The CEOs Dilemma: How to reduce costs and improve quality under NDIS

Some recent advice to leaders in the disability space specifying a reduction in service quality as a strategy to survival under NDIS has caused a stir amongst participants and their families. And quite rightly, it’s an important conversation to have, and a really controversial approach for providers to take in reducing the cost of service delivery. There is already much antagonism felt by participants and their families toward providers, I witnessed it first-hand at a family forum I ran last week with participants preparing to enter the NDIS in July. People are reluctant to share the details of their NDIS plans with providers. On probing deeper into the reasons why I discovered that some participants and families have low-trust or no-trust relationships with their providers. Conversations about reducing quality to reduce costs exacerbate this tension and indicate real desperation on the part of providers.

As the mother of an NDIS participant, previous DSP CEO and, current NDIS business consultant I’m interested in guiding the conversation towards an exploration of the many alternatives providers have to reduce costs and improve quality.  But, let’s start by getting clear about what we mean by quality.

NDIS customers are likely to evaluate service quality on the following 5 dimensions;

  • TANGIBLES: The appearance of your physical facilities, equipment, staff, and communication materials
  • RELIABILITY: The ability to perform the promised service dependably and accurately (i.e. do you turn up when you say you’re going to?)
  • RESPONSIVENESS: Your willingness to help customers and provide prompt service
  • ASSURANCE: The knowledge and courtesy of staff and their ability to convey trust and confidence
  • EMPATHY: The caring, individualised attention you provide participants’ and their families

If you feel like you need to compromise on any of these measures you may well be at desperation point, in which case I urge you to read on. The following four ideas are just the start in exploring ways to reduce costs and increase quality.

 

1.     Start with your people

Staff are, by far, the most significant cost in operating as a disability service provider so they offer the greatest potential for cost savings. But this should never be at the expense of service quality. I often remind providers that the magic happens between the support worker and the participant. The relationship between a support worker and participant (and often their family too) is your product - without that relationship you have no reason for existing. Investing in getting that relationship right is your best opportunity for creating high quality support for participants.

When you do a great job of matching participants with support workers their loyalty will most likely lie with the support worker – I know mine does. So, if you want my loyalty treat my support workers well. Not only will being an employer of choice help you develop long term relationships with participants and their families it will also reduce staff turnover. Ka-ching!

Since the early days of NDIS there's been much talk of creating autonomous teams as a method of reducing costs and increasing quality. It's important that the approach you take to this is appropriate for the Australian culture and nature of our disability support workforce. It might be helpful to start your journey to greater frontline autonomy by developing a high trust work environment.

 

2.     Get organised and go digital

Quit using manual and paper-based systems – it wreaks of unprofessionalism and it’s simply inefficient. Start by mapping your existing processes to identify activities that are duplicated, can be automated or improved through redesign or, don't add value and can be eliminated all-together. I once followed a paper-based request for support for 10 days across 7 desks in 3 different departments. Process mapping led to a redesign which centralised the request in a cloud-based CRM for review and action by 3 individuals in less than 48hrs. Service quality improved with faster on-boarding of new clients and reduced likelihood of losing requests somewhere along the paper trail.

Use of a cloud-based CRM can reduce costs and improve quality in a wide variety of ways not least of which is the ability to track progress towards participant goals - information that can position you as great value for money. 

 

3.    Support self-determination

Evidence shows a link between self-determination and quality of life for people with a disability and their families. There are a number of ways providers can structure their supports and access to their supports which give participants and their families greater control at a reduced cost to the provider including self-selection and booking of support workers and online registration to community-based programs and activities.           

Enhancing self-determination will also future proof your supports in the context of an increasingly sophisticated and independent market.

 

4.     Focus on your Sweetspot and collaborate

Too many providers I work with want to be everything to everyone, a ‘jack of all trades’. But as the story goes the result is a ‘master of none’. I’m experiencing this right now with one of Nicky’s providers, well and truly one of the ‘jack of all trades’. Nicky has some very specific and ambitious goals set for capacity-building this year and she can’t afford to work with a generalist provider. I’m seeking a specialist who can best support Nicky in meeting her goals.

The first step for providers is to determine where their unique strengths lie in relation to competitors and NDIS opportunities – this is what I call the Sweetspot. The second step is to establish a network of similarly minded providers who can work together in supporting participants to find the right provider, or team of providers, to meet their individual needs and preferences. The ultimate goal is better outcomes for participants and greater efficiencies for providers as they focus resources where they have the greatest impact.

In a market with fixed prices and a 100% increase in competition including providers with lower cost business models improved efficiency is essential but never at the expense of quality. Consider all options first and reduce quality at your own peril.