Defining the health social worker role and function—Struggling between discretion and standardization

Abstract This study investigated a project initiated at a Swedish hospital, striving to formalize the work of health social workers (HSWs). Focus is directed at the relation between standardization and discretion, and the aim of the study was to analyse the reflections and experiences the project raised among the HSWs and the manager. Six focus groups were conducted, and the empirical material was thematically analysed. The results suggest that the HSW role is shaped in a complex interplay between HSWs and colleagues representing other professions. HSWs have a wide discretion and attend to varying needs of patients as well as other professions and the healthcare organizations, in the nexus of social problems and health. Both HSWs and managers expressed a need to strengthen the position of HSW in healthcare, and they agreed that increased clarity towards other professions regarding what the work entails could have such results. However, the HSWs raised concerns regarding how an increased standardization could narrow their discretion and thereby delimit the contribution of the profession. The analysis highlights how HSWs can be analysed using Lipsky’s concept of pressure specialist, but how an increased standardization could result in them coming to function more like street-level bureaucrats.