Reengineering the rehabilitation process.

Introduction

During Federal Fiscal Year 1994, over 20,000 persons with disabilities in the State of Texas were successfully rehabilitated using the 497 counselors of the Texas Rehabilitation Commission. Ninety-five percent (95%) of these were placed into the competitive labor market, with 76% of all served classified as being severely disabled. Client satisfaction surveys revealed that 90% of the persons receiving services were either satisfied or very satisfied with services provided. From these data, one could draw the conclusion that the federal/state Vocational Rehabilitation Program in Texas is healthy, alive, and well. But VR clients were complaining about delays in services, being placed in low-paying jobs, having their cases closed in employment status without meaningful services being provided, and bureaucratic nightmares while receiving services.

Counselors providing vocational rehabilitation services were also complaining about shortages of case service funds, excessive numbers of clients, too many forms to complete, too many approvals needed, a lack of trust by management, too many codes with which to deal, and too much paperwork. Vendors of VR agencies were also asking to become more involved with the agency so that they could better plan for their role in providing services.

In assessing the need to change, the Texas Rehabilitation Commission realized that the process in which a person with a disability was served was not greatly changed since the inception of the Texas General Vocational Rehabilitation Program in 1929. It was not uncommon for clients to wait up to 6 to 8 weeks to have an appointment with a vocational rehabilitation counselor. In Texas, only 10% of the eligible population with disabilities currently receive services. Consumers of services were, of course, not satisfied with these conditions. Accordingly, an executive decision was made in August 1993 to develop a new streamlined process for serving persons with disabilities and on January 1, 1994, Reengineering the Rehabilitation Process was launched within the Texas Rehabilitation Commission.

About the Organization

The Texas Rehabilitation Commission is one of over 200 agencies in Texas state government, ranking eleventh in size with an annual budget of $240 million and some 2,500 full-time employees. The Commission administers two major programs, the General Vocational Rehabilitation Program and the Disability Determination Services Program (DDS). The latter is 100% funded by the Social Security Administration. in Fiscal Year 1994, the Commission provided services to over 80,000 persons with disabilities in the Vocational Rehabilitation Program and to over 220,000 in the DDS Program. The Commission employs 497 vocational rehabilitation counselors who serve persons with disabilities in 147 offices across the state.

Appointment of Reengineering Task Force

The first step in the reengineering process was to appoint a task force for the initiative. Subscribing to the theory that persons performing the jobs are the most knowledgeable about the tasks to be performed, the Reengineering Task Force consisted of six vocational rehabilitation counselors, three rehabilitation services technicians (secretaries to VR counselors), and two area managers. Central Office staff representing Planning and Financial Services, Management Audit, Information Technology, and Program Development were also assigned. To ensure input from the consumer population, a client being served in the Vocational Rehabilitation Program was included on the task force and was paid a consultant's fee to attend each meeting. A project manager was included to develop time lines and to schedule the activities to be completed within an 18-month time frame.

Reengineering Model

In an effort to draw upon the experiences of others who had previously been involved in reengineering organizations, the Reengineering Task Force subscribed to the theories expressed by Hammer and Champy (1993).

Hammer and Champy (1993) define reengineering as "the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical, contemporary measures of performance, such as cost, quality, service, and speed." (page 32) Four key words are a part of the definition. (Hammer and Champy 1993)

Fundamental

Reengineers must deal with three (3) basic questions in rethinking their organizations: (1) Why do we do what we do? (2) Why are we doing it the way we are? and (3) What value does it bring to the customer?

Radical

Radical redesign means getting to the root of things, not making superficial changes or fiddling with what is already in place, but throwing away the old.

Dramatic

Reengineering isn't about making marginal or incremental improvements, but about achieving quantum leaps in performance. Dramatic improvement demands blowing up the old and replacing it with something new.

Processes

Most organizations are not "process-oriented"; they are focused on tasks, on jobs, on people, on structures, but not on processes. A business process is a collection of activities that takes one or more kinds of input and creates an output that is of value to the customer.

A more simplified definition of reengineering is: "Starting over from scratch." This definition assumes that the organization or process will be destroyed and a new design is now being formulated.

Information Gathering

In its project redesign, the Reengineering Task Force dedicated six months to information gathering activities to identify the problems associated with the present VR process. Views were sought from clients, vendors, and Texas Rehabilitation Commission (TRC) staff. The reengineering leader, who also functions as the chief operating officer for the VR commission, scheduled 25 meetings across the State of Texas involving consumers of services, vendors, and staff of the organization. These meetings lasted 2 to 3 hours in length and were facilitated by the reengineering leader. During the first hour of each meeting, the subject of reengineering was discussed. Then, the participants were asked two basic questions: (1) what bugs you about the rehabilitation process, and (2) what suggestions do you have for changing the process? These questions were addressed by all present, with participation by the VR clients, VR counselors, VR supervisors, VR secretaries, other VR support persons, and by vendors. Comments of the participants were recorded on a large flip chart and placed on the walls of the room for reference.

This information served as a starting point for each of the unit offices. Each unit supervisor of the 25 offices was asked to submit a formalized written report to the reengineering leader within one month from the meeting date. The report was to include information that identified problem areas (things that bug you) and suggested recommendations for change. Reports also included input from clients, consumers, as well as from staff of TRC.

The 25 unit meetings were revealing and even shocking to the reengineering leader, a 29-year veteran in the field of vocational rehabilitation. Throughout all 25 meetings, there were some common threads that were consistently heard.

Comments from VR Counselors

* Drowning in paperwork.

* Too much redundancy.

* Too much duplication.

* Too many forms.

* Too many type service codes.

* Too many client statuses.

* Too many approvals required.

* Lack of empowerment. Documentation adds no value to the customer.

* Too many policies resulting in over control.

* Lack of trust.

* Captured data serves no purpose.

* Not enough time to spend with clients.

* Agency policy is more restrictive than state law regarding purchasing.

* Options to purchase locally must be recognized.

* Too much emphasis on process rather than outcomes.

Comments from VR Clients

Most of the input from clients participating in the 25 supervisory unit meetings across the state related to delays in services. Some were required to wait several weeks before seeing a counselor, while others awaited delivery of training/employment equipment for several months. Some clients were unable to complete their college work because of delays in obtaining computers. Lack of client involvement in the purchasing process was identified by some. The bureaucracy of the program was problematic to several clients. Having to sign too many forms, often in duplication, concerned the clients. Not listening to their stated needs by counselors was a common thread. Lack of availability of the VR counselor was identified as a sore spot by others.

Some of the actual stories related in the 25 unit meetings by clients who were present include:

Client A - Self-Employment

This 55-year-old male revealed that he was very pleased with the Texas Rehabilitation Commission and with his VR counselor. However, the client was concerned in that he had waited over six (6) months for his self-employment equipment and was still without such. This delay had made it difficult for him to support himself and his family.

The client said that before becoming disabled he was a truck driver. Each year, as a truck driver, he spent $250-$300 out of his own pocket for city maps and directions that pertained to intra-city delivery. For example, the trucker could easily follow a State of Texas map in going down Interstate 10 from Houston to El Paso, but when he came to El Paso, it was a different story in finding the Wal-Mart store on Montana Place. The client elaborated that truckers all across the United States spent the same $250-$300 from their pockets, as did he, on an annual basis to obtain intra-city directions. It was the vocational objective for this client to be self-employed and to develop and produce intra-city directions to various businesses for truck drivers across the United States. The Texas Rehabilitation Commission counselor agreed to buy a computer and other equipment for the client to use in his home. The equipment had been ordered through the Commission's Central Office but was delayed for six months.

After the client spoke of the delays in receiving the computer/office equipment, his vocational rehabilitation counselor indicated to the reengineering leader facilitating the meeting that if Commission policy permitted the equipment to be purchased locally, it could be obtained immediately, at an equal or lesser cost than going through the Central Office, and service after the sale would be local, rather than being provided by a supplier several hundred miles away.

Client B - 20-year-old male

This young, college student with paraplegia was being sponsored by the Texas Rehabilitation Commission as a college student, being provided tuition/books/supplies/and fees. As with client A, this individual was concerned that his VR counselor could not purchase drafting pencils at a local store on a timely basis, having to make such purchase through a central purchasing warehouse in the capital city. It is interesting that this client asked the following question during the unit meeting, "Why isn't my VR counselor empowered to purchase locally?" "I need my drafting pencils now, not in two (2) weeks."

Client C - Middle-aged female

This person with quadriplegia was in need of a computer to assist with her college studies. She needed special devices to be affixed to the computer to properly use the equipment. The client stated in the open meeting that she knew what special adaptive devices she needed, but was required to go to a distant Texas city some 450 miles from her home to be "fitted" for the equipment. Later, she reflected, the client was also visited by a vendor from the distant city. After several months of delays, during which time she was in need of the computer, the equipment was finally delivered. But it was not properly adapted in order for her to use the computer. The VR counselor proceeded to go through the cumbersome purchasing process a second time, with the cost for both computers now totally in excess of $9,000. The client stated she would graduate from college before the second computer was received. The final statement from the client was "If you would have listened to me the first time, I would have received a usable computer at a fraction of the cost that is being expended by the VR counselor."

Client D - Middle-aged male

This individual was critical of the purchasing process and to the bureaucratic rules that required so many approvals and signatures. As a disabled person, he was forced to go back and forth, to and from, a supply vendor and the VR counselor's office. Detailed policy requirements brought about time consuming demands upon the client and counselor.

Comments from Vendors

In one of the 25 supervisory unit meetings facilitated by the reengineering leader, 30 vendors were present. One hundred twenty thousand vendors provide services for the Texas Rehabilitation Commission across the state. Most of the comments supplied by the vendors were related to a desire to be included in planning efforts of the Commission so that the vendors could better anticipate service needs and revenue available for the coming year. With this information, vendors could add/subtract staff and design their programs of service to better address the needs of Commission clients.

Streamlining of services and payment processes were topics of concern. Some vendors voiced a strong desire to be linked to the Texas Rehabilitation Commission computer network. Encumbering, vouchering, and validating were all parts of vendor concerns. The major theme from the vendors was that they would like to be considered more of a partner and would like to work closer with the Texas Rehabilitation Commission.

Comments from TRC Field Management

These comments were similar to those of the VR counselors, as reported earlier. Many of the managers felt that they were required to approve too many decisions of the counselors, while some seemed to feel quite comfortable with counting the numbers of "i's dotted and T's crossed." There was a general consensus among all managers that many of their responsibilities were for other reasons than adding value to the client. Too many forms, too much documentation, redundancy in paperwork were all identified as wastes of time.

Submission of Written Reports

The reports were submitted by the area supervisors to the reengineering leader by the end of May 1994 and totaled some 200 typed pages of information. The data were entered into a computer data base and sorted by category. This information made it possible for the Reengineering Task Force to proceed to the next step.

Establishment of Two Reengineering Task Groups

After carefully reviewing and some preliminary analysis of the 200 pages of information that came from the 25 unit meetings, the Reengineering Task Force developed two separate task groups. One task group would be charged with the responsibility of redesigning the rehabilitation process (the manner in which a client is moved through the system), while the other task group would address the redesign of the purchasing process. Membership for both groups primarily came from the original membership of the Reengineering Task Force. In addition, each reengineering task group was represented by a member of Management Audit, Information Technology, a project manager, and a facilitator. These task groups worked together for a period of four (4) months, with each meeting lasting 2-3 days in length. The reengineering leader periodically met with the task groups to maintain continuity between the two. Each task group was charged with the responsibility to project outcomes from the reengineering efforts and to develop systems to measure the effectiveness of reengineering.

Picking the Low Hanging Fruit

As the two reengineering task groups redesigned the rehabilitation and purchasing processes, it became obvious that immediate changes needed to be made. The task groups identified these immediate changes as "low hanging fruit." It is important to note that these immediate changes would eventually be a part of the redesigns of the process and purchasing reengineering efforts. Examples of the "low hanging fruit":

1. Removing the stipulation of having VR counselors to obtain three (3) bids for client equipment costing less than $1,000. This was a significant change in policy, as 90% of all client purchases require expenditures that are less than $1,000.

2. Deletion of the requirement for counselors to prepare an individualized written rehabilitation program (IWRP) work-sheet in addition to that of the formal IWRP.

3. No longer requiring client signatures to verify receipt of tools or medical services.

4. Removing the requirement for counselors to receive prior approval of a local medical consultant before surgery is provided for a client.

By implementing these "low hanging fruit" policy changes, the reengineering effort suddenly became a reality to Commission employees throughout the state. In a very short time frame after the 25 unit meetings were held, field staff, clients, and vendors could see that the reengineering effort of the rehabilitation process was a very serious matter. Though the target date for implementing the reengineering effort is October 1, 1995, Commission staff would not have to wait for some of the identified problem areas to be addressed as the "low hanging fruit" was already being harvested. Reengineers made certain that all of the "low hanging fruit" implementations were a part of the major redesigns that would eventually be implemented in 1995.

Stopping the Train

A major obstacle became apparent in the reengineering effort while the redesigns by the two reengineering task groups were being formulated. This problem area centered around the issue of how to break the old habits of a long-standing culture. While the rehabilitation and purchasing processes were beginning to take new shape, managers throughout the organization had a tendency to continue to write additional detailed policies that focused more on process than on outcomes for the clients. This required the reengineering leader to expend considerable energies in curtailing old practices while new designs were being formulated. Managing change became a major challenge. Though the field staff, clients, and vendors had identified the problems and had suggested recommendations for change, there was a tendency in the organization to continue to do what was in the past.

Projected Outcomes of Reengineered Designs

After five months of deliberate work, the two reengineering task groups for purchasing and the VR process completed their redesigns on November 1, 1994. Of the 200 pages of identified problems and recommended solutions by field staff, clients, and vendors, all but four were addressed and incorporated into the redesigned processes. Of the remaining problems/solutions, one of these dealt with funding, while the other three were scheduled to be addressed in the next phase of the reengineering efforts, laboratory testing. Each of the reengineered designs was presented to executive management and to the six-member Governor-appointed Board of the Texas Rehabilitation Commission.

Projected Outcomes For Purchasing Redesign

Prior to reengineering, VR field staff spent in excess of 600,000 hours purchasing goods and services on an annual basis for VR clients. In the reengineered process, this amount of time will be reduced to 200,000 hours, a 66 2/3% reduction in field staff time. If equated to dollars, this would reflect a reduction from $6 million to $2 million in staff time. Again, this reflects a 66 2/3% reduction. In the current system, VR counselors spent 120,000 hours of counselor time in purchasing goods and services on behalf of VR clients. In the reengineered purchasing process, VR counselors' time will be reduced to 50,000 hours on an annual basis. This represents a 60% reduction in counselor time, equating to a savings of $1 million.

The Texas Rehabilitation Commission has a central warehouse that stocks client equipment and office supplies valued at approximately $1.5 million at any point in time. If a client is in need of some equipment that is not in stock in the Commission's warehouse, it may take up to 30 days in the present system for a client to be delivered that piece of equipment. In the reengineered purchasing process, the centralized warehouse will be phased out and the Commission will contract with a private sector supplier who will have as many as 29 warehouses strategically situated throughout the state. In this new purchasing system, there will be 1-day guaranteed delivery for any piece of client equipment. Counselors will also have the opportunity to purchase at the local level as well as through the 29 warehouses operated by the private sector supplier. In the redesigned system, counselors and clients will be able to sit at a computer at the counselor's desk and will have on-line communication with the private sector vendor. Computer screens will picture client tools and equipment, specific cost, size, and description. If consultation is needed, the private sector vendor will be available to provide guidance to the counselor and client on equipment needs.

Within the State of Texas, there are 45,000 medical doctors, 40,000 of which are actively involved in providing medical services. The Texas Rehabilitation Commission has written agreements with 400 hospitals across the state to provide services to VR clients. A Maximum Affordable Payment Schedule (MAPS) document is updated annually and distributed to all VR offices. This is a very cumbersome document and one which is very expensive to maintain. In the reengineered process for purchasing, the Texas Rehabilitation Commission will contract with a large volume medical provider which will negotiate medical fees with medical doctors across the state. It is anticipated that there will be a considerable reduction in medical fees paid through this large volume medical provider. The reengineered effort assures client choice of medical provider. Instead of processing 2,500 claims per day for medical/psychological purposes, the rehabilitation medical provider will make it possible for the Texas Rehabilitation Commission to process only two medical/psychological claims per week. It is anticipated that the Commission can redirect the services of some 90 staff persons who have previously been performing claims processing functions and other related activities pertaining to medical/psychological services.

Projected Outcomes for The Reengineered Rehabilitation Process

The reengineering task group relating to the redesign of the process in which a client moves through the system spent five months in its efforts. The task group members met for 2-3 days at a time and closely addressed the 200 pages of documentation received from vocational rehabilitation field staff, vendors, and clients during the information gathering phase of the reengineering activity. To make it possible for the VR counselors serving on the task group to participate in the reengineering meetings without causing delays in services to clients, Central Office program specialists, who had previously served as VR counselors, went back to the field and performed counselor responsibilities. This proved to be successful in several ways. First, the opportunity for Central Office staff to return to the field and carry a case-load using the policies developed by the Central Office staff was a lesson in humility. The Central Office staff developed a greater appreciation of the problems that VR counselors face today. A second meaningful outcome from this job-sharing experience was that the commitments to reengineering by the Texas Rehabilitation Commission became very obvious to all 2,500 staff. Central Office staff performing VR counselor responsibilities, in order that the counselors could come to the Central Office and reengineer the rehabilitation process, was a bold statement in action.

The reengineered rehabilitation process features fewer control points and a more streamlined, less bureaucratic system that facilitates clients to make informed choices. In the redesign, there are four phases to the rehabilitation process, instead of 16 statuses. During the Intake phase, initial contact between the VR counselor and client results in an exchange of information. The intake phase ends with the determination of eligibility by the counselor.

The second phase of the rehabilitation process is Program Development. A comprehensive assessment of the client's unique strengths, resources, priorities, concerns, and abilities is accomplished to plan services. Additional medical, psychological information may be needed. The counselor and client negotiate outcomes/objectives resulting in a rehabilitation program.

The third phase of the rehabilitation process is Program Implementation. Clients and counselors mutually agree to the need of given services, which are arranged by the VR counselor. As services progress and the client moves through the process, a major focus becomes monitoring of the services. This is accomplished through vendor reports and direct feedback from the client.

The final phase of the new design is Outcome Achievement. During this phase, the services previously provided are assessed to make sure that all needs of the client have been met to assure a meaningful outcome.

When one assesses the impact of the reengineered rehabilitation process, it is quite obvious that quantum improvements will be realized. The new system is far more streamlined, requiring less paperwork, fewer approvals, and less time to effectuate services. These differences will make it possible for counselors to spend much more quality time with their clients, resulting in better services. Anticipated outcomes of the reengineered process are:

* From client application to acceptance for services, there will be a 50% reduction in time.

* From client application to plan development, there will be a 40% reduction in time.

* There will be a 65% reduction in policy.

* During FY 1994, the Texas Rehabilitation Commission closed over 12,000 cases in status "28" (non-rehabilitated after a plan of service had been implemented). In the reengineered process, 35% of these status "28" cases will be converted to status "26", successfully employed.

* Weekly earnings by vocational rehabilitation clients will increase by 25%.

* There will be a 25% improvement in employee satisfaction.

* Counselors and their secretaries will be empowered to make many decisions currently made by supervisors.

* In the reengineered environment, supervisors will function more as job coaches, enablers, and mentors. The supervisor's role will become less "boss" oriented and more "support" focused.

Laboratory Testing the Reengineered Processes

The third phase of the reengineering activities within the Texas Rehabilitation Commission centers around testing the redesigns of the purchasing and rehabilitation processes. This activity began on November 15, 1994 and will conclude in May 1995. Two specially equipped laboratories, one to test the purchasing redesign, and the other to test the VR process redesign, were established in the Central Office of the Texas Rehabilitation Commission. Laboratories were equipped with special furniture, Pentium microcomputers, and other tools to facilitate the testing process.

Membership for the reengineering laboratories required some additional players. The lab groups are relatively small, with 12 members for the VR process team and 10 members for the purchasing team. Vocational rehabilitation counselors who were previously a part of the reengineering task groups served as laboratory leaders. Having VR counselors involved in designing/testing the newly created processes was critically important, as they are the experts on relating to clients. To obtain objectivity in the laboratories, some of the membership was entirely new, (i.e., having not previously served on the original Reengineering Task Force or either of the task groups involved in redesign). Management Audit continues to be represented. With redesign of the purchasing and VR process systems, some of the jobs performed in the old environment would no longer be needed, while some positions will need to be altered. It would also be necessary to create new positions in the reengineered environment that did not exist previously. To address the needs created by new and changing jobs, a Human Resource Management expert was added to each laboratory team to facilitate new/revised job descriptions, compensation, and classification.

Newly developed job descriptions would further create the need for staff training. Accordingly, each laboratory includes a Human Resource Development expert. With the purchasing and client processes redesigned, information technology (IT) plays a major supporting role in the reengineered process. Staff from IT became members of the laboratory teams. Throughout the reengineering effort, the Texas Rehabilitation Commission has been careful not to automate existing systems that would only exacerbate the need to reengineer. Automating existing systems only enables current mistakes to be made faster. Completing the make-up of the reengineering laboratories were two important players, the project manager, who is responsible for keeping the lab team on schedule, and the facilitator, who leads the discussion efforts.

The major function of the two reengineering laboratories is to test the designs against some 318 business rules relating to Federal, State, and Texas Rehabilitation Commission policy. Lab team members also had to design new screens to be used at the counselor/secretary/manager workstations. Fourth generation computer language will be used in supporting an open systems architecture, featuring local and wide area networks. Windows technology will be utilized, with special adaptive equipment for persons with visual impairments.

A list of resources was developed in order that the laboratories might bring in groups to validate/test new designs. Included were VR counselors, technicians, secretaries, clients, vendor/providers, and managers. Each laboratory leader was empowered to call upon as many resources as needed.

Unlike the redesign teams of phase 2, laboratory team members are full-time workers in the labs. Field staff come to the Central Office early each Monday and leave on Friday at noon. Special apartments were leased to accommodate out-of-town lab members.

During the spring and summer months of 1995, final programming will be completed by staff assigned to Information Technology. Training will be conducted by Human Resource Development personnel to make sure that everyone is ready for implementation. Following the laboratory testing, a field test will be conducted in the Dallas Metroplex area to assure that the reengineered processes have no faults before implementation of the new systems on October 1, 1995.

Conclusion

For the first time in 65 years the manner in which a client is processed through the system has been totally changed within the Texas Rehabilitation Commission. Persons with disabilities are demanding better jobs, timely services, and the ability to make informed choices. Vocational rehabilitation counselors (VRCs) are asking to be trusted by management and to be allowed to make decisions to further expedite services to disabled persons. The VRCs are also asking for a more streamlined system, featuring computerization, reducing the amount of paperwork and allowing for more time to spend with clients. Managers are asking to be relieved of policies which bring no value to the customer. Vendors of vocational rehabilitation services want to be more closely involved in the planning efforts of VR state agencies. The manner in which a vocational rehabilitation client is served on October 1, 1995 will be greatly different. Because of REENGINEERING, clients will be able to make informed choices in a streamlined service delivery process.

References

Hammer, M., & Champy, J. (1993). Reengineering the corporation. New York, NY: Harper Collins Publishers, Inc.

Texas Rehabilitation Commission Task Group on Reengineering (1994). The reengineered rehabilitation process. Austin, TX: Texas Rehabilitation Commission.

Texas Rehabilitation Commission Task Group on Reengineering (1994). Reengineered purchasing: a team approach. Austin, TX: Texas Rehabilitation Commission.

James L. Jackson, Executive Deputy Commissioner, Texas Rehabilitation Commission, 4900 N. Lamar Blvd., Austin, Texas 78751-2399