An agenda for excellence: the search for exemplary vocational rehabilitation services.

It has been three years since the J.M. Foundation conducted the first nationwide Search for Excellence. The experience has been gratifying in many ways. All across the country we found excellent programs and talented staff that consistently achieve outstanding benefits for persons with disabilities. Yet we also found ineffective programs that help only a handful of participants.

We have learned a great deal about excellence in the past three years. Utilizing technology development for the Search, we can now measure the range of benefits achieved by those served and, more importantly, define the outcomes that one should expect to receive from various programs. Our experience has resulted in an exciting concept called the "Agenda for Excellence" that we believe can revitalize rehabilitation facilities. The "Agenda" offers a challenging opportunity to achieve significant increases in benefits and program productivity.

Seven years ago when we initially began planning the Search, we found "excellence" to be a loosely defined term. Most awards were given to individuals instead of programs and recognition was based on vague impressions rather than measured performance. With the support of our National Advisory Committee, the Search judges, and other leaders in the field, we decided to define excellence in terms of benefits actually obtained by people with disabilities. We also began using productivity measures to assess how efficiently programs used their resources.

We found an enthusiastic audience for the Search for Excellence. During the first three years we received over 700 applications from a wide variety of organizations that provide vocational rehabilitation services. The need for excellence was endorsed by distinguished public figures including then Vice President George Bush, Senator Bob Dole, and former Secretary of Education William Bennett, all of whom participated in gala celebrations to recognize the most outstanding programs. Many leaders from the field of rehabilitation and other related areas also demonstrated their commitment to excellence by participating in the national award ceremonies honoring Search winners and finalists.

The applications we received from facilities resulted in a very large national database on performance. We can now describe how well over 700 vocational rehabilitation programs served over 39,000 persons with disabilities. For the first time, it is possible to define reasonable standards of excellence, such as the proportion of persons served who should obtain competitive employment following skill training and what is a reasonable wage level for participants in supported employment. Our research using this data has helped us to identify factors that affect outcomes-the most important influence being the difficulty level of those served. To the surprise of many, we found that some factors such as local unemployment rates and the amount of funds spent to provide services do not appreciably affect outcomes.

Every year the Search for Excellence was conducted, we found programs that dramatically out-performed others. Some results were upsetting to anyone who cares about empowering people to lead productive, self-sufficient lives. One southern facility, for example, placed 42% of those in its work adjustment program into competitive employment, while only a few miles away a similar program serving people with similar disabilities succeeded in placing only 17%. One state had programs that, on average, provided annual earnings in supported employment of just under $5,000, while in a neighboring state, participants in several programs earned less than half that amount.

While we anticipated that the top facilities would do well on various measures of excellence, we were not prepared when the data showed that the highest ranked one-fourth of employability development programs helped 50% of persons served get back to work while the lowest one-fourth succeeded with only 16%. Similarly, we were concerned about the substantial gap between the top and lowest ranked facilities when our data on supported employment showed that the top ranked programs had client earnings and benefits of $8,100 a year while bottom ranked programs provided less than $2,200 to each person.

Significantly, we found that facilities which helped participants to achieve exemplary benefits also tended to be low in cost. Programs with "enriched services," higher ratios of staff to participants, and higher costs do not necessarily achieve more benefits for clients than less expensive programs. On the other hand, we were pleased to learn that excellence is not limited to large, experienced, urban-based programs. In fact, new and emerging programs in small communities often out-performed their larger and more well-known colleagues.

Our first conclusion is clear. Exemplary programs are far better than the average, while others provide very few benefits to the people they serve. In personal terms, this means that a person with a disability is more likely to get a-job from some programs simply because they are fortunate enough to be served by an organization that consistently achieves good results. The gap between the results achieved by the top programs and those at the bottom is very large. In fact, depending on the measure used, the better facilities provide from three to eight times more benefits, and often do so at significantly less cost.

We have also found that these large discrepancies in outcomes cannot be fully explained by factors such as serving more "difficult" or severely disabled people, location in a small community, or a higher than average unemployment rate. Thus, a thorough review of Search data, as well as published research, demonstrates that some programs are far better than others, results do not necessarily get better over time, and that poor results cannot be accounted for by factors "beyond the control" of service providers whose programs are not doing well.

Excellence in vocational programs is not necessarily achieved by adopting technology-based solutions. Programmatic success, for example, is not assured if a facility uses computers, installs work samples that cleverly identify job skills, or adopts counseling techniques based on the latest rehabilitation theories. Instead, exemplary performance seems to be related to an unyielding commitment to excellence on the part of at least one of the following: founders who purchase services and make it clear they expect results; facility boards who expect to be told what happens to persons a program serves; managers who provide feedback to staff when results are less than expected and allow staff freedom to decide how results should be improved; or front-line staff who hold themselves personally accountable for achieving program goals. Furthermore, this commitment, regardless of its source, empowers staff with a strong drive and the resourcefulness to achieve benefits for people with disabilities. Simply stated, when excellence is found in programs, direct service staff are always highly motivated to achieve outcomes and they usually have been monitored, encouraged, and supported by others who expect good results.

If excellence is to be achieved, it required a serious, long-term commitment. The pursuit of excellence requires that providers adopt standards, assess achievement on a regular basis and use this knowledge to improve their programs. Our 1986 Search demonstrated that nearly 90% of the applicants did not have systems in place which could describe the level of benefits achieved and maintained by those served after they left the program. Still fewer organizations could accurately describe how efficiently they managed time, staff, and financial resources in operating a program. Administrators cannot improve program services without having sufficient objective data to help evaluate the efficiency and effectiveness of new approaches.

Vocational rehabilitation organizations have many fine programs, but they can do better, much better. The relative scarcity of excellent performance has not been due to a lack of will. A great deal of effort and millions of dollars on research and training have been spent to improve vocational programs. Those investments have resulted in hundreds of well-written publications, workshops, and skillfully provided consultations. Yet, in spite of these efforts, too many people with disabilities are ill-served in vocational programs.

It is time to replace approaches that have not worked with one that will. This new strategy must become an integral part of the facility as long as it continues to serve people with disabilities. Further, the approach must be self-correcting and enable the organization to constantly achieve excellence regardless of changes in funding preferences or the types of persons who are served. Finally, the approach should not be prescriptive and assume that there is one "best" solution for every program or organization.

There is considerable evidence that one approach works, and works very well. It is one that does not necessarily require new staff, additional funds, or complicated research. Instead, it taps the creativity that already exists in every facility and establishes partnerships with resources where help is needed. This concept is called the Agenda for Excellence.

The Agenda is based on the time-tested strategy of cybernetics that has helped complex organizations succeed for many years. The cybernetics process begins with a commitment by decision-makers to achieve clearly defined goals, obtain feedback on how well the goals are realized, and make programmatic changes until goals are achieved. It has three major components, all of which are vitally important: an overall plan, a system to assess the level of excellence achieved, and a management strategy that helps administrators and others make changes in programs to achieve excellence.

Vocational rehabilitation facilities have a rich tradition of concern for people and a well-deserved reputation for providing quality services. In spite of these accomplishments, vocational professionals must use their considerable talents to increase excellence- and in doing so, establish high standards of performance for all programs that serve disabled people. On behalf of everyone who has made The J.M. Foundation Search for Excellence such a success, we urge you to adopt an Agenda for Excellence and to accept nothing less than the best for yourself and those you serve.

During his 1988 presidential campaign, George Bush stated, "I'm going to do whatever it takes to make sure the disabled are included in the mainstream. For too long they've been left out, but they're not going to be left out any more." President Bush also praised the national network of voluntary agencies and characterized them as a "thousand points of light." In his inaugural address, the President stated his intentions to seek out those that are the "brighter points of light." Through their association with the Search for Excellence, the President and other leaders across America have demonstrated their commitment to excellence. Organizations providing vocational programs to persons with disabilities now have the potential, and more importantly the obligation, to achieve excellence and join those "brighter points of light."