangement, the researcher in residence is truly at the heart and interface of social work practice and research, with accessibility to populations for data collection and direct practice input for the identification of research question priorities. Accordingly, research has the potential to exponentially and meaningfully advance social work knowledge creation that directly reflects on the ground clinical issues. Moreover, the results of this research can then be rapidly and seamlessly translated back to clinical practice.

673 Social Work, a department with 45 full-time equivalent clinical social workers across a range of health and mental health programs, traditionally was not research-intensive and, rather, had been seen as almost exclusively service-based. Over the course of a 20-year period, this ethos substantially shifted. Accordingly, social work research ultimately focused on multiple clinical areas including adaptation to living with a chronic health condition, parenting, social support, palliative care, quality of life, social determinants of health, health equity, diversity, interprofessional practice, and family-centered care; all elements that are critical to clinical practice and central to knowledge advancement priorities.

Method
A modified, retrospective case study analysis has been implemented, whereby information units were identified and reviewed as we historically reflected on our experiences and the processes and outcomes of social work research at SickKids. Case study methodology was helpful in identifying orienting parameters around this process such as depth of description intensiveness in reflecting on the case (Flyvbjerg, 2011; Yin, 2009). Accordingly, data have been gathered by synthesizing and incorporating relevant, in-depth information and salient commentary. The case study approach has been modified in the sense that we used only retrospective information because we did not consider the project to be a study per se, but rather a reflective commentary on the progression of our department of social work. Accordingly, the work was not previously planned nor conceived of as a study, and therefore has not been subjected to traditional research ethics review. In our minds, this work is rather a historically based commentary. Our approach of critically distilling information through reflection and dialogue has offered important parameters for chronicling events and analysis of processes and properties. In terms of this longitudinal, retrospective approach, this commentary has emerged from independent reflection followed extensive peer debriefing and dialogue, as both authors held previous roles as social work researchers within this department.

Results
In reviewing the progression of social work scholarship at SickKids historically, it appears that this development occurred over three broad, incremental phases over two decades (19902010) that cumulatively constitute vision, advocacy, trial, evaluation, adjustment, and consolidation. As a case study, the journey is described below, including current trends and ongoing shifts as the model continues to evolve.

Need for Model Development and Testing: A Case Study

Despite the intuitive appeal of such models, there are few existing examples that guide the intentional academic advancement of social work in clinical settings. One example in which PhDtrained researchers are integrated in the clinical environment is in the Department of Social Work at The Hospital for Sick Children (SickKids) in Toronto, Canada. SickKids is a 275bed tertiary care pediatric facility with a strong tradition of clinical care, research, and health sciences teaching. However,

Phase 1: Research Introduction and Incubation (19901993)

The first wave of social work research advancement and leadership comprised what Hess and Mullen (1995) identify as the

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674 infusion of clinical social work research from the academy. At this stage, a pediatric-focused researcher at a local university was contracted to conduct two key literature reviews addressing the impact of pediatric health conditions on children and their families and the effectiveness of social work interventions. This initiative reflected an effort to strategically focus social work academic activity on areas of perceived relevance for clinicians. This development spurred interest and dialogue among some clinical social workers in considering what social work research could offer to practice. A proposal to create a halftime PhD research position was developed at this stage; however, although the funding was feasible within the social work budget, it was blocked by the hospitals executive administration and perceived as inappropriate relative to overall hospital priorities at that time. It was clear that a vision for social work research was needed that was simultaneously integrated within the culture of the organization. In hindsight, despite being an academic hospital, this initiative to create a half-time research position was premature and did not reflect organizational values and priorities for social work. A related development that had an academic dimension was the creation of a workload management and reporting system that identified specific clinical issues that a social worker identified for each new case, along with a corresponding clinical outcome measurement system. This system had sufficient reporting capacities to allow scrutiny of practice patterns, including workload utilization, clinical problems identified, and perceived outcomes. Despite the challenge of measuring social work issues, activities, and outcomes, these initiatives contributed to a beginning culture of inquiry and evaluation within the Department of Social Work.

Research on Social Work Practice 22(6) research and thus supported the establishment of these two endowments. In addition, other funds were raised through department fund-raising events to support social work research. While this phase further strengthened the development of a culture and a modest funding infrastructure for social work research, clinical workloads were prohibitive in that they hampered the uptake of research despite the identification of potential areas for study initiation. Nevertheless, three members of the department were sufficiently interested in academic development to begin PhD programs and a fourth person with pediatric social work experience who was already enrolled in a PhD program was recruited.

Phase 3: Productivity and Solidification (19972010)

The third wave of research development and integration built on the initial two but yielded significant advances and dividends in terms of research productivity, creating a hub of pediatric social work research activity. The impetus for this growth largely emerged from a proposal, presented to hospital administration, for the development of two social work Academic and Clinical Specialist roles. Ironically, this vision was a counterproposal to pressures for the reduction of two existing senior social work clinician positions due to fiscal reductions. The elimination of these senior social work positions permitted the creation of the new academic roles, which constituted PhD-prepared social workers with protected time to advance independent programs of research in clinically relevant substantive areas. The positions each comprised a 0.6 full-time equivalent research role, with the remaining elements including clinical practice and/or administrative roles. These positions were attached to clinical programs in which the clinical managers and their respective teams warmly welcomed clinical acumen as well as research proficiency. Consistently over time, social work research productivity within each of these clinical areas was exponentially advanced. It should be noted that both successful candidates for these social work research and clinical positions were initially actively completing PhD studies and brought substantial pediatric clinical social work experience which strengthened their ability to integrate an academic and organizationally relevant contribution. Together with the Director of Social Work, who was simultaneously completing a PhD, these individuals constituted the leadership team for social work and, in so doing, brought heightened priority for research advancement and appreciation for the infusion of scholarly pursuits. It is highly unusual for positions such as these to be approved at any time let alone during a difficult financial point. However, key hospital processes were underway that made it feasible. The hospital had recently renewed its strategic plan, which included an increased emphasis on its role as an academic health sciences center. It was also a time when a focus on evidence-based practice and family-centered care was gathering momentum. To support the proposal for reorganizing social work to create these academic positions, it was argued that if the hospital was committed to evidence-based practice,

Phase 2: Transformation (19941996)

The second phase comprised an infusion of efforts to strengthen research knowledge for social work clinicians. This included the development of a departmental education program, including learning modules and methodology rounds for clinicians to advance their understanding of research design. In addition, interested social workers were encouraged to undertake advanced training in research methods offered within the local universitys Faculty of Social Work. Within this program, clinical social workers were taught and mentored in research project proposal development, which included conducting small studies addressing pressing social work issues among their clinical populations. A related development during this period was the establishment of two small endowments to support social work research. Access to small amounts of funding is often needed for small studies such as the ones that began to develop at this stage. While competing for external funding may be desired, it was often not feasible at this stage of social workers development of research skills. For this reason, the social work director worked closely with the hospitals fund-raising foundation, and donors were found who were sympathetic to social work

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McNeill and Nicholas there needed to be the capacity within each discipline to create relevant knowledge through research to inform practice and to translate existing research into practice. Hospital administration accepted the proposal, recognizing its alignment with overall academic priorities and being assured that no new funds were needed to launch this enterprise. The creation of these positions permitted social work to actively contribute to the academic mandate of the hospital. This productive collusion of contributing factors highlights the value of a departmental and professional vision that aligns itself with the overall mandate of the organization as a whole. Such alignment and leverage with the values and priorities of key stakeholders at the hospital were central to broad support that enabled changes within the Department of Social Work to foster social work research advancement. In considering these changes within the broader organizational context, the development of these PhD social work research roles occurred at a time when the hospital was consolidating its shift to program management, an organizational structure that saw the elimination of social work departments in many hospitals. This phase marked substantial changes with less emphasis on departmental line management of clinical social work and greater accountability of clinical social workers to the patient care programs on which they worked. In this context, the role of the Social Work Department shifted from clinical supervision and management to an emphasis on practice standards, education, and research to inform practice. Supporting clinicians to integrate a greater role for evidence in their practice became an important component of the emerging model. Evidence-based practice resources were developed, which included literature reviews associated with the preparation of research proposals on a variety of relevant practice issues. This wave was thus marked by a reformulated balance in which the earlier emphasis on clinical supervision was eased, although not eliminated, in favor of a stronger academic focus. While there was some initial trepidation about the shifting nature of practice amid less supervision, there was also enthusiasm among many clinical staff who viewed these changes as opportunities for research capacity building and the integration of an increased evidence base within their practice. In balancing the differential need for supervision and support for clinical staff by the members of the social work leadership team, these activities were targeted to those staff who needed them most such as new staff. In addition, case consultation was offered for complex and high-risk cases. To address the broader implications of these changes, peer mentoring and peer consultation were introduced across programs which had benefits associated with greater empowerment and valuing of frontline staff expertise and simultaneously leveraged increased time for research activity among members of the leadership team. These changes were important in rendering the operational restructuring more gradual and retaining clinical strength, hence ensuring that the structure remained palatable for clinicians and clinical programs. In so doing, departmental staff largely recognized the value added by the new positions: clinical expertise, consultation and support,

675 research mentorship, and an emerging ethos of excellence in research-informed practice and practice-informed research. Along with these structural shifts, the Academic and Clinical Specialists offered some time to nurture and mentor clinical staff who had viable research questions, often taking a leadership role in acquiring research funding and ensuring methodological rigor in proposal development and study implementation. By 2005, 7 years after reorganizing to contribute academically, research productivity had burgeoned to a vibrant research division within the Department of Social Work, including over $1 million in national and international research grants, 15 additional research support staff, multiple publications in social work and related health journals, and invitations to present research findings both nationally and internationally. Moreover, the Department of Social Work was increasingly seen as offering leading practice. Throughout this transition to social work research advancement in the clinical health sciences setting, an internal departmental cultural shift increasingly acknowledged and celebrated both the department and the professions research and clinical strength. Consistent with the hospitals culture of academic leadership, the PhD-trained social work researchers were increasingly invited as key knowledge leaders in various arenas in hospital planning. This inherently required a balance for academic social workers in intentionally remaining focused on social work research amid competing time demands related to leadership requests within the hospital. Areas in which social work leadership was requested included diversity development, interprofessional practice, transition planning, and family-centered care. This shift served as a springboard to social works increasing role as a knowledge leader within the hospital. In chronicling this advancement of clinically based research, there were distinct yet iterative developmental phases of incubation, transformation, and solidification. In each of these incremental phases that reflect a range of contributing circumstances, including facilitators and barriers, some key elements are noted. First, the initial impetus toward increased social work research productivitytermed incubationcomprised several elements. These elements were embodied by the identification of a pressing need and priority for social work research leadership. This was followed by heightened communication about, and planning for, how that need could be met through organizational and departmental change, careful aligning of this emergent strategy with organizational values, and accommodation for inherent priority shifting required to enact these departmental changes. This formative and preparatory phase of incubation was followed by the next phase of transformation which in turn was marked by the development of pro research strategies and structures that created the environment and ethos for departmental research creativity and advancement. Department and hospital investment in research infrastructure was implemented, including setting and aligning goals, infusing resources to hire Academic and Clinical Specialists, as well as implementing educational opportunities for research capacity building available

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676

Research on Social Work Practice 22(6) justice issues in particular have been essential for raising awareness within the hospital about the toxic effect of poverty on the lives of children and their families. In fact, the president of the hospital shared verbally the results of this research with the Minister of Health and facilitated an invitation to write a full report for the government. Deliverables of both knowledge translation and mobilization, include examples such as this. In another instance, research informed the creation of a pro bono family legal health program which was initiated in partnership with key collaborators and which ultimately attracted national health services and media attention interested in this novel evidence-informed intervention.

Need Identification Examination of Fit with Organizational Values Communication of Need Development of ProResearch Structures

Incubation

Priority Setting

Transformation

Targeted Education for Capacity Building

Infrastructure Investment: Setting Goals and Plans

Recruitment of Clinician Researchers Align Research Foci with Organizational Priorities

Solidification
Shape Clinical and Administrative Tasks to Research Priorities Target Resources to Research Funding for Optimal Leverage

Reflections on Developing an Academic Role for Social Work

In developing the academic role of social work within a health care facility, several key lessons have been learned. They are listed below. 1. Setting a goal to develop research is an indispensible dimension of the planning necessary to achieve this result. Without a clear vision and concerted effort to realize the goal, research advancement is unlikely to be substantially realized. This observation is consistent with Bland and Ruffins (1992) description of critical elements required for developing a vibrant program of research within a department. Having one Director of Social Work over this 20-year period likely made it easier to maintain and adapt the vision as necessary; nevertheless, a vision to advance social work research could be achieved potentially by multiple, sequential leaders if the vision was prioritized and advanced by subsequent leaders. 2. Aligning the vision for social work research with the broader organizational vision and mission was essential in securing support among senior leaders within the hospital. The hospitals identity as an academic health sciences center evolved over this period and both shaped and was shaped by the social work vision for research development. Hospital agreement to support social work research can be nurtured. Finding points of synergy and common goals between social work academic aims and hospital values invites creativity, relationship development, and the articulation of common priorities and aspirations. In this particular case study, the collective appetite for knowledge advancement was leveraged in making a compelling case for social work academic leadership. 3. It is worth noting that there is not universal support within the hospital regarding social work research or that of other nonmedical disciplines. At issue is how the salary costs of a researcher should be paid and whether hospital operational budgets should be used. In the absence of alternatives, these positions were funded through the hospitals central budget; however, there is ambivalence about this funding model. Efforts are underway to try to find additional options to fund salary costs of researchers across nonmedical disciplines.

Figure 1. Model of research development within the Department of Social Work.

for all departmental social workers. The recruitment of PhD-trained social work clinician-researchers served to monumentally advance this research productivity within this transformation phase. Finally, social work research development entailed solidification, occurring primarily in the latter era of these three phases of planning and implementation. Solidification was marked by continued refinement and periodic realignment of research studies and direction according to substantive departmental and organizational priorities (and vice versa). Social work researchers rapidly advanced their individual programs of research through extensive external research funding and the progression of their funded research from project inception to knowledge translation and uptake. Strategic alignment of research aims with organizational priorities was sought in order to leverage social work academic innovation with organizational currency and leadership. Accordingly, researchers attempted to strategically address hospital priorities of family-centered pediatric care and practice innovation (which fortunately corresponded with researcher interests and priorities). To maximize productivity, day-to-day clinical and administrative tasks were organized and structured to complement research goals. In so doing, marked gains of social work research productivity, advancement, and impact were realized. Each of these developmental phasesincubation, transformation, and solidification are outlined in Figure 1. Advancement of social work research has included key elements of methodology development as well as leadership in substantive issues related to practice and policy development, social justice, the social determinants of health (e.g., poverty and social support), and health services use (e.g., interprofessional practice, family-centered care, culturally competence in practice and health service program development). Extensive knowledge translation has been implemented by this social work research team, not only in shaping the research program but also by influencing the impact of that work. For example, social works research on poverty and related social

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McNeill and Nicholas For example, the model of endowed chairs would help to achieve sustainability and advancement of research leadership within allied health professions. Although each phase of research development in this case study met with some success, the recruitment of PhD-prepared social workers was the most productive in providing leadership and advancing the academic vision. These individuals provided expertise for the design, proposal writing, conduct, and translation of research. Yet, having these researchers as core members of the leadership team in the department also offered vicarious benefits that a hired external consultant or university-based partner could not provide. As members of the department, they were immersed in the work of the discipline and intimately connected to intra- and interprofessional developments within the hospital. This investment enhanced the integration of academic and clinical priorities and helped to ensure the relevance of research activities. In addition, it facilitated connections with senior management and interprofessional teams, thereby integrating social work leadership in strategic priorities across the organization. Further, it fostered ongoing accountability for social work research productivity and innovation. There was no expectation for frontline staff in the department to conduct research. However, the leadership team sought to create a culture within the department in which interested clinical social workers could access support for research involvement. If a clinician had a viable idea for a study and had the support of the clinical program on which they delivered services, it was often feasible to negotiate time to conduct the study. Usually this was limited to a half day per week, and social workers were expected to manage their time effectively to attend to urgent situations occurring on their program. Clinical programs were often keen to support academic activities that were closely aligned with the clinical operation of the program such as a needs assessment, program development, quality improvement initiative, or program evaluation. Many social workers preferred to partner with one of the PhD researchers who took the actual lead in obtaining funding and conducting the study. This provided an opportunity for clinicians to have their academic interests supported without having to assume full responsibility for managing a study. Demonstrating the value of on-site academic resources in the Department of Social Work has been an ongoing focus. Attention to both social work and hospital priorities ensured the relevance of academic contributions. This created winwin situations for the researcher by supporting her or his program of research, for the social work clinician by advancing practice capacity and leadership on their team, and for the department and hospital at large by demonstrating excellence and innovative knowledge production. In this way, there was active consideration of strategic opportunities and efforts to find critical synergies (e.g., a social work researcher interested in diversity issues

677 facilitated a partnership with a patient care program, whereby the researcher provided overall leadership and developed an innovative study). In another case, a social work researchers study examining transition issues lead to a broader consultation role in this substantive area within the hospital. Upon reflection, we conclude that visibility and communication proficiency of the social work researcher, made manifest through daily interaction with colleagues in the hospital, are important for achieving credibility and perceived relevance regarding institutional initiatives such as health equity, interprofessional practice, family-centered care and diversity. 8. Success in proposal-writing and securing external research grants has been an essential indicator of productivity, recognition, and role sustainability. Appointment of the social work researchers within the hospitals Research Institute as scientists served to legitimize their roles and highlighted the caliber of their work. Presentations at hospital educational rounds, invitations to national/international conferences, and publication of papers within professional journals are examples of activities that have maximized synergy and credibility within established research activity metrics and provided evidence of social work research relevance. 9. Creation of the academic roles in social work was initially made feasible as a result of the elimination of two senior social work positions. Consequently, the leadership team consisted of the Director of Social Work and the two academic and clinical specialist positions in a department of approximately 45 full-time equivalent social workers. As a result, the department had to develop innovative ways of handling traditional management functions. This was accomplished in ways that incorporated elements of a self-managing team and shared leadership framework. It was thus discovered through necessity that other ways of managing, although not ideal, were feasible and successful. In addition to the development of peer mentoring and case consultation initiatives for clinical social workers outlined above, the department developed a professional practice model that allocated full responsibility, authority, and accountability to frontline staff for their work, including recognition when consultation on a complex case was needed. The department leadership team employed an open door approach to offering consultation on high-risk cases as a way of supporting staff and managing liability. There were challenging but not insurmountable obstacles. Cumulatively, these initiatives and reorganization activities facilitated ongoing departmental management, including effective clinical practice, education, strategic academic contributions, and hospital leadership. In summary, the opportunity to create clinically based academic roles in social work provided a way of strengthening the integration of key professional activities such as clinical practice, teaching, professional development, and research. Over time, clinical staff became more enthusiastic about academic possibilities, which, in turn, advanced practice and contributed

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678 to a number of clinical (MSW-trained) staff ultimately embarking on academic career paths, including doctoral studies in social work. For example, over the 20-year period reviewed in this case study, 12 clinical staff commenced PhD programs and/or came to work in the department after starting a PhD program. Although it was not fiscally feasible to retain all of them in academic roles at the hospital, importantly there now exists a network of social work colleagues in academic settings across North America whose academic career can be traced to this academic culture at a formative point in their career. Moreover, of those who have moved to other academic roles and centers, many continue to collaborate on various academic activities such as research and knowledge translation.

Research on Social Work Practice 22(6) There is a need for more social work researchers who are employed in academic roles in clinical and community-based settings to advance social work knowledge. Such a development would complement the current model of university-based researchers who form strategic partnerships with hospitals and other organizations to conduct clinically relevant research. This arrangement has an important place and may be the only viable option for many social work settings; however, models in other disciplines such as medicine where physician researchers are embedded in the work of the profession are informative and point to effective ways to support excellence in clinical practice. Of relevance to this discussion, among the current cohort of PhD social work students at the local university, a majority is reportedly seeking academic careers in nontraditional settings (i.e., outside university-based faculties; C. Azzopardi, personal communication, October, 2011). To date, strong linkages with the local university have developed, including the cross-appointment of the individuals in these roles within the academy. This important linkage has provided credibility to the academic roles and offered ongoing opportunity for academic recognition, teaching, and career developmentall important considerations for those on an academic career path. A stronger alignment with the university would potentially lend additional credibility and support to the role. For instance, harmonization of tenure processes with university policiesakin to the university/teaching center tenure alignments of other disciplines (e.g., medicine) needs further development in social work. Synergies exist between clinical practice, teaching, and research, and it is beneficial to both the university and the hospital to look for creative models and structures to maximize these opportunities. Limitations of this study include the fact that we used a case study design, based on retrospective data in which we as authors were also a part of the processes being reflected upon. Moreover, we have examined only the experience of one social work department (albeit with multiple data sources and perspectives). Readers may identify potential areas for the transferability in considering application to other settings; however, this case study design admittedly limits widespread generalizability. Future research is needed with robust methodologies to examine both the determinants and outcomes of hospital-based clinical social work research capacity development, relative to varying approaches that could be taken for research production. This invites studies with larger samples and ideally from multiple sites across diverse health systems, regions, and academic structures. To that end, this study has identified exploratory, salient processes and potential outcomes in this emerging substantive and disciplinary area. It offers experiential markers which have not yet been well documented within our professional literature. The current lack of theoretical and empirical data in this area appears to speak to increased research. Innovative yet sound methodologic approaches are needed. This seemingly invites both quantitative and qualitative designs within future studies, as well as instrument development for this purpose.

Discussion and Applications to Social Work

While research development is an admirable and potentially promising aim for social work in health care, a limitation could be leveled in suggesting that social work priorities could be overshadowed by competing institutional and health sciences interests (e.g., critical pathways, care efficiencies; Kayser, Hansen, & Groves, 1995) note that contemporary health care may not always align with social work commitments and priorities. For instance, social work has a long-standing commitment to social justice, which at times may collide with priorities related to efficiencies in management. While such challenges in hospital-based research call for increased social work-based health research, a potential trade-off in achieving research and especially research funding success may be a tendency to move from the center of social work priorities. For example, social work researchers could feel compelled to focus on areas of research that are less intensively based in a social work ethos or set of commitments. In reflecting on our local experience, however, we found that partnering with colleagues generally was highly beneficial (and not distorting) in ultimately developing a strong social work track record of academic leadership and research scholarship. We generally were able to find intra- and interdisciplinary colleagues with whom to partner on projects, as needed. These colleagues often were successful researchers in their own right; however, they also were interested and willing to engage with us, that is, social work researchers, as the project leaders. While this model of embedding PhD-prepared researchers within a hospital-based social work department has increasingly become valued within the organization, much work is yet to be done. The merits of integrated, on-site social work researchers who are immersed in the work of the hospital are evident; however, a key unresolved issue relates to funding salary costs. Within medicine, there has been considerable success finding alternative funding models such as the clinician scientist role (i.e., 20% clinical and 80% research) and this is necessary for social work as well as colleagues in nursing and other professional disciplines.

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McNeill and Nicholas Much is yet needed in understanding the complex elements herein; however, this article begins to map out some elements as they have emerged in this social work and research experience and interface. In conclusion, this case study serves to highlight possibilities for developing and evaluating an academic social work program and profile within a hospital setting. As a discipline, social work continues to demonstrate and refine its contribution to the health care field. Integration of research to inform clinical practice is an essential vehicle for professional development and sustainability in an increasingly knowledge-based, yet fiscally strained health care context. Being deliberate and proactive as knowledge leaders emerge as critical activities for a strong, forward-moving health-based profession. As social work continues to evolve, new models and strategies are needed to advance the work of the discipline and ultimately to enhance our ability to provide the best possible service to patients and families. Declaration of Conflicting Interests
The authors declared no conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Funding
The authors received no financial support for the research, authorship, and/or publication of this article.

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