Organizational Competency: Investing in Front Line Staff

by Cary Griffin, Director of Training, The Rural Institute

Life at the Front

ONE OF THE MOST CRITICAL ISSUES facing Community Rehabilitation Programs (CRPs) is the recruitment, training, and retention of quality front line staff. The role of direct line staff in CRPs has evolved dramatically. Twenty years ago, when I was a front line staff person, I was expected to help folks get through the day safely and make certain the contract work in the workshop got done. That was pretty much the extent of my job description. In my own career I saw the evolution begin as I went from working in a group home, to starting a supported living program, to taking over as director of the adult vocational program. Within six months my duties and responsibilities had changed drastically. I have to admit that my salary also improved.

Today, a front line staff person has fewer opportunities for advancement because the systems are more bureaucratized, professionalized, and complicated. People stay at the same jobs, for the same pay, with little lateral or vertical career advancement. The pay at the front lines is relatively the same as it was twenty years ago—slightly better than minimum wage. Also, with the move to community integration, the demands of front line staff have increased. Now, direct support staff (Please don’t call them direct “care.” It is paternalistic and harmful to the image of people with disabilities!) work and make decisions often in full view of the community and businesses. We expect that they are directed by consumers, and we expect serious outcomes such as home ownership and employment. Certainly they are not solely responsible for these outcomes, but staff are major contributors to success.

This level of responsibility and stress, coupled with meager or outdated training, leads naturally to high turnover on the front line. Turnover rates vary from coast to coast, but 80% annual staff replacement for a CRP providing vocational and residential services is common. In fact, it is this high turnover rate that is often blamed for the unmanageable cycle of resignations and hirings. CRPs are continually forced to reinvest in recruitment and basic training rather than increasing salaries, providing better management support of staff, offering advanced training, and increasing support resources used to achieve community outcomes. The reasons CRPs universally give for not using Plans for Achieving Self Support (PASS—a significant source of consumer-directed revenue for achieving career goals), is that management is too busy putting out fires, and front line staff do not have time to learn how to use this Social Security Work Incentive. The same reasons apply for not effectively partnering with Vocational Rehabilitation, not using assistive technology, and for not creating business collaborations that lead to employer-initiated jobs.

Turnover saps the potential of CRPs, and, therefore, seriously undermines the potential of talented staff and consumers who rely on these agencies to support them in non-segregated environments. Couple this with Non-Value Added activities in the CRP daily routine, and outcomes become very difficult to achieve.

Non-Value Added activities do not directly relate to achieving essential consumer outcomes, such as home ownership and real jobs. The types of Non-Value Added activities are many and varied, and are found in most social service systems. They include such items as staff meetings that perpetuate inactivity, certifications of quality that do not have a direct and obvious influence on consumer community outcomes, standardized or norm-referenced testing and evaluation, readiness or pre-vocational training, various day activity classes performed in artificial environments, cost-response behavior approaches emphasizing behavior change instead of finding ecological validity. If CRPs focused on providing just what the consumer needed to be supported in community environments, many of these wasteful accouterments of rehabilitation would be eliminated. Functional approaches, such as on-the-job experience and situational assessment save significant resources, can generate funds from partners such as Vocational Rehabilitation, give front line staff and consumers real world experience and success, and build adaptive corporate cultures focused on outcomes achieved through systematically defined and implemented operations.

Breaking the Cycle

Eliminating or seriously reducing front line turnover and increasing consumer outcomes requires that organizations immediately quit doing things that do not work. Telling the truth about our efforts is job one. For more than fifty years, the promise of community rehabilitation has gone unfulfilled. The programs grow; the outcomes dwindle. Today, sheltered workshops serve more than one million people with developmental disabilities. Despite the promise that a system of day-programs would train and place many people in the community, only slightly more than 15% of consumers have successfully achieved community employment.

Another significant action is identifying those Non-Value Added activities. In one organization in the Mid-West, we systematically audited staff time expenditures. We discovered that this agency (with a $3.5 million annual budget) had 30 standing committees or meetings and that in one year, salary and benefits expended in attending these meetings topped $800,000! These were all meetings that had no direct connection to an individual consumer, but were procedural or reporting events that did not produce measurable results. Certainly meeting to share information and plans is critical, but not worth almost 25% of operating income. The agency had no significant outcomes, except that staff turnover remained constant at about 85% per year. The cost of turnover was approximately $100,000 when training time, paperwork, advertising, interviewing, and overtime pay for staff coverage were computed. This is an extreme example, but even in well-run organizations, $200,000 or more is typically wasted each year. That amount would provide significant wage increases and training for staff, and foster substantial community outcomes for consumers.

The intervention plan for this particular agency increased the use of communications technology (voice and e-mail) to broadcast and report information; eliminated most of the non-outcomes directed meetings; managed remaining meetings with quality improvement techniques, and created staff position profiles of front line staff to use in recruitment. This last action shifted thinking about front line staff from accepting turnover as inevitable to managing the situation and solving the problem for the long term.

Culture Change

Effecting a Culture Change that establishes front line staff as an organization’s most valuable investment (after consumers) is dramatic. Such a change requires an investment mind set. Exit interview data reveal that many front line staff leave for three primary reasons:

• Low pay

• Frustration with management’s lack of focus and support for outcomes

• Restricted autonomy or power in decision making

In the example above, the agency could potentially capture more than $500,000 if wasteful processes and meetings were eliminated. Reducing turnover to 30% would result in an additional savings of $70,000. That increases the agency’s fund liquidity by $570,000. Most organizations could change overnight if this money existed as cash, but for the first year or two of a change program, the money is largely theoretical until it has been saved. It cannot be saved without solving turnover and waste problems. Without an investment strategy the process is slow. By eliminating wasteful activities, which is inexpensive, the nest egg accumulates within a year or two. Then, it is important to create the recruitment profile for each department’s front line staff. This means identifying places where probable candidates might be found, the competencies they should have and those the agency will invest in developing, and designing a salary scale equivalent to similar positions in the private sector. The money exists in human services to do just this; it has been done. It has not been done without a leadership commitment to drastic operational change.

In Seattle, Jill Deatherage applied an investment approach to the sheltered workshop at United Cerebral Palsy. She needed more and better trained staff to help close the workshop and get people into real jobs. The Executive Director and Board advanced her program $60,000 to begin the process. She leveraged this investment with partners such as Vocational Rehabilitation who purchased services from UCPA. She and her team got everyone served into community employment; she returned the $60,000 along with a healthy profit; she was able to increase salaries across the board; and the employment department’s turnover rate was reduced to roughly 15%.

Core Competencies

One of the first steps in accomplishing such dramatic change is identifying the necessary front line Core Competencies. A competency is a set of skills and attributes that influences job performance and can be measured and improved through training and practice. Personalities do not appear to change through training, so new hires should exhibit potential for competency, and also have personalities that support organizational change and mesh well with the demands of quality customer service. Achieving this match of skills and personality takes much more work than simply hiring warm bodies; it is a long-term investment-based strategy in consumer-desired outcomes. A quality supported employment specialist might exhibit competency in the following areas:

Negotiation
Image/Marketing/Public Relations
Customer Service
Systematic Instruction
Self-Management
Communication
Problem-Solving

Turnover savings and partnerships with local universities and businesses make skill training possible. Further, good recruitment entices people away from other businesses that have already trained these staff in many related and complementary skills. The key here is that the CRP must compete on salary as well as working conditions, work autonomy, and clear outcome expectations. It is true that front line staff leave because of low wages as much as for other reasons. It is not the only reason, but it is essential that staff be able to feed and house themselves. Reinvesting the savings from organizational re-engineering can significantly enhance salaries and high quality training.

What’s Next?

Initiating a “Save the Front Line” program requires the following basic steps:

1. Analyze organizational outcomes data in relation to the baseline that all people with disabilities should live, work, and recreate in typical community settings.

2. Account for all staff time and effort over approximately a 2-month period. Compare the work that’s being done to the work that needs to be done. Recent research studies indicate that many rehabilitation personnel are not actively engaged in outcome related work most of the day.

3. Calculate unproductive personnel time in terms of salaries, benefits, and if possible, in terms of lost opportunities and billables.

4. Calculate the cost of personnel turnover throughout the agency in terms of overtime pay for coverage, lost billables, advertising, interviewing, orientation, and training time. If possible, calculate the stress turnover causes to consumers, staff, and managers. Consider also the lost opportunities, the impact of staffing emergencies, the inconsistency of customer service to community employers, et al.

5. Create a competency-driven staff recruitment profile that focuses on finding and retaining the best staff possible.

6. Develop an equitable salary scale that makes CRPs competitive with business.

7. Change the organization’s rhythm to one of continuous communication, refinement, invention, and quality. Avoid falling victim to the myth that rehabilitation is doomed to forever pay people less than they are worth, and that people with disabilities deserve less than the absolute best. Think future development and capacity building.