A Study on the Role Model of Medical Social Workers for the Effective Functioning of Home Care Teams : Focusing on Discharge Conferences
Title
在宅ケアチームが有効に機能するための医療ソーシャルワーカーの役割モデルに関する研究 －退院時カンファレンスに注目して－
A Study on the Role Model of Medical Social Workers for the Effective Functioning of Home Care Teams : Focusing on Discharge Conferences
Degree
博士（健康福祉学）
Dissertation Number
甲第37号
(2026-03-17)
Degree Grantors
Yamaguchi Prefectural University
Abstract
The present study aims to elucidate how medical social workers (MSWs) engage with patients, families, and multidisciplinary teams during discharge conferences and the surrounding practice processes, with particular attention to the formation, coordination, and continuity of supportive relationships. The objective of this study is to theoretically and empirically clarify the structural underpinnings of MSW practice in the context of discharge support.
In recent years, amid healthcare system reforms and the promotion of community-based integrated care systems, discharge support has been increasingly institutionalized as a core function of medical institutions. Discharge conferences, in particular, have been positioned as key mechanisms for implementing multidisciplinary collaboration. However, while institutional compliance and procedural standardization have progressed, several practical challenges have been identified. Discharge support tends to become procedure-centered, making it difficult to adequately reflect patients’ and families’ values, preferences, and perspectives on daily life. Moreover, existing research has paid limited theoretical attention to the processes through which multidisciplinary collaboration is actually generated and sustained, as well as to the concrete roles played by MSWs within these collaborative practices.
To address these gaps, this study conceptualizes discharge conferences not as isolated or event-based meetings, but as part of a continuous practice process extending from the early stages of hospitalization through the initial period of post-discharge support. Within this continuum, the study focuses on how MSWs position themselves relationally and how their practices contribute to the coordination of support and decision-making. A mixed-methods research design was employed, integrating qualitative and quantitative approaches.
The qualitative component consisted of semi-structured interviews with MSWs working in acute-care hospitals. These interviews explored concrete experiences related to discharge conferences and associated practices, including interactions with patients and families, coordination with multidisciplinary professionals, facilitation of shared decision-making, and reflection on practice following discharge. Qualitative analysis revealed that MSW practice is structured around five interrelated factors. The first factor, mediation, involves bridging patients’ and families’ narratives with professional judgments, as well as connecting medical treatment perspectives with everyday life contexts to establish a foundation for mutual understanding. The second factor, coordination, refers to practices through which MSWs reconcile diverse professional expertise, roles, and values to support the formulation of coherent and shared care plans. The third factor, reflection, involves reviewing cognitive discrepancies, ethical tensions, and relational dynamics that emerge during practice in order to refine judgments and interventions. The fourth factor, relationship continuity support, focuses on rebuilding and maintaining relationships among patients, families, and professionals to ensure continuity of care following discharge. The fifth factor, deepening reflection, captures the process through which MSWs enhance their professional expertise and sustain ongoing practice improvement through accumulated experience.
Based on the qualitative findings, a questionnaire was developed and administered to MSWs nationwide as part of the quantitative phase of the study. The collected data were analyzed using covariance structure analysis to examine the relationships among the identified factors. The results confirmed that the five factors are structurally interrelated and collectively constitute the practice structure of MSWs in discharge support. These findings provide quantitative support for the validity of the practice structure model generated through qualitative analysis.
Overall, this study demonstrates that the role of MSWs during and around discharge conferences should not be understood as a fixed set of tasks or procedural functions. Rather, MSW practice represents a dynamic and relational process in which practitioners continuously reposition themselves within evolving relationships through mediation, coordination, and reflection. By articulating this practice structure, the study makes both theoretical and practical contributions to the field of medical social work. Furthermore, it offers a conceptual basis for reimagining discharge conferences as collaborative spaces that support the reconstruction of patients’ and families’ lives, rather than as formalized procedures driven primarily by institutional requirements.
In recent years, amid healthcare system reforms and the promotion of community-based integrated care systems, discharge support has been increasingly institutionalized as a core function of medical institutions. Discharge conferences, in particular, have been positioned as key mechanisms for implementing multidisciplinary collaboration. However, while institutional compliance and procedural standardization have progressed, several practical challenges have been identified. Discharge support tends to become procedure-centered, making it difficult to adequately reflect patients’ and families’ values, preferences, and perspectives on daily life. Moreover, existing research has paid limited theoretical attention to the processes through which multidisciplinary collaboration is actually generated and sustained, as well as to the concrete roles played by MSWs within these collaborative practices.
To address these gaps, this study conceptualizes discharge conferences not as isolated or event-based meetings, but as part of a continuous practice process extending from the early stages of hospitalization through the initial period of post-discharge support. Within this continuum, the study focuses on how MSWs position themselves relationally and how their practices contribute to the coordination of support and decision-making. A mixed-methods research design was employed, integrating qualitative and quantitative approaches.
The qualitative component consisted of semi-structured interviews with MSWs working in acute-care hospitals. These interviews explored concrete experiences related to discharge conferences and associated practices, including interactions with patients and families, coordination with multidisciplinary professionals, facilitation of shared decision-making, and reflection on practice following discharge. Qualitative analysis revealed that MSW practice is structured around five interrelated factors. The first factor, mediation, involves bridging patients’ and families’ narratives with professional judgments, as well as connecting medical treatment perspectives with everyday life contexts to establish a foundation for mutual understanding. The second factor, coordination, refers to practices through which MSWs reconcile diverse professional expertise, roles, and values to support the formulation of coherent and shared care plans. The third factor, reflection, involves reviewing cognitive discrepancies, ethical tensions, and relational dynamics that emerge during practice in order to refine judgments and interventions. The fourth factor, relationship continuity support, focuses on rebuilding and maintaining relationships among patients, families, and professionals to ensure continuity of care following discharge. The fifth factor, deepening reflection, captures the process through which MSWs enhance their professional expertise and sustain ongoing practice improvement through accumulated experience.
Based on the qualitative findings, a questionnaire was developed and administered to MSWs nationwide as part of the quantitative phase of the study. The collected data were analyzed using covariance structure analysis to examine the relationships among the identified factors. The results confirmed that the five factors are structurally interrelated and collectively constitute the practice structure of MSWs in discharge support. These findings provide quantitative support for the validity of the practice structure model generated through qualitative analysis.
Overall, this study demonstrates that the role of MSWs during and around discharge conferences should not be understood as a fixed set of tasks or procedural functions. Rather, MSW practice represents a dynamic and relational process in which practitioners continuously reposition themselves within evolving relationships through mediation, coordination, and reflection. By articulating this practice structure, the study makes both theoretical and practical contributions to the field of medical social work. Furthermore, it offers a conceptual basis for reimagining discharge conferences as collaborative spaces that support the reconstruction of patients’ and families’ lives, rather than as formalized procedures driven primarily by institutional requirements.
Creators
Yanagisako Mitsuhiro
Languages
jpn
Resource Type
doctoral thesis
Publishers
山口県立大学大学院健康福祉学研究科
File Version
Not Applicable (or Unknown)
Access Rights
open access