An entrepreneurial spirit for relieving the healthcare system

15.09.2022 Some patients offload their daily worries at the doctor’s practice and thereby overburden their doctors. This issue can be alleviated if social workers work closely together with doctors. Researchers at Bern University of Applied Sciences (BFH) have examined four cases of this kind of collaboration and brought impressive results to light.

Frau führt ein Beratungsgespräch
Social counsellor Dunja Vetter from «Caritas beider Basel» talks to a patient: the relief organisation was one of four institutions that BFH scientifically accompanied as part of the project «Social work in doctors’ practices». Image: supplied

Marta H. is in despair. She lost her job a couple of months ago and hasn’t yet found a new one. Money is running short and she is finding the situation hard to bear. She is worried that she won’t be able to pay her health insurance premiums any more. Is there a way to get a discount on them? And who should she contact? She comes to her doctor with these questions. Shortly before, her doctor had to reassure Hans M., who is barely getting by with his OASI payments. He says he needs to apply for supplementary benefits, but where and how can he do so? The doctor tried to clarify this with him, but she wasn’t able to fully reassure him. They hadn’t even had a chance to speak about his sore back yet.

General practitioners are a point of contact for worries of all kinds

These kinds of situations are part of daily life in Swiss doctors’ practices. Some patients don’t know who to turn to with their everyday problems, and so they come to their doctor with their troubles. It’s easier to overcome the shame of talking about things in a doctor’s practice, because general practitioners are key confidants for many people. «They keep coming with the same lawyer’s letter or with a letter from their landlord. They come to me with all their issues and expect advice or a solution,» explains another doctor. «I can’t just tell them ‘That’s not my job, go away.’ That makes people feel offended. But I simply don’t have time for it.»

Social work in doctors’ practices can provide relief

«The conditions in which we live can make us ill,» says René Rüegg, a research associate at BFH’s School of Social Work. «Illness can lead to losing your job, which increases the risk of poverty. And, in turn, poverty then negatively affects our health.» Because social circumstances are linked to health in so many ways, you absolutely have to take them into account when it comes to primary health care, adds Rüegg.

Social work can be utilised here in a range of ways: it supports patients with getting to grips with the healthcare system, it promotes social integration and mental health, and it relieves the burden on medical staff.

Still not a widely used model

The problem is that although social services are an integral part of hospitals and psychiatric clinics in Switzerland, the principle of «social work in doctors’ practices» has already more or less established itself in other countries (such as with the «Maisons Médicales» in Belgium), while there are very few such services in Switzerland. René Rüegg sees potential here, and started a research project sponsored by Innosuisse with his team two years ago (see box). The goal is to scientifically accompany existing services, support them and connect them with each other.

Reducing healthcare costs and increasing satisfaction

«If social work is made an integral part of primary health care, it increases disease prevention in the population. Over the long term, this can reduce healthcare costs,» states Rüegg.

The results of the project are also encouraging: the high level of satisfaction of everyone involved is particularly notable, says Rüegg. Both patients such as Marta H. and Hans M. and medical professionals would benefit enormously. Thanks to social work in doctors’ practices, patients would have better mental health and greater independence. Doctors are relieved of an emotional burden and can focus on medical work during their office hours.

«You can sense the can-do attitude»

«As a university of applied sciences, our task is to help society progress using innovative projects,» says Rüegg. He adds that the «Social work in doctors’ practices» project has shown that collaboration between doctors and social workers is very possible with a reasonable amount of effort. This is true both for models, in which everyone is united under one roof, and also for collaborations between two institutions. He is also particularly impressed by the vigour and the perseverance of the doctors and social workers involved: «You can sense their can-do attitude, the resolute will to make a difference.»

So is there nothing standing in the way of further services in this vein? Unfortunately, not quite. «We have jump-started an innovation process with our research project,» explains Rüegg. «A few changes are still needed for these kinds of services to be established, such as in terms of financing or training. Here at BFH, we’re ready to continue accompanying this journey.»

Four institutions, two models

Holistic and patient-centred primary health care is a key requirement of the World Health Organization (WHO). The Swiss Conference of the Cantonal Ministers of Public Health (GDK) also advocated for this in a framework paper back in 2012. As part of the project «Social work in doctors’ practices», BFH researchers examined the specialist and organisational foundations of such services. They also looked at how much patients and doctors benefit from the services. Four institutions were involved in the project, including joint practices such as «Gesundheitspunkt Oberägeri» in Zug, which directly employs in-house social workers. The researchers also examined social institutions such as the social advice office «SoBü Bärn» in Bern, to which doctors’ practices can refer patients.

About René Rüegg

Porträt von René Rüegg
René Rüegg: «If social work is made an integral part of primary health care, it increases disease prevention in the population and reduces healthcare costs.»

René Rüegg has been working at the Institute for Organisation and Social Management at Bern University of Applied Sciences (BFH) since 2016. He qualified as a social worker from a university of applied sciences, and studied sociology and social and cultural anthropology at the University of Zurich. In 2022, he completed his doctorate in public health at the Graduate School for Health Sciences (GHS) at the University of Bern. His work focuses particularly on social work in healthcare, the quality of social services, evaluations and reporting.