The management of productivity in the operation of vocational rehabilitation programs

The technical efficiency of 75 of the Veterans Health Administration's Compensated Work Therapy (CWT) vocational rehabilitation programs was evaluated, and explanatory variables tested for their influence on efficiency.; Technical efficiency measures the extent to which a program produces the maximum outputs from available inputs. Measurement of efficiency was accomplished through the use of Data Envelopment Analysis (DEA), a non-parametric, production frontier analysis technique that calculates the efficiency of each program by enveloping inefficient programs in the best-practice frontier, and ranking them in relation to the most efficient.; The existence of wide variation among programs in efficient use of resources was supported by this research.{09}Inefficiency represents unused capacity that could provide additional access to treatment if less efficient programs increased productivity levels to those of the most efficient programs. The analysis demonstrated that utilizing the reserve potential of all programs could allow more than 10,000 more individuals to participate annually without the allocation of additional resources.; To guide managers in the improvement of productivity, the second part of the research tested clinical, organizational, and managerial variables to determine their influence on efficiency. Many evidence based clinical practices, such as case management, case review, and staff accountability for outcomes were found to improve clinical efficiency (the production of successful outcomes). However, case management decreased operational efficiency (the number of participants and contracts). Moderate support was found for the influence of specific leadership characteristics on efficiency. In addition, efficient managers are responsible for effective clinical practices, supporting the notion that management decision making is central to establishment, maintenance and study of efficiency.; It is clear from this research that the cost of inefficiency is substantial, whether measured by the inefficient use of scarce resources or the lack of treatment access for potential participants. The research has also clearly determined that the factors influencing efficiency are primarily aspects of good clinical process that should be elements in the rehabilitation of individuals with mental illness. These are treatment models of long standing application, substantial research support, and acceptance in the treatment and rehabilitation community. They also show a significant effect on efficiency. Implementation of these practices is the concluding step in this process.