Problem: Organization X, an organization that serves at-risk and homeless youth in King County, is facing challenges with their contracted counseling agency utilized to serve clients. The contractor has been underperforming in a variety of different ways including missing appointments and appearing to not hold the cultural competency necessary to adequately serve Organization X clientele. Unfortunately, because Organization X has such an expansive service area, securing an alternate agency to contract that is willing and able to meet this demand has been challenging. Additionally, Organization X is operating with a limited budget to secure these services and may not have a realistic budget for the market value of their desired services.
The current counseling services provided and the way they are delivered do not address the array, depth, quality, or flexibility of services Organization X clients require to receive effective interventions and support.
Objective: To secure a sustainable counseling service that allow effective interventions and support. This is a multi-faceted objective as it strives for long term sustainability. The driving objective is that clients are satisfied with the services received, that services are delivered with an equity lens, and that the interventions and services provided are effective. Additionally, the counseling providers will need to have a consistent delivery model that maintains the flexibility needed from Organization X clients, that is also within the agency’s budget and addresses their complete service area.
Due to the problems in the operation of the existing model, a sustainable practice will require formal operationalization including multi-way feedback loops and regular performance assessments.
- Utilizing multiple vendors to provide services throughout King County.
Pros: Providers located within the community that they are serving will be more closely connected to the community and will be primed to understand nuances of the community being served. Additionally, it will provide more autonomy to Organization X, if an individual provider is underperforming, they will be able to adjust their relationships as needed. Additionally, this model could offer different funding models (pro bono, residencies, etc.) that would align with the service-oriented nature of Organization X.
Cons: This model comes with the risk of inconsistent quality of service providers, more staff time spent in coordination for clients and for administrators. Because this model is highly variable it could have impact on the effectiveness of treatment. Finally, the implementation time would be the longest of all considered alternatives as it requires the most research, labor, and operationalization
2. Maintain status quo and find time to do a deeper assessment of the issue.
Pros: This model would require the least staff intervention and would maintain the low cost of operation. Additionally, this model could also be used to bide time while more information is collected regarding clients’ needs and desires from a counseling provider to create a clearer analysis of the problem. It also maintains the low cost of the current operating model, allowing Organization X to utilize funds for different services and programs that are desirable to their clients.
Cons: The risks associated with maintain the status quo include furthering trauma to those receiving inadequate service, and ultimately undermining the mission of Organization X. Additionally, this inadequate service could lead to harm to clients and the erosion of Organization X’s reputation among clients and the sector at large.
3. Work with the current vendor to build capacity and address service gaps.
Pros: Advantages of this model would include maintaining existing relationships with providers and clients, maintaining the strengths of the existing organization, and keeping the same low cost (though this is variable, and could have some changes). While this method would take increased staff resources, it would still be less than alternative options and would provide better outcomes to those seeking services. This would also be an ongoing effort so implementation time would be ongoing with some quick wins, and some longer-term goals. Additionally, by building the capacity of the existing organization, Organization X would be building a strong partner within the sector – allowing for further reach beyond their organization.
Cons: This model would take a significant amount of labor from Organization X, it would rely heavily on training, and could require spending more resources and involving outside organizations. Because the implementation process would be ongoing, the variability in services provided still poses risks to those receiving services.
4. Hire a service provider as Organization X staff to serve clients directly.
Pros: This model would allow Organization X complete control over the services provided and the scheduling of the provider. It would eliminate the ambiguity of utilizing a contracted service and allow training to the Organization X mission and vision. While there are many unknowns of what this model could look like (such as staff cost, training time, etc.) it also serves the mission of Organization X most directly.
Cons: Hiring an in-house provider might damage the relationship with the contracted organization, it may provide inconsistent service to clients, and will require more staff time and resources to recruit, train, and work with a new employee. Another risk to consider is the longevity of staff. By placing resources, training, and client trust into one internal staff member, Organization X risks facing this issue again and retraumatizing clients when this person leaves the organization or is ineffective.
Conclusion: While the weighted consideration did alter the margins between the options, it did not fundamentally change the ranking. Option one (securing multiple service providers) is overshadowed and cannot be considered for implementation. Because options 2-4 have such close margins it is advantageous to build a strategy implementing elements of all options.
Judgmental biases that were considered, and the steps taken (or needed) to mitigate them are listed below.
Anchoring: The assumption that the current service provider is inadequate overlooks the strengths that they are currently bringing as a provider, and therefore influences their rankings in effectiveness and client satisfaction without any true data to confirm this. To lessen this data around shortcomings such as frequency of missed appointments, client satisfaction, and implementation of effective interventions would need to be measured.
Overconfidence: There is a belief that Organization X staff and administrators understand the need of the population and the shortcomings of the contracted provider. However, because the staff is not representative of the service population it is overreaching to treat this lens as an absolute assessment.
Loss aversion: Half of the alternatives considered are centered around loss aversion (maintaining the status quo and capacity building) – as there is a perception of greater risk around losing the current (ineffective) model, because it does provide a certain level of service that Organization X can offer to clients.
Ethical considerations: Need data and input from the clientele served. The problem statement and understanding are inadequate without their input. It is unethical to make decisions about service providers without representatives of the service demographic’s input and perspective.
Final Decision: A combination of capacity building and brining in-house staff to serve clients will most adequately address Organization X’s operational problem. This method would utilize the existing strengths of the current partner including the low operating cost, large service area, and existing relationships with clients and would supplement gaps with an in-house provider as Organization X works with their vendor to build capacity, and more accurately understand the needs of their service population.
Proposed Implementation: Before implementation it would be crucial to gather input from the service population to add weight to different categories, assess the implications of each plan, and to seek insight into the decision makers’ biases.
Once this is done and if the conclusions drawn from this assessment remain the same, the implementation would be a three-part process.
The first step would include a deep dive data pull to determine what client needs are and how to evaluate success metrics of the services provided. Information would include effectiveness of equity trainings, availability, perception of trust within the service community, the quality of interventions offered, and other measures that were mutually defined by providers and clients. Additionally, assessment framework and timelines would need to be agreed upon by the provider and Organization X. The regularity of check-ins and performance reviews would be agreed on as well as objectives.
The second step of the implementation timeline would be hiring an in-house provider to serve immediate needs of clients that went unmet by the contracted provider during the period of capacity building. This position would also serve as on-call when and if appointments are missed so that clients are not underserved. This step would require the recruiting, hiring, and onboarding of a new staff member. To be truly effective this staff member would have to not only bring technical skills and solutions for clients, but would also need to have a high degree of training in equity informed service and the Organization X mission to be truly effective. Simultaneously Organization X would be working with their existing partner to train and assess performance with the goal of capacity building.
The final step of implementation would be regular assessments of effectiveness and client satisfaction, with adjustments made as necessary and continued equity trainings.