Two Lives: A Mandate for Quality Customer Service in Community Rehabilitation
By Cary
Griffin, Director of Training
The Rural Institute
The University of Montana
Introduction
Although most of us would agree that life and services for people with disabilities have improved in recent years, there remains a great gulf between what is and what should be. The tendency to recount the many good things that have occurred minimizes the very prevalent failures that contribute to an 80% unemployment rate along with a home ownership rate that is nearly non-existent for people with the most significant disabilities. By looking at what does not work, we sometimes can create the sense of urgency so desperately needed to efficaciously address the many challenges facing consumers, families, and systems.
This chapter contrasts the stories of two people, illustrating what contributes to successful lives. These factors include:
- staff development and personnel investment by rehabilitation organizations,
- state and federal policy,
- the absence of "cost-response" behavioral approaches, and
- increased connectedness of the rehabilitation field to the general community.
The chapter also shows how, with a little effort, positive outcomes can be achieved without massive systems change or new appropriations. The second profile demonstrates that success happens when staff receive intensive training in customer-centered approaches to support development, and the system avoids the negative behaviors of a self-perpetuating system established to "need" such people to justify its existence. One person was viewed as a "client" in need of structure; the other was viewed as a "person" capable, with support, of directing her life. The intent of this short study is to point out real, inexpensive, low-tech approaches to getting on with the work many of us are charged with doing. In fact, it was a vocational provider's sincere interest in improving a life that brought the details of this first story to light. Focusing on customer service, values, and the elimination of wasted effort led to the successes recounted in the second story. The author served as the person-centered plan facilitator for both individuals.
Winston
The first situation illustrates extremely poor customer service. "Winston," an African-American male in his late twenties, is described as having dual-diagnosis (mild mental retardation and a psychiatric disability). When the career planning process began, Winston was working daily at a used car dealership, detailing cars for resale, cleaning up the premises, and performing various maintenance tasks. The owner of the dealership took great interest in Winston's welfare and helped him talk through his spells of anger on the job. Winston was also a regular at her home in the country, and he especially enjoyed visiting when her children and their families would come for a Sunday barbeque. The employer went beyond our typical impression of "the boss" by being personally interested, protective, and hopeful. In fact, Winston let it be known clearly that his employer treated him with much greater respect than his assigned residential staff.
Winston made it known to his boss and his vocational staff (the latter provided very limited on-the-job support) that he desired a job with more hours, higher pay, and less physical work. The vocational coordinator approached Winston with the idea of developing a career plan. He agreed, and a team consisting of Winston, his employer, a paid advocate, a residential counselor, and the author met one snowy Rocky Mountain afternoon at the car dealer's home.
The vocational coordinator explained that Winston might wish to keep some personal issues to himself. Winston explained that if the details were important to developing a new job, he would share these facts of his life at the meeting. A person-centered career planning process was used to form the foundation of the career advancement plan (Griffin & Hammis, 1996). Winston's boss was dedicated to keeping him employed while he sought out other opportunities and would use her influence in the community to help develop job leads and interviews.
Our first task was to develop a relationships map. Here we discovered the important people in Winston's life and a little about their relationship with him. We discovered that Winston was somewhat well connected in his local neighborhood, although a good number of his friends were also devalued individuals and several were in trouble with the law. We found, as the residential provider already knew, that the influence of these folks was often harmful to Winston. Meeting up with these friends sometimes resulted in fighting, being late to work, or being cheated out of his money. The residential staff, with good intentions, wished to restrict Winston's access to these people. However, no social replacements were found, except for Winston's roommate, who Winston found "annoying."
On the positive side, Winston had a good relationship with another person at work and especially with his boss, who invited him to her home. Still, Winston's access to the community was quite limited. He "hung out" with his friends who took advantage of him, or he walked from his apartment to a local bar where he went dancing on the weekends.
Winston's mother lived about 50 miles away in another town, and he occasionally visited her when he could get a ride. His mother was dying of cancer, which naturally upset Winston a great deal. His only other close relative was his brother who was serving a jail term in a federal correctional facility in the state. Winston's support system lacked friendship and intimacy. He did date a couple of women on a regular basis, but, because these women were considered a bad influence by the residential provider, access was limited. Further, Winston's access to privacy for his relationships was severely inhibited because he lived with a roommate.
Winston and the team decided to seek out other opportunities to make friends. Past experience illustrates that this best occurs in environments where meeting other people is possible. Lists of places Winston wanted to visit, and his preferred activities, were developed. Further, a community member would be sought as a connector and role model for Winston.
The team next explored Winston's preferences and dreams. He explained that he would like to explore several new jobs. He thought he might enjoy selling cars and that a few classes in sales might be worthwhile. Someone commented that Winston's inability to read and comprehend well would make the job "impossible." It was explained that "impossible" is not the focus of a career plan, but that creative approaches are. If being a salesman was Winston's dream, it was our obligation to help create that reality.
Winston also offered a number of other job possibilities that were discussed. One career possibility that he strongly wished to explore was carpet cleaning. A plan was made to contact a number of carpet cleaning businesses to find out if they were hiring and if they would hire Winston if he brought his own equipment to the job (in the same way that a mechanic brings her tools to a car dealership, or a computer programmer brings his education to a software firm) (Griffin, 1999a). Other factors such as transportation to the job would need to be determined. The team decided to investigate funding under a Plan for Achieving Self-Support (PASS) and through Vocational Rehabilitation as methods of increasing support and Winston's ownership and control.
Because a job is only one facet of a person's life, other preferences were explored to bring balance and help improve Winston's quality of life. Winston reported that he liked women, dancing, gambling, motorcycles, and that he really wanted to live on his own. A job could go a long way towards securing many of these life enhancements. However, it became apparent that the advocacy organization and the residential provider had different views of Winston's abilities and desires.
The provider and advocacy organization representative volunteered little input during the employment discussion, and it became obvious now that they did not fully endorse the plan of action. Together they recounted Winston's many negative behaviors: others often influenced him negatively; he got into fights; he was moody; his current boss was "one in a million" so employment was a pipe dream; his hygiene was too bad to allow him to work as a carpet shampooer; he fought with his roommate—the list seemed endless. When questioned about a functional analysis of these behaviors, they ascribed Winston's behavior to his psychiatric diagnosis and his general personality. A positive behavioral approach had never been employed. The behaviors were considered "maladaptive" and control was to be maintained, otherwise Winston risked being returned to a state institution.
The team was stunned to learn that Winston had to take a week's vacation because he had acquired too much in savings ($5,000) and faced benefits loss from Social Security. Half the group saw this as an opportunity. After all, Winston needed money for sales classes, social events and dating, and needed money for carpet shampooing training and equipment; and/or he could put a down payment on a home of his own, using a local bank's discounted mortgage rate for buyers with disabilities. Instead, we were informed enthusiastically by the residential provider and the paid advocate that Winston was going to Disneyland.
Winston could be incredibly compliant, especially when those who controlled his money insisted he do something. In this case, the residential provider had mismanaged Winston's funds, and Winston was now going to pay for this malfeasance by personally paying the travel expenses of two residential staff assigned to accompany him to Disneyland. He was not allowed to take a friend or relative. The people who failed to control his finances were now claiming that Winston's behaviors dictated strict controls on his freedom. Winston had some challenging behaviors, reinforced by the dread of his mother's impending death and the role-modeling of his brother, but the residential staff themselves, through control and manipulation, had taught Winston exactly how to behave.
Winston made his trip, despite efforts to cancel by the vocational service provider. When he returned, Winston found that his belongings had been moved to another floor of his apartment complex and that he now had a new roommate. He was very upset that Sunday evening and did not sleep. He went to work the next morning, was teased by co-workers for visiting Disneyland, got into a fight, and struck a fellow worker. The boss had little recourse: fire Winston or face a liability lawsuit. She fired him and pledged to help him find a new job and to remain his friend. Throughout this process, the employer was Winston's strongest advocate.
Little has changed for Winston. He lives with a roommate he did not choose and does not like. He has a part time job sweeping the parking lot at a fast food restaurant. Placement on an enclave has been discussed. He has limited social engagement and sees a community role model only occasionally. His mother passed away and when he attended the funeral he re-established a few family links. His PASS plan is still under development, but moving forward under his direction. Many of his support staff feel his behavior is deteriorating to the point that he probably cannot work and that he should be placed in a specialized behavioral group home.
Winston is living a self-fulfilling prophecy. He has been set up to fail by a system concerned with "slots," "case loads," and "programs." He is surrounded by staff who work in bad management systems, without clear values-based leadership, where inventiveness is simply an inconvenience, and are stuck in the daily grind of human services. Winston has little to say about the quality of the service he receives and he is surrounded by many people with no sense of immediacy. There is no incentive for positive, consumer-directed outcomes. Instead, the desired outcome seems to be maintaining stability. The management system seems troubled by the ideas of Winston having his own home and having access to a career, and by a full accounting of his finances. The support agencies are managed for numbers, not individuals.
Winston is stuck with his history. The staff no longer trust his ability to self-direct his life. They have created a no-win situation where his assertiveness is seen as non-compliance and with formal evaluations that justify their basic pessimism regarding Winston's dreams to be free. His file contains statements to the effect that: "Winston has maladaptive behaviors;" "he has low self-esteem and creates fantasies to fulfill his goals;" "he seems to think the world revolves around him;" "he prefers to be left alone." This evaluation doesn't contain any statements as to why Winston may behave the way he does. One might think that this evaluation could be used to drive a new life for Winston. Instead it is used to justify organizational malfeasance. Winston's behavior clearly indicates what he wants and needs. Instead, the provider agency is spending thousands of dollars ensuring that he gets exactly what he is rebelling against. This control model of program management wastes resources and is disrespectful of human beings.
There are critical lessons to be learned here.
- First, treat individuals as individuals, not as cases. Winston is a living, thinking, feeling human being who has entrusted his life to us. Professionals owe him action.
- Second, act as though "60 Minutes" is auditing program outcomes. Winston's assigned staff have wasted the better part of a year with almost no tangible outcomes (getting a resume typed up has taken over two months and acquiring a debit bank card to assist with creating a credit history is still in limbo).
- Third, hire and develop staff as if the quality of their work means the difference between life and death.
- Fourth, create management systems that focus on outcomes the individual wants.
- Fifth, create organizations that incubate collaborative relationships within the community. Throughout Winston's life, human service agencies have failed to take advantage of typical and/or professional community supports that would assist Winston and reduce the workload on agency staff.
- Sixth, develop and maintain a sense of urgency. If agencies cannot perform, they should be assisted. Nothing presented in Winston's story is out of the realm of the possible. Indeed, many people with fewer resources are living happy, interdependent lives. Such outcomes can be achieved in any community if the desired outcomes are respected and clear (Lovett, 1996).
Leanne
"Leanne's" story provides a sharp contrast to Winston's. Leanne, a woman in her early twenties, lives in an eight-bed group home duplex, with men on one side and women on the other. Family members live nearby and her parents typically take her home on weekends. When I first met Leanne, as the facilitator for her career plan, I found that she spent most of her day in Work Activities performing basic assembly tasks at piece rate and occasionally got limited computer training on an outdated Apple computer loaded with pre-school number and alphabet recognition software. Her file indicated that she had an I.Q. in the mid-30s, was non-verbal, used a motorized wheel chair, had severe cerebral palsy, and was virtually "unemployable."
The vocational service provider was convinced that Leanne could find meaningful work in the community, and a person-centered career plan was initiated. Leanne and her vocational support staff created an initial invitation list and we met at her group home one afternoon. Attending the gathering was the facilitator, the vocational director, the job developer, two residential staff and their manager, Leanne's mother and father, and her older brother. The meeting, unlike Winston's, was positive and upbeat. Leanne communicated largely through the staff, who knew her well, and through her family.
As maps of her personal history, likes and dislikes, hopes and dreams developed, it became clear that Leanne's family was well established with a broad circle of friends and business associates in this city. Also, it was obvious that Leanne had numerous interests that lent themselves well to job exploration and that staff needed a great deal more information about assistive and universal technology and funding that would help Leanne accomplish some of her possible employment goals. Further, it was clear that staff had not worked collaboratively with other agencies such as Vocational Rehabilitation, Adult Continuing Education, or Social Services. Few of the staff had strong links to the business community. The difference between this group and the team working with Winston was that this group wanted to take action and asked for assistance and training. They were focused on the outcomes Leanne wanted and were willing to experiment in unknown territory to meet her needs. After all, if she was brave enough to trust them, staff certainly should respect that courage and support of goals.
Another key issue arising from Leanne's first meeting dealt with communication. She did not have even a simple pictorial communication system, making her interactions with new acquaintances extremely difficult. Leanne was often in public places with her family on the weekend. Together they went shopping, visited neighbors, and dined out. A sophisticated communication system might help break the silence barrier. The residential provider volunteered to assess Leanne's Medicaid account and within weeks had ordered a new computerized voice synthesizer. Although months later it still had not arrived, the point here was that personnel had acted. By creating a team approach and bringing the desires of the individual and the family to bear, staff took decisive action.
Leanne's work preferences showed that she desired jobs possibly doing clerical work, such as paper shredding and photocopying. She also indicated that she liked clothes, makeup, and fashion in general. During our second meeting, about a month after the first, Leanne made it clear that she might like to pursue a career in modeling. The team rose to the occasion. They thought there were concrete steps to take to prepare for such a career.
First, she would have a make-over at a beauty salon. Next, professional portraits would be taken to create a portfolio. The vocational director assigned a new job developer, who had a background in professional modeling, to work with Leanne. Leanne was thrilled, but it was obvious that several team members doubted the existence of work for Leanne and stated their concerns. The team decided to push forward despite their reservations.
Over the next several months progress was slow. Personnel changes due to high turnover in three involved organizations seriously interrupted plans. At long last another gathering was convened with Leanne, her mother and father, the facilitator, the vocational director, the new job developer with modeling experience, a new job coach, a new case manager, and a new residential support person.
From the start it was clear that a good deal of education was needed. The new case manager was hesitant about recommending that the modeling career be pursued. She was concerned that no one would hire Leanne and that we were setting her up for failure. Looking at it from another point of view, one could say that in almost 30 years Leanne had not been provided one true career attempt, this was what Leanne and her family wanted, and that career failure was all Leanne would ever know if she was not "allowed" to try.
After much discussion it was clear that Leanne, the vocational staff, and the family were quite serious about quickly pursuing the modeling career. It was also clear that modeling jobs were limited for anyone wanting to become a model and that Leanne should consider a "day job" while her fashion career matured. Leanne's parents, who both worked in companies that had clerical openings, were enlisted to help develop a clerical job, which with some minor assistive technology, would allow her to be productive. The job developer would research adaptive equipment funding.
Today, Leanne has a part-time clerical day job. She has a professionally photographed portfolio, which was donated through personal staff connections with a photographer, and a request has been made to Vocational Rehabilitation to open Leanne's case for service and to provide her with what all good models need—an agent. Leanne has filmed her first local television commercial for an automobile dealer. The development of Leanne's career is critical to her, her family, and her team. Unlike Winston's team, these people believe that everyone can work and that behavior is often a reaction to life's circumstances. Leanne is being treated in a respectful manner and is responding by working on her job for today, as a clerical assistant, while trying hard for that break that launches her into the modeling career of tomorrow.
21st Century Rehabilitation
It is convenient to blame poor funding of human services for the difficulty in promoting meaningful, inclusive outcomes for people with the most significant disabilities. In reality, there appears to be sufficient funds to accomplish community employment and living for people with disabilities (Butterworth, et al., 1999). What is not occurring is the use of these funds in effective ways (Griffin, 1999b; Griffin, 1994a; Griffin, 1994b; McGaughey, et al., 1994; Mank, 1994; Murphy & Rogan, 1995; Braddock, et al., 1995; Wehman & West, 1996; Wehman & Kregel, 1998).
Person-directed customer service demands that individualized supports be facilitated to meet unique needs, instead of creating program categories that theoretically fit the mean. The issue of community inclusion is less technique-dependent than it is a matter of leadership and management realignment with the changing needs of the market. As in other economic sectors, the business of rehabilitation must conform to a customer friendly, highly competitive, fast-paced marketplace. Sheltered workshops surviving on state and federal appropriations, which offer vocational training through subcontracted, hand-assembly work, are especially anachronistic. Most hand work in industry is done by machines or robotics these days, and the contention that piece-work training prepares people for employment is not realistic in an economy steeped in the Third Industrial Revolution of the Information Age (Rifkin, 1995; Taylor & Wacker, 1997; Griffin & Hammis, 2000).
Sheltered workshops are by and large preparing people for lives in sheltered workshops. Even many entry-level, supported employment jobs are beginning to disappear. Soon, fast food restaurant customers will order food at drive up computer touch screens. Machines already do most of the cooking. Those upper-level "clean hands" service jobs (e.g., bank tellers) are disappearing at an alarming rate. The banking industry planned to eliminate 700,000 jobs by this year. Ninety million jobs in the United States are critically vulnerable to replacement by machines and computers within the next decade (Andersen Consulting, 1991; Ben-Ner & Benedetto, 1993; Drucker, 1993; Hammer & Champy, 1993; Reich, 1992; Womack, Jones & Roos, 1990; Rifkin, 1995). Thinking that the rehabilitation world is invulnerable to the changes of the information economy is deadly wrong. Customer service and the need for solid, person-directed outcomes have directly influenced the development of managed care, personal service vouchers, state and federal capitation of funding, generalized taxpayer revolt, and self-advocacy criticism of community based rehabilitation. Recovery can be accomplished, but not without a reexamination of leadership and management functions.
The leadership imperative for the future has numerous components. Job one is reorganizing to place the consumer in the target zone of valued organizational activity. Accomplishment of such a massive undertaking is best understood through a critical consideration of values alignment, personnel functions, and leadership orientation (Griffin, 1999b). This challenge will be faced directly at the community provider level, but success will certainly not occur until state and federal policy changes drastically, allowing local programs to meet consumer needs.
The leaders of tomorrow are challenged to adopt a new way of thinking and managing. Central to this metamorphosis is the realization that the future will be substantively different from the past. Those who rely on past practices and relationships will miss the opportunities necessary for transformation and goal attainment. Successful leaders and personnel throughout organizations will also recognize that power and politics can be forces for incredible good. Typically, human service workers underutilize personal, economic, and political power to influence agency quality improvement and consumer outcomes. New leaders, managers, and front line staff will find it necessary to call upon networks of friends, business associates, and neighbors for personal support of citizens with disabilities. Members of our Boards of Directors will be required to contribute fiscally to programs and to serve as role models in their communities by hiring and befriending people with disabilities. The twenty-first century organization will demand this of their officers.
Business relationships must also change. Creative organizations should leverage partnerships with their suppliers. Continued patronage of a grocery store should hinge upon that business employing people with disabilities, for instance. Perhaps the local insurance company that carries an organization's liability coverage can provide free seats in their staff training programs for word processing, sales, customer service, TQM, supervision, and first aid. These mutually beneficial partnerships will cut costs and provide integrated activity for often segregated staff and consumers in both industries.
The hiring process needs reframing. Today, front line staff especially are seen as expendable. Few organizations track the actual costs of turnover and the reasons staff leave, or have action plans in place to counteract this threat to success, opportunity, and community relationship building. In the future, hiring and training will become a key investment issue for successful organizations. As consumers and funders gain greater flexibility in selecting service providers, competition will increase and create the necessity for a stable, inventive, high performance, highly professional workforce that is capable of creating business relationships, utilizing modern information and assistive technology, uncovering hidden fiscal and community resources, facilitating natural supports, and providing superior service overall, without overshadowing or "clientizing" consumers. The successful twenty-first century organization will hire for quality and potential, make a substantial investment in this intellectual capital resource, see market demand grow based upon this capital asset, and change direction effectively through a diverse, stable, outcome-focused staff (Carbonara, 1996). Such staff at all levels will require the skills illustrated in the table below.
| Critical Personnel Capacities for the 21st Century Organization | |
| Skill | Descriptor |
| Exemplary Communicator | Conversational, Agile Listener, Action Oriented, Technology Competent |
| Self-Managing | Meets Customer Requirements, Uses Time Beneficially, Requires Leadership not Management, Trustworthy, Encourages Team Members toward Mutual Goals |
| Technologically Innovative | Understands Common Technology, Utilizes Local Expertise in Solving Technology Problems, Embraces Labor Saving Items |
| Life Long Learner | Actively Pursues new Ideas and Learning Opportunities, Encourages Others to Learn, Invests in Own Career |
| Active Community Member | Seeks out Opportunities to Connect with Others, Joins in Civic Activities, Understands Public Relations & Promotion, Involves Consumers in all Aspects of Daily Community Life |
| Collaborative & Political | Knows the Difference between Opportunity & Ceremony, Seeks Personal Power & Consumer Power, Makes Ethical Deals for Mutual Benefit, Exhibits Honesty in all Pursuits |
| Adventuresome | Seeks New Ideas & Activities, Not Dependent, Collaborative Decision Maker, Calculated Risk Taker |
The key to hiring will be recruitment from competitive sectors that attract and incubate such people. Agencies that continue to hire untrained, disconnected, and expendable staff will find themselves irrelevant.
Waste: the Enemy of Improvement
A bottom-line approach to sustaining a competitive advantage must focus on increasing positive, consumer-directed outcomes while minimizing the waste that comes from traditional service delivery methods and models (Hammer & Champy, 1993; Juran, 1989; Floyd & Wooldridge, 1996; Gilbert, 1978). Focus groups conducted across the United States indicate that consumers of community rehabilitation want:
- real jobs,
- friends,
- community participation,
- money,
- control over their lives, and
- access to transportation on demand (Griffin, 1994b).
Traditional service arrays provide consumers with:
- sheltered work or work activities,
- pre-vocational training,
- standardized testing, and
- fixed route agency transportation.
With fewer than 25% of people with the most significant disabilities receiving integrated employment, the change to adaptive, customer-aware/customer-driven supports is a monumental undertaking (Butterworth, et al., 1999; McGaughey, et al., 1994; Wehman & Kregel, 1998).
To accomplish this sea change, a critical effort must be made to eliminate waste in the system, first at the federal and state levels where funding parameters originate, and then at the local level. Waste is defined as the value of what customers are unwilling to buy (McNair, 1994). Today's bottom-line customers of community rehabilitation have little say in what they get, want, or need. Programs are designed to fit funding streams and professional job descriptions. In the near future, this situation will likely change radically. Waiting for the change before acting is certainly the way to become more irrelevant, waste taxpayer dollars, and eventually become bankrupt. A focus on value-adding work will make rehabilitation agencies competitive (Griffin, 1996).
On slim budgets it is easy to understand why program administrators believe their programs are not wasteful. However, if consumer desire and state-of-the-art outcomes are to be achieved, the waste in comparison to what is currently paraded as quality becomes strikingly obvious. Technology and funding streams currently exist to get people with diverse labels into real community employment (Griffin & Hammis, 2000; Sweeney & Griffin, 1996; Mank, 1994; Smith, et al., 1995). Recognizing that most community rehabilitation agencies do not extend themselves sufficiently to provide such outcomes is the critical point of conflict. To meet customer needs, major change has to occur, but the forces of change have been weak enough and the forces of resistance strong enough to hold the customers hostage. Until competition grows significantly in this country, it appears service providers will not adopt or use proven techniques for support. Car buyers can leave a dealership that refuses to sell red cars; people with disabilities rarely have the luxury of leaving one agency for another.
A wasteful program does not produce what is truly in the best interest of the consumer. Recognizing this is the first step towards organizational recovery. This is the big step: the truth is that after wholesale adoption of segregated services for over half a century, little has changed in the lives of the customer. People served still live in poverty, have few choices and little personal power, and are secluded from the daily life of their communities. Does this mean that people who operate segregated services are bad? Of course not. They are hard-working, caring individuals. However, archaic, patriarchal, and inflexible federal funding regulations, outdated training initiatives, and unclear system and consumer objectives conspire to maintain an overly complex, wasteful structure.
There is a great deal that local agencies can do to utilize their funds effectively, however. Leaders and managers will do well to refocus on outcomes and to recognize the least successful efforts of the community rehabilitation system. An investigation in each agency is warranted that appreciates the following truths about waste.
Recognizing waste is the first step. Transforming to an adaptive, customer-friendly orientation is the next significant milestone. This process can be exceedingly complex in application but can be explained through a few discreet actions: 1) Work with customers and determine, over time and through education and exposure, what the valued outcomes (products and services) are. 2) Identify the Non-Value Added but Required (NVA-R) costs that are absolutely essential to producing the desired outcome: rent, accounting services, various reports to funders and publics, and meetings. 3) Compare the difference between what will be paid for the outcome and the cost of providing the services to determine the lost profit. Organizations that can cut costs and streamline operations, while increasing revenues through quality customer service, will flourish (McNair, 1994; Deming, 1986; Stacey, 1992). Those that maintain non value-adding activities (such as sheltered work, IQ testing, etc.) will eventually become less competitive and slowly sink from the market (Griffin, 1996). The flow chart above illustrates that when waste (unnecessary process) is present, the market value created is less than the value of the resources available. Over time, unchecked waste leads to organizational decay, irrelevance, and death.
| Why Recognizing Waste is Difficult |
|---|
| Little Consequence or Reward for Consumer Directed Outcomes The Most Waste is Found in Older, More Established Agencies where change in Business Practice is more Difficult Waste is What we Do Wrong and Few of us Embrace our Mistakes Accounting Systems measure Costs not Waste Most of Our Data is Historical, Not Future Oriented: No Motivation to Understand or Adapt to Future Trends Budget Creep Caused by Unchallenged, Unexamined Annual Increases Value-Creating Potential is Difficult to Measure Values-Alignment Challenges our Core Beliefs and Processes. This leads to Organizational Anxiety and is Often Avoided in Order to Maintain Harmony and the Facade of Quality Leadership/Management |
As long as waste is embedded in organizational process, positive outcomes at reasonable prices are difficult to achieve. This is why so many community programs struggle to provide supported employment and other integrated options but do not succeed to the desired level. They fail to recognize that offering inconsequential services such as long-term day activities or sheltered work can no longer be considered adequate outcomes. In order to afford quality for everyone served, it is critical that we eliminate segregated services, which are our biggest source of waste. Segregated outcomes are meaningless in a society based on personal accomplishment, property ownership, and community participation. In business, one does not continue to manufacture products simply because the factory has the machines and personnel to do so. Products are produced that people want to buy. Substantial evidence of the demand for inclusionary outcomes exists to justify the downsizing of sheltered employment (Gardner & Nudler, 1999; Murphy & Rogan, 1995; McGaughey, et al., 1994; Hayden & Abery, 1994; Callahan, 1996). Just as the automobile industry in this country during the late 1970s had to radically change its definition of quality and customer service or face further humiliation in the market, so, too, must rehabilitation change by eliminating wasteful programs and processes.
Structural waste is a common problem area in organizations. Typically, the older an organization the more these processes have become embedded in the corporate culture and the daily routine of workers. Routine or habitual work can be quite difficult to change. Often, for example, accounting processes are set up to comply with specific funding streams and program offerings. If values alignment has not taken place in coordination with the change in process, changing this to meet the requirements of powerful consumers will prove difficult. For instance, if an organization has a long history of managing all consumers' money, a shift to vouchers or personal bank accounts may prove troubling to accounting department personnel who have learned to focus on protection and on minimizing risk because of the belief that many people with disabilities are incapable of money management. The good intentions of those who wish to provide protection may sabotage a move to more consumer control without a concentrated re-education on the values of inclusion, customer service, and empowerment.
But, structural issues remain even after a values alignment. Key indicators of problems to come include the existence of excessive departments and specialization; obvious program boundaries and "Us and Them" thinking; inadequate capability and opportunity for personnel to interact internally and externally; and excessive complexity within the system that makes it hard for staff and consumers to understand and foster outcomes. Add to the structural issues the deleterious effects of process waste, and patterns of decay and habit become evident.
In many organizations, process waste is the most difficult to recognize and change because processes are often imposed from outside by funders or certifying/accrediting bodies, or they are held dear and sacred by the person who designed and/or performs these process functions. Other process disconnects are easier to recognize. Variation in process, for instance, from one staff person to another, or from department to department, is common. In performing an individualized consumer assessment, as an example, the residential department may use a Social Skills checklist in a group home setting, whereas the vocational evaluator may perform a work try-out in industry to capture social interaction data. Chances are the two processes will reveal very different data, resulting in different habilitation program recommendations. Regardless, the discussion and decision over which is more accurate produces more waste. Values alignment regarding the use of typical, non-segregated settings would solve this problem and reduce testing expenses and departmental bickering.
Other wasteful components include the use of internal measures of quality instead of external measures. Typically, internal measures include accreditation audits, exhaustive case notes, and program plans (IPPs, ISPs, ITPs, IHPs) that relate to process outcomes having little to do with consumer employment or emancipation. Many individualized program plans still focus on readiness and compliance issues and are used as a barrier to moving into the community. External measures would more accurately reflect what consumers want, how well supports are provided in community settings of choice, and how well the organizational image portrays staff and consumers in the attempt at inclusion.
Finally, there exists a key process function that is ubiquitously hated but that is seldom analyzed and improved. This is the function of meeting: team, council, board, staff, parent, consumer meetings ad nauseam. While many easily adopted improvement strategies for meetings exist (Scholtes, 1988; Griffin, 1999b), few appear to be implemented. The habit of doing things the company way, the belief that nothing will change, and the unpleasant realization that for many staff the essential job function is to attend meetings, points to one easily remedied waste center, if only leaders are motivated to act upon the waste of money and human potential so obvious to the observer.
One strategy in approaching the structural and process changes that hold an organization together is what one might call the technique of the obvious. That is, when examining an agency for structural or process waste, ask why five times:
"Why do we use this form?"
"It's used to collect personal data."
"Why do we fill it out each time we have a meeting?"
"In case something has changed."
"Why don't we just send a note to case management instead
of completing the whole form?"
"Probably because they need a consistent looking file."
"Why would they need a consistent looking file? Aren't they
using a word processor template anyway?"
"I don't know."
"Why don't we try just sending over a note."
This process works for all types of habitual and established processes and is exceptionally telling in the initial analysis of challenging behaviors. When this technique was used regarding Winston's aggression towards his co-worker we found that: 1)Winston hit his co-worker because he was being teased; 2) he was being teased because his co-worker thought it odd that an adult would go to Disneyland with two human service workers instead of a girlfriend or family; 3) Winston was upset because upon his return from Disneyland he found that the residential staff had moved him to a new apartment without his consent or knowledge; 4) Winston had not slept all night before work due to his anger about being moved. Winston was not treated as an equal human being in the service delivery process and his savings were mismanaged, resulting in the loss of his job and dignity. Great waste of effort, time, and human capacity was the result. Had the leadership of the organization been truly invested in customer service, they would have capitalized on serving someone as hard working and independent as Winston. Instead, they created new behaviors that justify more waste through the implementation of restrictive behavior programs, produced further reliance on public funding for Winston (who could have been self-supporting) and increased destructive and partnership-inhibiting friction between the vocational and residential agencies. This residential provide's primary funder learned of this and other such incidents and is reducing this provider's funding while inviting consumers to utilize more progressive and responsive providers.
Winston's story is about waste. There are four critical areas of concern once the process and structural waste issues have been recognized and the rebuilding stage is anticipated. The questions that need to be asked relate to: Service Functionality, Service Flexibility, Development Capabilities, and Process Quality Standardization.
Service Functionality: Does the service meet customer expectations in terms of price, convenience, quality, delivery, simplicity, options, features, and consistency? Customers include people with disabilities, as well as employers, Board members, funders, and other publics.
Service Flexibility: Can the service be adapted to meet new needs; utilize the latest technologies; be customized with little cost; offer variety and uniqueness? Organizations need to anticipate the future without investing in capital assets that are non-liquid or that do not provide a direct benefit to the customer.
Development Capabilities: Does the service effectively use current resources and current processes that can be modified to deliver new services: Are suppliers available for referrals? What is the delivery cycle time? Organizations need to position themselves for change and adaptability through functional design based upon customer need while remembering that any function performed that does not directly satisfy the customer is waste that eats away at reinvestment capital.
Process Quality Standardization: Does the service use proven processes already utilized by this or other successful organizations? Does it use expertise from within and without? If unique skills and processes are needed, are they easily obtainable and easily implemented? Leaders need to hire for skill, knowledge, and action and raise the level of organizational commitment through task accomplishment and values coherence. Learning organizations will prosper in the twenty-first century (McNair, 1994; Senge, et al., 1994; Floyd & Wooldridge, 1996; Griffin, 1996).
Conclusion
The road to high performance customer service appears to be littered with lost opportunities and management challenges as diverse as the communities served. However, a number of organizations are creating a new customer service orientation and are using the resiliency and accomplishments of people such as Winston and Leanne as their benchmarks. Those organizations that are succeeding are focused on:
- improving personnel core competencies;
- adopting modern information technology to streamline communication;
- examining employee turnover and hiring for the long haul;
- using best practice and staff training to reduce process variation in such critical undertakings as job match and functional analysis of behavior;
- reducing office complexity through computer technology and rooting out duplication and redundancy of operations;
- asking customers what they need and taking them seriously;
- recognizing that lack of success leads to a high degree of staff frustration and stress;
- seeing that turnover and poor performance result in extensive lost opportunities throughout their communities;
- knowing that at the heart of any substantive organizational change, values alignment is more critical than funding.