音声ブラウザご使用の方向け: SKIP NAVI GOTO NAVI

CONTINUOUS QUALITY IMPROVEMENT OF REHABILITATION TECHNOLOGY SERVICES IN VOCATIONAL REHABILITATION AGENCIES

Cynthia C. Flynn, Ph.D. Center for Rehabilitation Technology Services West Columbia, South Carolina

ABSTRACT

A continuous quality improvement effort for rehabilitation technology programs in Vocational Rehabilitation agencies has been developed and is being piloted in three agencies. This effort focuses on customer satisfaction and the effectiveness and efficiency of services provided. A guide explaining the process has been written which includes surveys to measure satisfaction and perceived effectiveness of the services provided. These data are collected from counselors, clients, and employers (when they are involved). A form for collecting cost efficiency data is also included. These data are collected by the technology provider. Revisions will be made based on pilot test results and the Guide will be made available to all VR agencies in late 1996.

BACKGROUND

There has been considerable interest in the rehabilitation technology field in determining which service delivery models are the most effective and efficient means of providing these services. However, since most rehabilitation technology programs were not developed according to a specific model or pattern, making meaningful comparisons across programs is extremely difficult, if not impossible. If comparisons across programs are not reasonable at this time, another method to assist agencies in determining whether their service delivery approach is meeting the needs of the customers is warranted. One alternative is for agencies to conduct a self-assessment of the efficiency and effectiveness of their programs. Since many Vocational Rehabilitation (VR) agencies are becoming involved in quality improvement efforts, an extension of this effort into the rehabilitation technology area appears to be a logical mechanism for assessing program efficiency and effectiveness.

One of the most difficult aspects of conducting a continuous quality improvement process is the development of effectiveness measures. It is especially difficult in the rehabilitation technology area where direct measurement of outcomes are not available. In an attempt to assist rehabilitation technology programs in VR agencies to assess the quality of their programs, the Center for Rehabilitation Technology Services (CRTS) developed a continuous quality improvement process with effectiveness, efficiency, and satisfaction measures which agencies could adapt for use in their own programs. This process is being piloted in three agencies to determine its adaptability and usefulness in VR agencies.

OBJECTIVE

The major objective of this study is to determine whether the continuous quality improvement process developed for rehabilitation technology programs in VR agencies can be adapted and effectively used by these agencies to improve the quality of their programs.

METHOD

CRTS staff hired an expert in total quality management and an expert in business administration to work with CRTS staff to conceptualize an approach to continuous quality improvement specifically for rehabilitation technology services programs in VR agencies. Definitions of terms to be used in the process were established first. A thorough review of the literature was then conducted to avoid replication of already existing procedures and instruments and to determine how best to measure outcomes of rehabilitation technology services. The process was conceptualized and measurement instruments were developed. Throughout the process, focus groups were held to ensure that the instruments and procedures were appropriate and practical. All instruments were periodically mailed to selected technology providers for review. Comments were incorporated into various drafts of these instruments. CRTS staff and consultants went to each pilot site for further input on the entire process. Final revisions were made prior to initiation of the project.

A Guide to Assessing Rehabilitation Technology Program Quality Measuring Satisfaction, Effectiveness, and Efficiency was developed to explain the process. The process is currently being piloted in three agencies. During the pilot phase, each participant attended a training session to learn about the process. The Guide was provided at that time to each participant. The data collection process was explained and a set of customized forms and return envelopes were provided to everyone involved. The instruments, training, and data collection process will be refined and the Guide will be revised based on feedback received during the pilot phase.

APPROACH

A good definition of quality considers both outcome and process (1). Both of these aspects of quality define the value of the service. This definition can beexpressed as an equation: Value = Quality/Cost. Theoperational definition of quality in this definition is satisfaction times effectiveness (Q=S X E). Quality can be understood and improved only in relation to cost. Changes in cost that do not maintain or improve quality do not add value. In programs which offer exceptional value, customers get appropriate products and services when they need them and the processes people use to design, deliver, and maintain products and services are efficient. The value equation was used as a guiding principle in the development of the quality improvement process.

As a part of the quality improvement process, data must be gathered which can be used to determine the value of the services offered. Three types of data are being gathered by rehabilitation technology staff: efficiency, effectiveness, and satisfaction. The efficiency component focuses on direct costs that the rehabilitation technology provider can control, staff time, and client elapsed time in the rehabilitation technology process. The technology service provider tracks these data and also records some demographic information about each client. Demographics such as degree of functional limitation, gender, education,age, work status, etc. are used in the final analysis to weight the cases. The effectiveness component focuses on the extent to which rehabilitation technology increased the functional capabilities of theperson served. At this time, direct measurement of outcomes in rehabilitation technology are not available. The next best method is to have the customers rate effectiveness. Satisfaction is relatively easier to measure. Research has identified the service components which have the most impact on customer satisfaction (2, 3). Eleven components of service have been selected for use on these satisfaction rating forms. Effectiveness and satisfaction are being examined through the use of surveys to be completed by clients, rehabilitation counselors, and employers (where appropriate). These surveys are mailed within 30 days after services have been delivered. Efficiency, effectiveness, and satisfaction data are then analyzed. Since continuous quality improvement uses a systems approach, all outcomes are considered important. The focus is on what in the system allowed this to happen, not who allowed it to happen. Through this system, services can be continuously improved.

During the pilot study, completed efficiency, effectiveness, and satisfaction forms will be mailed to CRTS for analysis. Preliminary analyses are conducted and sent to the participating agency. Additional analyses are conducted at the direction of the agency. These data will not reported by CRTS in any publications. CRTS staff are interested in the viability of the process and will only report on those issues. Participating agencies are not identified to other agencies verbally or in written reports. At the conclusion of the pilot study, a final meeting with agency staff and CRTS staff and consultants will be held to evaluate the process. Revisions to the quality improvement process will be made based on this and other input gathered during the pilot phase.

DISCUSSION

The pilot phase has just begun thus, some comments can be made relative to the development of the process, but little can be said about its usefulness or how well it can be adapted to fit individual agency needs.

Developing a continuous quality improvement process for rehabilitation technology programs proved to be very challenging, especially since it is being developed for use by others. The philosophy of continuous quality improvement suggests that these efforts be developed as a result of a commitment to improve the value of their services. Leaders then involve everyone and quality measurement instruments are developed by those involved in the process. If agencies choose to usethe process designed by CRTS, this normal flow of events is changed. The process and the measurement instruments have been designed by someone outside of the agency. Typically, the development of measurement instruments is difficult for staff due to lack of expertise or time to develop appropriate instruments. As a result, the process frequently falters at this point. CRTS decided that the development of instruments which could be adapted by individual programs may help agencies overcome this obstacle to the implementation of a total quality improvement process. Instead of having to completely develop these forms, rehabilitation technology programs are encouraged to customize these instruments thus staff are involved but much of the tedious work has already been done.

As previously mentioned, measurement instruments are difficult to develop. This is especially true in the effectiveness area since outcome measures for rehabilitation technology services have not been developed. Compromises had to be made in this area. Effectiveness is rated by various customers of the services rather than measured. While this is far more subjective, obtaining ratings from a variety of sources may provide some viable information. Pilot test results will help to determine the efficacy of using this approach.

Publication of the final report of the study is planned for late 1996.

REFERENCES

1. Scholtes, P.R. (1988). The team handbook: How to use teams to improve quality. Madison: Joiner Associates, Inc.

2. Berry, L.L., Bennett, D.R., & Brown, C.W. (1989). Service quality: A profit strategy for financial institutions. Homewood, IL: Dow Jones-Irwin.

3. Zeithami, V.A., Parasuraman, A., & Berry, L.L. (1990). Delivering quality service: Balancing customer perceptions and expectations. The Free Press.

ACKNOWLEDGEMENTS

The author is indebted to Dr. Randy Lamkin and Dr. Roger McGrath for consulting with CRTS staff on this project and developing this approach to continuous quality improvement.

The Center for Rehabilitation Technology Services (CRTS) is a part of the South Carolina Vocational Rehabilitation Department. Support for this work has been provided through the National Institute on Disability and Rehabilitation Research (NIDRR), U.S. Department of Education, Washington, D.C. as part of the rehabilitation engineering research center grant #H133E20002-96.

Cynthia C. Flynn, Ph.D. Center for Rehabilitation Technology Services SC Vocational Rehabilitation Department 1410-C Boston Avenue West Columbia, SC 29170