Streamlining: moving beyond the quick fix.
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.
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.
The Michigan Rehabilitation Services (MRS) has also enjoyed a stellar reputation for high quality rehabilitation work and has been touted as having one of the best human resource development programs in the nation. Beginning in the late 1980's and continuing to the present, MRS has placed great emphasis on "performance excellence," a series of strategies developed to enhance service quality and change the basic culture of the Michigan rehabilitation agency from that of a more traditional state agency to a state-of-the-art organization (Estell, 1994). Many of the strategies used by MRS involve principles common to streamlining.
Streamlining as an activity, a process, or a philosophy has been widely used within the state-federal program of rehabilitation, primarily by state rehabilitation agencies. As can be seen from the above examples, much of this activity has been ongoing for the past two decades. What circumstances have conspired more recently to compel stakeholders in the larger rehabilitation system to formalize streamlining as a primary process for creating change?
Both federal and state governments are heavily invested in attempts to stem the tide of so-called out-of-control bureaucracy in the late 20th century. The Paperwork Reduction Act, downsizing and streamlining mandates, and executive branch attention to making government "leaner and meaner" reflect current federal initiatives intended to reduce the size of government and at the same time make it more efficient and effective.
In state government settings, there currently exists a plethora of initiatives, many touted as the answer to bureaucratic ills. Included among those initiatives are the following:
* privatization of government services,
* total quality management (TQM) programs,
* resource redirection, including the reduction of resources after redirection, and
* continuous improvement programs.
Most current initiatives in state governments contain some elements of streamlining, whether called by that name or not. Most require some identification of desired outcomes, an analysis of efforts required to achieve those outcomes, and some comparison of desired future operations to current operations.
Streamlining can be simply defined as an "attempt to make organizational processes more efficient," especially through cutting or reducing unnecessary steps in a process or in a set of work activities (Stephens, 1996). Streamlining is but one tool in a larger tool kit commonly known as reengineering, popularized in the more recent management literature (Hammer & Champy, 1993).
Streamlining activities, per se, do not require decisionmakers to question the overall effectiveness of a process, although most streamlining activities lead naturally to questions regarding whether or not processes are producing desired or needed outcomes. In the state-federal program of rehabilitation, the streamlining initiative sprang from the convergence of environmental factors and issues mentioned earlier, the three C's. In 1993, leaders of the state-federal program met at the Aspen Institute to discuss the need for streamlining the program and entered into an historic agreement which has resulted in streamlining activities being conducted in most of the state rehabilitation agencies in the country (RSA/ CSAVR, 1996).
It is important to note that there is a philosophical undercurrent to streamlining activities which can be traced back two or more decades and connected to the larger shifts in society and the rehabilitation community mentioned earlier in this article. Those undercurrents include the following precepts:
* Traditional notions of dysfunction in organizations and organizational processes reflected a belief that people become dysfunctional and that dysfunction, in turn, produces dysfunctional processes and systems. Streamlining approaches require the belief that processes and systems themselves can become dysfunctional and in fact are often at the root of many organizational evils.
* A corollary to the idea of organizational dysfunction is that of searching for deviance in organizational processes rather than searching for deviants among organizational members. A search for deviants usually results in someone being punished rather than an examination and analysis of existing processes and functions.
* Many government organizations have traditionally waited for directional signals from legal authorities, legislating bodies, and the issuance of rules and regulations in order to make significant changes in the way business is conducted. In the current environment, waiting for directional signals is akin to being left in the starting blocks when the race begins. While legal authorities cannot be ignored, neither can consumers of services and other constituents and stakeholders. Organizations must develop faith in their own ability to anticipate needs and trends and act upon them before being told to act.
* Traditional notions of management dictate that management take responsibility for acting on the need to improve processes and systems. Current practice dictates the understanding that those closest to the process, including those who use the process as a work tool, are perhaps the best equipped to analyze and ultimately restructure those processes. It follows that those closest to the process should be the first to be consulted about changing the process.
The following issues were originally raised in an editorial in the Journal of Rehabilitation Administration (Stephens, 1996) and are still relevant to any discussion of streamlining efforts in general and state-federal rehabilitation program efforts in particular.
* Streamlining, while geared toward making processes more efficient, will not necessarily make them more effective. If the process is flawed, no amount of streamlining will cause the process to produce better outcomes. A 1966 Volkswagen produced with streamlined processes is still a 1966 Volkswagen.
* Streamlining of processes may have little or no effect on other important variables which are known to influence outcomes. For example, policy, organizational systems, and supervisory and leadership behaviors have tremendous effects on the quality of outcomes produced in an organization. Lack of attention to these variables may blunt the best of streamlining efforts.
* Streamlining activities can have unintended and unanticipated consequences for organizations. Even relatively small changes in processes can sometimes significantly alter the daily fabric of behaviors and interactions in organizational life. A simple change in what is attended to, what is counted, or what is focused upon can sometimes have profound effects which cannot be predicted.
* Streamlining may simply not go far enough to create major systems changes, which some believe to be necessary for all government programs. Is it enough to make processes more efficient? Should major changes be made which go far beyond process improvement?
* In addition, there is now enough streamlining experience in state rehabilitation agencies to begin drawing some tentative conclusions about the process of streamlining and what can be expected as a result of the activity. In the southeast, 11 of 12 state rehabilitation agencies have participated in the formal process of a streamlining review and the following observations can be made (Stephens, 1997):
* Streamlining the process used for providing rehabilitation services often results in a search for the rationale for doing things a certain way. There is a tendency in organizations to forget why business is conducted in a particular way. Once analyzed, it is often feasible to alter the process because the rationale is no longer applicable. The ability to constantly ask "why we do it this way," especially if posed by an outside peer, can be a powerful incentive for deleting unnecessary requirements.
* Streamlining reviews serve as powerful reminders to organizational members that the power to make decisions to do things differently resides largely within the organization. The nebulous reference to they becomes the specific reference to the more accountable and responsible we.
* It is obvious in most streamlining reviews that much of the clutter in rehabilitation agency processes was placed there for good reasons: the desire to protect the rights of service recipients, the desire to right a perceived wrong committed by an organizational member, or an attempt to capture the intent of new laws and regulations. Unfortunately, often there has been little attempt to root out outdated or misguided clutter before moving on to new requirements.
* No matter how frequently or intensely organizations conduct streamlining type activities, inconsistencies and flaws in processes are almost always uncovered in subsequent reviews. Infrequent streamlining probably has limited value, with much more to be gained through a continuous improvement mode of operation.
* There is much to be gained by having persons outside the organization participate in streamlining activities, including rehabilitation professionals from other states, advocates, consumers, advisory council members, and others. The outside perspective, while not always technically sophisticated, is almost always direct and provides the organization with an unvarnished point-of-view that is difficult if not impossible to find inside the organization.
One of the primary goals of any organizational change effort is to create greater efficiencies in the processes used in producing desired outcomes and at the same time add value to what is produced. One of the limitations in using streamlining as a major technique for improving rehabilitation services is that while greater efficiencies may be realized, often little attention is paid to increasing the value of what is produced. For example, it is possible to serve persons with disabilities more quickly and provide more choice in the process without improving the quality of employment, which is the ultimate measure of value. It is also possible to successfully streamline processes yet continue to produce undesirable or flawed outcomes. Obviously, streamlining is but a piece of a larger approach to bringing about desired change in rehabilitation, especially if significant value is expected to be added to rehabilitation outcomes.
Based on the preceding discussion of streamlining and recent experience in participating in streamlining reviews, the following recommendations are offered which should enhance the capacity of the state-federal vocational rehabilitation program to assist persons with disabilities in achieving more valuable outcomes.
* Before engaging in comprehensive streamlining of all processes, state rehabilitation agencies would be well advised to promote full scale discussion and analysis of the desired outcomes they and their constituents desire, including but not limited to a market analysis, an analysis of mission and long- range vision, and a comprehensive effort geared toward developing the commitment of all organizational members.
* Rehabilitation organizations would do well to borrow another concept from the management and organizational literature, that of reengineering. Reengineering is defined as the "fundamental rethinking and radical redesign of... processes to bring about dramatic improvements in performance" (Hammer & Stanton, 1995). At least one rehabilitation agency, the Texas Rehabilitation Commission, has adopted a reengineering approach to examine key processes. Reengineering requires a more comprehensive approach to adding value to agency outcomes.
* Organizations must consider and subject to analysis other organizational variables which have proven to be associated with productivity and high quality outcomes. These include, but are not limited to, supervisory, managerial, and leadership behavior, policy, procedure and best practice systems, and overall reward systems within the organization. Failure to consider these variables will almost certainly diminish the overall effect of streamlining. Unintended and unanticipated consequences are common outcomes associated with streamlining and other organizational change efforts. Consequence structures have evolved to high levels in all organizations, including state rehabilitation agencies. For every pattern of behavior there is a complex consequence pattern, which, if altered, will often bring about significant changes in individual and group behavior. As processes and systems are analyzed and changed, consequence plans often need to be developed in order to insure predictable outcomes (Daniels, 1994).
The current streamlining initiative in the state-federal program of rehabilitation represents a significant departure and transition from a more traditional era. Old style command and control organizations will face significant obstacles in the organization of the future, with flexibility and continuous improvement strategies needed for ultimate adaptability and survival. Streamlining represents a small yet significant step toward a complex future.
1. Daniels, A. (1994). Bringing Out the Best in People. McGraw-Hill: New York.
2. Estell, L. (Ed.) (1994). Performance excellence strategies. Michigan Jobs Commission.
3. Field, T. (1981). The application of counselor performance standards: counselor training manual. University of Georgia Management Control Project, Athens, GA.
4. Hammer, M., & Champy, J. (1993). Reengineering the Corporation. Harper Collins: New York.
5. Hammer, M., & Stanton, S. (1995). The Reengineering Revolution: A Handbook. Harper Collins: New York.
6. Joint RSA/CSAVR Vision and Strategies for Streamlining the Public Vocational Rehabilitation Program (1996). Washington, DC.
7. Schwab, J., DiNitto, D., Simmons, J., & Smith, T. (1996). Evolution of the Texas Rehabilitation Commission system for measuring quality rehabilitation. Journal of Rehabilitation Administration, 20 (1), 25-36.
8. Stephens, J. (1988). Turnaround at the Alabama Rehabilitation Agency. Public Policy Review, 21 (3), 67-84.
9. Stephens, J. (1996). Guest editorial: Streamlining the public vocational rehabilitation program. Journal of Rehabilitation Administration, 20 (2), 91-92.
10. Stephens, J. (1997). Streamlining the public vocational rehabilitation program: part II. Journal of Rehabilitation Administration (In press).
Mr. Stephens has directed the Regional Rehabilitation Continuing Education Program (RRCEP) for Administration and Management at Georgia State University since its inception in 1978. He served as president of the National Rehabilitation Administration in 1990 and in 1993 was awarded the Guy F. Hubbard Award, NRAA's national award for excellence in rehabilitation management.
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|Title Annotation:||Streamlining Service Delivery; improving vocational rehabilitation services for the disabled|
|Author:||Stephens, James E.|
|Date:||Jun 22, 1997|
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