Improving Disability Services: 5 Techniques

Introduction: High Performance Disability Services?

It’s well enough known that disability services are under-provided, chronically so in many cases. It’s also well documented that there is substantial unmet demand (for example, by the Australian Institute of Health & Welfare in their 2007 publication Current and Future Demand for Specialist Disability Services).

While there must be a focus on increasing funding for disability services and the overall level of community service resourcing, the under-provision of services also means it’s important to focus on making the most of what there already is.

Managing services for greater impact means that client and carer outcomes are maximised even when funding and resourcing remain the same, or services are provided for more clients with the same resources.

Viewing the management of disability services from this vantage point helps moves us away from a deficit mentality that focuses on lack and scarcity, to a more resourceful orientation that uses what’s available to produce greater results for those who need them most.

And in the event that resourcing for disability service does increase, a focus on enhancing disability service performance will mean that those extra resources will have even greater impact for those who need them, who are among society’s most vulnerable and dispossessed.

Here we identify five techniques and methods you can use to enhance your service’s performance.

1. Define the Results Your Service Aims to Achieve

It sounds so obvious and common sense that to improve performance you have to know what it is you are trying to achieve, that it hardly bears saying .. but it’s not.

Many organisations in many industries provide services without having a clear understanding what high performance, or success, or excellence, actually look like.

Moreover, the actual objective of many disability services – that is, what they are specifically trying to achieve – is unclear or ambiguous.

Does a day program aim primarily to provide a quality of life experience for its clients, or is its purpose to enable carers to get on with their lives, earn income and have a break? Both, you say. Perhaps, but the orientation and weighting of each affects how it is managed and how resources are allocated. In the former the focus is on creating rich and fulfilling experiences for the clients, with resources focused accordingly. In the latter case there might be an emphasis on more clients being able to access the service to lift the burden on the local carer community, or on running services for longer hours so carers have more time to do what they need to do when they’re not caring for their disabled family member.

Each objective brings with it a different implication for what constitutes good performance. The day program that aims to give people with disabilities quality of life might define success as its capacity to give clients happy, community-oriented experiences and engage with each other in their time together.

The service that aims to reduce the burden for carers, on the other hand, might define success in terms of their capacity to take on more clients, and give much-needed relief to more families. Each approach balances service quality and service access in a different way.

The decision about this balance should be made consciously: if the service allows itself to slide between different objectives trying to accomplish all of them without understanding its own orientation, allocation of people and money, and how this sits vis-à-vis the needs of its community, then all objectives will be compromised. And clients and carers will feel the effects of that.

Action Point: Make sure there is clarity in your service about what the objective of the service is, and what results your service aims to achieve. Key decision-makers in the service should be part of this process

Hint: Don’t be put off if this seems harder than first thought: objectives have to be traded off, and decisions about priorities have to be made. The process – far from being straightforward – can be difficult and nuanced. But achieving the results your service sets out to accomplish – because those results are clearly understood ahead of time – makes it well worth it

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2. Gather Information So You Can See How Your Service is Performing

Once your service’s objectives are clear and the results you’re aiming to achieve are well understood, it’s necessary to gather the information that tells you whether you’re achieving those results.

This could mean numerical data such as cost per client, staff to client ratios, or client satisfaction survey results. Or it could entail qualitative data such as descriptions, interviews, or focus group material. Or it could be a combination of both.

Numerical or quantitative information are often presented as performance indicators or key performance indicators (KPIs). Recently there has been a trend to present this information in a dashboard or scorecard format, so that all the major indicators showing how the service is performing can be seen at a glance.

The disability sector doesn’t have a strong history in identifying and using performance information, and this is an area that needs more work.

Here is a starter list of KPIs that you might want to use or adapt for your service:

• number of community visits per client (or per client service days)
• proportion of clients with up to date case plans
• ratio of staff to clients
• client or carer satisfaction survey results
• staff satisfaction survey results
• staff turnover
• cost per client (or per client bed-day)
• overheads as a proportion of total spending.

There should be a mix of KPIs, since your service will reflect a chosen balance of different objectives (see point number 1 above). Ideally your service’s performance indicators will move in the direction you choose. If they do, you know you’re on track and can plan how to enhance them further. If they don’t, at least you’ll be aware of that and can take corrective action.

Many organisations collect KPIs and performance information but don’t feed that information back to improve their services. Use the KPIs and performance information in a continuous loop where actual results can be compared to targets and expectations, so that you know when improvements can be made to your service, and in what areas.

Action Point: Collect a suite of numerical KPIs (10 to 15 at most) and qualitative performance information and report against them regularly

Hint: If there are KPIs set out in your service level agreement (SLA) or funding agreement, don’t just report against them in your annual return or funding applications: use them as part of your overall management of the service

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3. Understand Your Service’s Competence and Distinctiveness

Because of the history of under-funding in the disability sector, there is not a background of being attuned to where there is strength and competence.

Yet there is precious little else on which to build a high-performing service. Without them you’re relying on goodwill or noble sentiments – each of which has limited supply.

What are your service’s strengths? What does your service do very well?

Feeding back actual results to compare against targets and expectations is an excellent way to answer these questions. Form your own answers, and ask staff, carers and other stakeholders their views. Frame the question along the lines of: What do we do very well? Where are we really making a difference?

Perhaps your service has excellent case management, or a particular expertise in behaviour management. Maybe there is very good staff training. There might be a strong culture of respect for clients and their dignity and independence in all aspects of service provision. Or maybe your service is well networked with local community groups and adept at fund-raising.

Whatever your service’s strengths, you need to identify and understand them so you can build on them and leverage them. They provide areas of focus where you may aim to pour extra resources so your service can accomplish new and bigger things, or have greater impact.

And once you’re in that terrain, you’re service can start planning for innovation and distinctiveness.

Action Point: What is your excellence? Identify your service’s areas of strength and competence

Hint: If your service provides more than one service type (day programs, supported accommodation, respite, attendant care etc.) look at the strengths of each service type, as well as how they interconnect

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4. Undertake Service and Program Reviews

Giving each of your services or programs a complete once-over periodically can improve them substantially.

Reviewing services, say, annually ensures they’re on track and delivering what they’re supposed to be delivering. When done by an outsider a review can bring the objectivity that a fresh and independent set of eyes offers. Perhaps the service is delivering more than anyone expected of it. There may be a real innovation in there which no one appreciated before. Or there might be some unintended side-effects somewhere in the continuum of care which need to be taken to book.

Reviews help keep a program or service true, that is, aligned with the original intent and mission of the service provider, or at the least send up a flag if a change needs to be made.

And as with gathering performance information (number 2 above) if program reviews are a compulsory part of funding agreements, they needn’t just be reporting obligations or bureaucratic imposts; used intelligently they can be mechanisms for improving the performance of disability services.

Action Point: Commit to regular review of programs and services for each service type. Annual reviews are ideal

Hint: The results that your services aim to produce – as discussed in number 1 above – should form the basis of any review. Performance should be assessed relative to your objectives, that is, what the service aims to achieve

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5. Review Performance Collaboratively

One of the most powerful ways to build a sense of solidarity in a team is to pose the question: What did we do right?

This not only builds morale and creates a clear sense of what is valued and aligned with the team’s purpose; it also helps bring to light the team’s strengths. And as management guru Peter Drucker rightly observes, an individual or organisation can only perform through strength.

Make no mistake, this is not a fluffy ‘feel-good exercise’; it’s a concrete way of highlighting what has been accomplished and of orienting people to what is most productive. It serves as a guide for action.

This is particularly important in disability services where results can be hard to distinguish or only be clear over a long period of time. Recognition and acknowledgment for what works gives staff greater direction. Just posing this question regularly – and being in a frame of mind to answer it – places a team of disability workers in a more empowered state and creates a climate in which clients can receive greater support.

Action Point: At team meetings, pose the question What did we do right? and answer it collaboratively

Hint: There is strategic value in collecting a team or unit’s responses over time to the question What did we do right? Collate the answers and feed them into strategic planning sessions when you’re identifying your organisation’s strengths

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References and Further Reading

Peter F. Drucker Managing the Nonprofit Organisation: Principles and Practices (audio book) (Harper Audio, 2007)

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© Michael Carman 2010-2012