RE: REQUEST: Measuring service quality in social service

["Bawn, Loren" <LBAWN@dhs.state.ia.us>]

We have two requests regarding measures of quality in human services.  To my
knowledge, work in this area is in its infancy.  Many of the measures I see
taking hold have to do with measures of administrative efficiency (time to
process an application, error rate, number of rings to answer the phone,
etc.).  The other large area is customer satisfaction, which we generally
don't do very well.  Most of the work here has been in poorly designed
surveys that are done once (no comparability from year to year).  

In the
mental health realm, there are also a number of "functional assessment"
tools that attempt to measure an individual's "quality of life" based on
what the developers of the instrument define as "normalcy."  These tend to
be not-so-subtly laden with value judgements concerning work, interpersonal
relationships and public behavior, so generally end up measuring a
customer's progress in achieving outcomes valued by the funder (or in some
cases, the treatment community) rather than those valued by the customer.  I
am not aware of human services organizations that have made huge strides in
moving to a customer focus, although the work of the Robert Wood Johnson
Foundation regarding customer-designed services is somewhat encouraging.

Currently the buzzword is "outcomes". The argument seems to be that if we
measure the outcome of service delivery, rather than just how much was spent
on what, quality will miraculously improve.  I find it ironic that the
acronym "MBO" could quite easily stand for "management by outcome" and we
could go through the whole suboptimizing,
just-make-the-numbers-who-cares-how that business went through when "MBO"
stood for "management by objective".

That said, I believe there is potential in identifying the outcomes our
customers find important, and determining if the system is capable of
producing them consistently.  For example, one outcome being bandied about
in the mental health realm is "community tenure" or the number of days an
individual with a serious, persistent mental illness is able to remain
outside an inpatient institution.  Now, this outcome is likely more highly
valued by the funder (inpatient services being generally significantly more
costly than outpatient) than the individual experiencing the symptoms, but
we'll set that point aside for a moment, and suppose that the customer
highly values "community tenure" as defined above.  There are a number of
services government funds to "treat" mental illness.  It would be feasible
to run the numbers on various service providers in an attempt to discover
whether and where stable systems existed to consistently achieve these
outcomes.  It may then be possible to attempt to answer the "by what method"
question, and attempt to disseminate the information so that other service
providers could adjust their systems and determine if they can achieve
similar results. 

The approach above is possible, and I try to move my little slice of heaven
in that direction as much as possible. My concern is, that as an "industry"
we will wind up merely publishing the measures, and punishing those service
providers who don't "make the numbers," thus effectively removing from them
the resources they need to improve. Frustrating?--Yes. Work worth
doing?--Definitely!

Keep the Faith,
Loren Bawn
Executive Officer for Community Systems
Iowa Department of Human Services