Institutional Change and Healthcare Social Workers’ Identity: An Analysis from the Street-Level Perspective

The COVID-19 pandemic is only the most recent challenge for healthcare professionals. Critical change processes, synthesized in the terms neoliberalization, globalization, and digitalization, have affected institutional settings and workplaces and altered work practices and working conditions in this professional area. Such processes have also influenced how professionals perceive their roles and interact with managers, peers, and users, calling into question professional identities. This chapter focuses on healthcare social workers – namely, social workers who work in healthcare facilities and collaborate with other professionals to address complex situations – arguing that they have been severely hit by the above changes and are further threatened by the COVID-19 pandemic. Based on a literature review, the analysis shows that neoliberalization is the fil rouge that connects social, institutional, and professional change and identifies new public management as a factor that significantly modified social work practice in healthcare. Street-level bureaucracy literature, though, revealed ambiguous effects on social workers’ discretionary autonomy. Then, while it is clear that the pandemic crisis has affected work organization and working conditions, its impact on identity dynamics is nebulous.