Streamlining: moving beyond the quick fix - improving vocational rehabilitation services for the disabled - Streamlining Service Delivery

American Rehabilitation,  Summer, 1997  by James E. Stephens

• E-mail
• Print
• Link

Streamlining is but one response of private and public sector organizations to what has been called the challenge of the three C's: customers, competition, and change (Hammer & Champy, 1993). Beginning in the early 1980's, American society has seen a shift in the fundamental relationship between sellers and buyers in the private sector and service providers and consumers in the public sector, with this shift having a profound effect in most of the western democracies.

Consumers of goods and services, including public services, now tell suppliers what they want, when they want it, and what they are willing to pay. In the public program of rehabilitation, laws have been passed which affect all phases of the traditional rehabilitation service delivery process, including some aspects of consumer choice, timeliness, and service quality. Consumers of public rehabilitation services have demanded and been granted unprecedented levels of participation and control in making decisions which ultimately affect expected outcomes.

Competition between and among producers and suppliers in the private sector has been the hallmark of the American free enterprise system. However, public sector goods and services have traditionally been seen as immune from the vagaries of private sector market forces. This difference may no longer be as apparent in the late 20th century. Competition among providers and suppliers in the rehabilitation marketplace is fierce and will only intensify. As resources become more scarce, efforts to find comprehensive solutions to very complex problems will accelerate. Among those solutions will be attempts to privatize public services, downsize government, and find faster and better ways to produce needed services. Streamlining has been among a myriad of methods introduced in an attempt to improve efficiencies in the public sector.

Change is the third and most pervasive of the three C's. Little reminder is needed of the tremendous changes in society in general and public and private organizations in specific that have come about as a result of the vast technological and information revolution sweeping the world. Most members of American society have instant access to a wide variety of information which not only informs but creates a level of receptivity to market segmentation never before achieved. Accessing goods and services more quickly, when they are desired and where they are desired, is no longer a wish but an expectancy.

Against this complex backdrop of fundamental change, streamlining has emerged in the public program of vocational rehabilitation as one response to a complex set of circumstances.

Early Efforts

Efforts to incorporate streamlining techniques for change in state rehabilitation agencies is not new. In 1981, the Georgia Division of Rehabilitation Services and the Management Control Project (MCP) at the University of Georgia began a collaborative effort to significantly streamline the existing state agency rehabilitation process (Field, 1981). The rationale for developing the MCP effort, remarkably similar to that supporting the current effort, included:

* a belief that the system was somewhat dysfunctional due to the layering of controls,

* a history of more and more controls added to ensure that workers were complying with federal guidelines,

* a supervisory staff performing primarily monitoring activities rather than supporting the best efforts of service delivery staff, and

* a growing awareness that major constituents, including consumers, wanted to take a more active role in shaping the program.

It is notable that the Georgia rehabilitation agency, though having gone through many permutations of streamlining-like activities since 1981, is currently undergoing a major metamorphosis that includes significant changes in organizational structure, mission focus, service provider and management roles, and major markets. This attempted transformation can be seen as a part of a two decade long effort to improve services and outcomes and stay abreast of issues created in part by a dizzying rate of change in the rehabilitation community.

In 1984, the Alabama Division of Rehabilitation Services started a journey of organizational change which has continued unabated (Stephens, 1988). One of the first efforts conducted after the agency allowed total staff to participate in strategic planning was a thorough review and revision of both policy and service delivery processes. By today's standards, it would be considered streamlining at its best. An ongoing concern for the Alabama agency has been unlocking the secret to stimulating a continuous effort to examine existing processes and make necessary revisions, regardless of the current perception of the goodness of the process in question.

Since the early 1990's, the Texas Rehabilitation Commission (TRC), generally considered to be an outstanding state rehabilitation agency, has worked to streamline its processes and bring a streamlining philosophy to its operations, including the measurement of quality in the rehabilitation process (Schwab, DiNitto, Simmons, & Smith, 1996). The TRC effort has been described as reengineering, and consequently contains many of the elements considered essential to effective streamlining. Needless to say, the TRC effort is much broader and more comprehensive than efforts typically referred to as streamlining.