Redesigning the state rehabilitation program in New York State.

Over the past several years, state vocational rehabilitation (VR) programs throughout the country have been involved in fundamental redesign of the management and delivery of VR services. Recently, the Council of State Administrators of Vocational Rehabilitation (CSAVR) and the Rehabilitation Services Administration (RSA) received the prestigious Hammer Award, given by Vice-President Gore in recognition of their leading the way in the reinvention of government programs. The Vice-President stated that CSAVR "can be proud of your role in the largest reform initiative the United States has seen in this century."

While the following pages detail redesign efforts in New York State, the most important aspect of these efforts, wherever they are undertaken, is the people who benefit from these improvements. Administrative efficiencies, streamlined procedures and "user friendly" approaches mean nothing if they do not provide a better service that leads to a better result for people. People with disabilities, and employers, are the customers of state rehabilitation programs. Any redesign effort must improve our ability to meet their needs. It's that simple. It's that direct.

The Vision

There is an old saying: you won't get to where you want to go if you don't know where it is. That is a gem of wisdom for all of us to keep in mind as we reengineer our services, whatever they may be. It may sound trite, but it is essential to have a clear vision for your improvement efforts. In New York, we have embraced the vision so eloquently stated in the Rehabilitation Act of 1992

People with disabilities will. . .

"(A) live independently;

(B) enjoy self-determination;

(C) make choices;

(D) pursue meaningful careers; and

(E) enjoy full inclusion and integration in the economic, political, social, cultural and educational mainstream of American society. . ."

We have organized within the New York State Education Department so that all services for people with disabilities, from preschool, through school age, to vocational rehabilitation and independent living services, are administered under the same umbrella, to create a lifelong approach to reach this vision.

Redesigning vocational rehabilitation services will only reach its true potential to the extent that we are successful in the redesign of the rest of the lifelong continuum. However, it is a truly important component and has the potential to be an important catalyst in many more people's lives.

The Context for Redesign in New York

In the late 1980's, New York State's VR program, then called the Office of Vocational Rehabilitation, was mired in controversy and viewed widely as having become a cumbersome bureaucracy that had lost its sense of focus and responsiveness to the people it served. In 1990, the State Education Department began a stem to stern redesign of the system, including an overall reorganization of the management of all services to people with disabilities in the department and a renaming of the program to the Office of Vocational and Educational Services for Individuals with Disabilities (VESID). Though lengthy, the new name is more aligned to a new philosophy of service. That year, a serious and long-term redesign of the state VR system began.

The Use of Quality Management Strategies

If there is any government service that can benefit from the use of quality management tools and improved business practices, it is the vocational rehabilitation system. The tools to identify process improvements, redesign systems and procedures, and install continuous improvement measures should become an integral part of the everyday "business" of administering and delivering VR services. No systematic redesign should be undertaken, nor will it result in true systemic change, unless it is supported by a solid strategic management plan and redesign tools.

With the help of IBM and the Xerox Corporation, the VESID management team was able to receive substantial training on the use of quality tools and to set up a Quality Support Team structure to assist regional offices in institutionalizing continuous improvement practices. Without this initial attention to training and long-term support, our redesign efforts would not have been as successful.

Phases of Redesign

The redesign of the state agency's VR system was conducted in three phrases. The first phase focused on improving access to the program, one of the most problematic aspects of the system according to consumers and referring agencies. The intent was to refocus the consumer/counselor relationship and to build much stronger collaboration with other agencies. The goals were simple:

* Provide services to individuals as quickly as possible.

* Simplify the steps in the process of entering the vocational rehabilitation system.

* Provide the highest quality services possible.

Did it work? Chart A shows the dramatic increase in referrals, applicants, and people determined eligible for services.

[Chart A ILLUSTRATION OMITTED]

Applications were made simpler. The consumer became a primary source of information about his or her own needs and goals. Unnecessary evaluations, which had become a part of the "culture" of the system, were eliminated.

Phase II of the redesign effort focused on improving the quality of the delivery of services to consumers. No traditions were sacred. An internal task force was established which identified aspects of the service delivery process that impeded or delayed individuals from having successful outcomes. An external advisory council worked with the internal task force to identify priorities for Phase II. They were:

* Increase integrated employment opportunities.

* Institute performance based contracting focusing on outcomes.

* Consolidate contracts.

* Improve educational linkages.

* Increase access to higher education.

* Initiate regional service planning.

Each priority was managed by a team, consisting of staff from the central and regional offices, other relevant state agencies, and consumers of service. In addition, 366 external stakeholders were involved in drafting the teams' recommendations. Three thousand copies of the draft recommendations for reform were distributed to consumers; local agencies; professional organizations; educational institutions; business, industry, and labor groups; and advocacy organizations. More than 500 people returned comments on the recommendations for change. There is no question that stakeholders were involved in this phase of redesign from the outset. The recommendations that were adopted affected virtually the entire service delivery system.

Phase III of the redesign effort addressed the entire array of VESID's internal processes. New redesign teams (comprised primarily of counselors, with representation of clerical staff) were formed, with particular emphasis on applying quality tools to improve our internal processes. The teams used the information gathered over the first 3 years of reform efforts and interacted with stakeholders to establish a plan with two goals and a set of critical success factors for each.

Goal #1 is: Develop a service delivery system that is consumer responsive and enables us to provide quality services leading to productive and meaningful employment for all eligible consumers within our human and fiscal resources.

The critical success factors for this goal are:

* At a minimum, 20,000 consumers each year in jobs in the most appropriate and integrated settings possible.

* One hundred percent consumer satisfaction rate with VESID services, processes, outcomes, and interactions with VESID staff.

* Recaptured human and fiscal resources redirected to help greater numbers of consumers obtain productive work.

* Skills and abilities of staff maximized to better achieve outcomes consistent with the needs of consumers.

* Human and fiscal resources directed to achieving integrated employment outcomes.

* Cost-effective use of space, technology, and administrative services to support service delivery.

* Consumer access to appropriate job opportunities at any stage in the service delivery process.

* A focus on securing appropriate employment outcomes as quickly as possible for all people with disabilities, including those with the most severe disabilities.

* Individualized services to meet consumer needs; consumers will not be required to accept a "package" of services.

* Convenient access to vocational rehabilitation services.

Goal #2 calls for the development of a service delivery system involving the public and private sectors that is employer responsive and maximizes cooperation in planning, implementation, and resource allocation.

The critical success factors for Goal #2 are:

* A regional network configuration that enhances employment outcomes, reduces duplication, and enhances interagency and intra-agency cooperation, resource sharing and support consistent with the needs of the region.

* The regional network, comprising public and private sector representatives, will increase the number of jobs developed annually.

* The system will respond to an employer's request for assistance in filling a position within 2 working days. Previously our best efforts resulted in a 2-week response time.

* One hundred percent employer satisfaction rate with VESID and regional job development, placement, and support services. Today, in an office that has completed most of its redesign, employer satisfaction is above 90 percent.

* The regional network will maximize a cost-effective use of space, technology, and administrative services to support the delivery of services to consumers.

The plan for redesign of VESID's service delivery system represented significant differences in the structure and function of the VESID system and the way people with disabilities and employers experience it.

The Results of Redesign

The key to any redesign effort is to establish key performance indicators and to track data on these measures. Collecting timely data on employment outcomes, timeliness and cost effectiveness of service, staff productivity, and consumer satisfaction will tell you if your process improvements are making a difference and when and where to make adjustments.

Chart B depicts a new schema for the delivery of vocational rehabilitation services developed by the redesign teams. It shows:

[Chart B ILLUSTRATION OMITTED]

* an easier application process;

* closer connections to schools;

* group orientations that are more efficient and effective than past practices;

* a team approach to serving the consumer that is more efficient for both the consumer and staff;

* more options for the consumer to move to employment as quickly as possible;

* a highly focused outcome on employment; and

* greater dialogue with and attention to the needs of employers.

Chart C describes how the reform effort directly affected results. When we set the goal of 20,000 placements annually nearly everyone said that it was too high, and that it was unattainable. We are now close to two-thirds of the way toward our goal; and we will get there.

[Chart C ILLUSTRATION OMITTED]

Chart D shows how redesign has led to an alignment of resources and results with the goal of increasing integrated employment options and placements.

[Chart D ILLUSTRATION OMITTED]

Employment Outcomes

The following are other highlights of data which measure the change the redesign effort has effected:

* Total placements have increased 77.6 percent since 1991. In this same period, competitive placements have increased 91.8 percent and supported employment placements have increased 324.5 percent, while sheltered employment placements have decreased 22.4 percent. During this same period, the percentage of people with severe disabilities placed has increased.

* The total first year earnings of the 16,041 people with disabilities who were successfully placed in state fiscal year (SFY) 1996 was $171 million. Using the approximately 9,000 per year as a base, more than $75 million of this total can be attributed to reform efforts in SFY 1996. The cumulative increase in first year earnings during the reform effort has now reached $128 million. Similarly, of the $19 million in public assistance that was saved as a result of the 16,041 job placements, more than $14 million of these savings can be attributed to reform efforts during SFY 1996. The cumulative impact saved through reform efforts is $83 million.

* Increasing numbers of people applying for services were found to be eligible. In federal fiscal year (FFY) 1990, only 56 percent of all applicants were found to be eligible for VESID services, while 69.8 percent of all applicants were found to be eligible for services in FFY 1996.

* In FFY 1996, an average of 4,108 individuals were referred to VESID each month, a 34 percent increase in monthly referrals since FFY 1990.

* The number of people applying for services has grown by 53 percent, from 2,610 per month in FFY 1990 to 3,994 per month in FFY 1996.

* In FFY 1995-96, eligibility determinations averaged 91 days, compared to 6-18 months in 1989-90, despite the fact that the total active caseload had increased 88 percent and the number of vocational rehabilitation counselors had decreased by more than 10 percent due to a state hiring freeze.

* The transition between schools and vocational rehabilitation has become more streamlined for students. A case review conducted in late June 1995 showed that maximum use was made of school records to determine eligibility in 97 percent of the cases.

Customer Satisfaction

For the last 2 years, VESID has annually surveyed approximately 15 percent of its consumers, active and closed cases. Even with a more than 80 percent increase in active caseload and more than 10 percent reduction in counseling staff, customer satisfaction overall remains at 87 percent. Consumer satisfaction approaches 95 percent in the two offices where the team approach to vocational rehabilitation counseling has been implemented. Also, local surveys are conducted which ask both consumers and employers how VESID is delivering on the requirements that are important to that customer. For example: Was the information helpful? Were you treated well? Was the building accessible? Would additional office hours be helpful to you?

This consumer input is a major force in directing redesign efforts. It is a simple, but easily forgotten principle that organizations, especially public agencies, need to continually remind themselves whom they serve. When we ensure that our customers are satisfied we reaffirm our commitment to their trust.

Cost Effectiveness

* Interagency collaboration with the Office of Mental Retardation and Developmental Disabilities (OMRDD), Office of Mental Health (OMH), and the Commission for the Blind and Visually Handicapped (CBVH) has resulted in approximately $46,240,000 being made available from these state agencies for supported employment in SFY 1995-96, compared to $14,460,000 in SFY 1990-91. In addition, VESID funding for supported employment has increased from $9,145,000 to $21,246,000 during this same period.

* As of the current state fiscal year, $13.42 million from evaluation services that traditionally were dedicated to sheltered employment placement programs has been redirected to programs that lead to placement of individuals into integrated settings.

* The average cost per consumer for vocational rehabilitation services over the past 4 years has dropped from $1,320 per consumer in FFY 1994 to $1,054 in FFY 1996. The decrease has resulted from an effort to approve more cost-effective performance based programs for consumers and the implementation of an internal budgeting system in VESID that focuses on accountability.

* Eliminating the need for repetitive evaluations of consumers allowed $721,908 to be redirected to other services.

Chart E provides specific data which indicate that reliance on existing documentation reduced the need to request new and sometimes duplicative general and specialized medical exams for purposes of determining eligibility.

[Chart E ILLUSTRATION OMITTED]

What was Learned from the Redesign Efforts?

Having undergone 6 years of redesign and continuous improvement, what was learned that might be of value to others?

1. It never ends. Know from the start that you'll never get to the ideal state. Try hard to get to the point where continuous improvement tools and strategies become an organizational way of doing business.

2. You need a vision that you collectively believe is right. You will need that as a lens to continuously check to see if redesign efforts are delivering the intended results.

3. You must invest in staff development. The people on the front lines need the most support; they can most quickly apply the benefits of their training. However, managers must be trained first, or they will be able to offer little long-term support to staff.

4. Your customers are your reason for being. You must meet their needs. Consumers and employers are the primary customers. You need to focus your efforts on satisfying their requirements for specific outcomes and services and you must attend to their need to have them delivered in a manner which is timely, reliable, and courteous. While staff are important internal customers to many of the work processes, they are not the primary customer. If you adopt this viewpoint, what a difference it will make in your decisionmaking.

5. Invest in technology. Staff must have the tools to work smart and be more efficient. Don't expect that demanding it will make it happen. Supporting greater effectiveness is as important as expecting it.

6. Involve your stakeholders from the start. Redesign efforts will always require changes in policy and procedures. What seems like a good idea internally may have unintended consequences externally. You need to have stakeholders help improve upon initial thinking and to alert you to improvements that could be made that you would never have considered on your own.

7. Set high expectations for performance. Don't be surprised if the initial reaction is negative. High expectations can be threatening to people and organizations, but low expectations are harmful to people and organizations. Redesign must be a vehicle to improve results, not just make work easier.

8. Collect data on key indicators and publish it widely. Don't be afraid to publish the bad as well as the good. The purpose of collecting data is not to make you look good, but to discover where your opportunities to improve are and to get the baseline for that next improvement.

9. Use key data to drive day-to-day operations. Important information on key indicators can help frontline staff to truly understand how they are doing and where they need to improve. Identify data with which to track the critical milestones in the vocational rehabilitation process--e.g., time from application to eligibility, time to develop an individual plan, and time from completion of training to placement in work. Make this data readily available in a clear and understandable format so counselors and supervisors can use it on a regular basis to monitor their own work.

10. Invest your resources in performance, not in the amount of service being provided. There is not enough money allocated to vocational rehabilitation and there never will be. Target your resources on results.

11. Benchmark the processes you are trying to improve. Many best practices can be found within your own organization. It is easy to overlook this in favor of "outside experts." When staff are undertaking projects to improve the way they work, expect them to check with others within the organization on the ways in which they are doing business. Not only do you share the best work of staff, saving others from reinventing the wheel, it is a good way to recognize and reward those who have already accomplished improvements. Also, there is no logic in government benchmarking only within government. Get fresh ideas from the best in whatever aspect of your business you are redesigning.

12. As you collect data and track trends, don't be uncomfortable marketing your successes. If you want support for your program and your redesign efforts are benefitting your customers in clear, measurable ways, let others know. Vocational rehabilitation is an investment in people. It's the best kind of investment there is. If you truly improve your program by improving its benefit to people, you have a wonderful story to tell.

Conclusion

Any service system that is still using age-old traditions as core processes is a system that is antiquated and experiencing diminishing effectiveness. People in New York State demanded that the vocational rehabilitation system be redesigned and streamlined. This has resulted in an ongoing effort to improve the state VR program. This redesign has proven to be very timely with the recent federal legislation on welfare reform. The rehabilitation system will need to respond to increased demands to serve more people within compressed timelines.

Significant improvement has been made in the program, but many problems still exist. Since the redesign effort must be based on the needs of customers, which change over time, it must be a continuous pursuit of a better way to do business.

Mr. Gloeckler is Deputy Commissioner, New York State Education Department, Office of Vocational and Educational Services for People with Disabilities.