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Tending to business in human services

by Betty O'Keefe, publications & communications, CARF International

Standards for business practices in health and human services are robust and forward-looking in the CARF model. However, this important area can be underemphasized or overlooked entirely by other accreditors. David Wilber, executive director of Diversified Enterprises, witnessed the difference in results and volunteered his perspective for the white paper Developing sophisticated systems for success, recently published by BB&T Capital Markets.

In the summer of 1982 Dave Wilber got into human services almost by accident. A college student living in Alexandria, Virginia, he needed a job. His summer work as an electrician had fizzled with the housing downturn. Someone his mom knew needed a driver, so he interviewed at a place called the Alexandria Center for Employment. It was a small sheltered workshop.

Dave had no idea what a sheltered workshop was, but he got the job and soon discovered helping people with disabilities was rewarding in a way he’d never experienced. He fell in love with the work, and thus began his 35-year-and-counting career helping individuals with disabilities access employment and inclusion in their communities. Dave’s journey led him from providing direct support to developing programs and eventually to running the business.

In his eight years at the Alexandria Center, Dave generated opportunities beyond piece-rate work through grant funds, developed enclaves and individual supported employment, and created more than 100 community-based integrated jobs. In the years that followed, he went on to senior leadership roles at other organizations, building sustainable business foundations to support their work.

image of quoted textDave's path mirrors that of others in the field, sparked by mission-driven passion, sustained by navigating business realities.

In communications about a recent white paper on business sustainability in health and human services and the impact of CARF accreditation, Dave spoke of industry changes—in regulations, funding, and stakeholder expectations—and the increasing need for providers to tend to business.

“I have seen the traditional not-for-profit charity models fail if they were not able to adapt and develop their business operations,” he said. “To be successful in today's service arena, one must marry a strong business acumen with the desire to do great mission-oriented work.”

Staying alive—continuity of service & business operations

Dave Wilber joined his first CARF-accredited organization in 1990, and nine years later he also became a CARF surveyor, helping peer service providers across the U.S. and Canada apply CARF standards to their programming and business operations. A realization set in: “CARF accreditation is a differentiator for organizations.”

Dave’s understanding evolved through lessons learned, the heart and soul of risk management, including it’s not if something will go wrong but when. He told us about a few of them.

Lesson 1: Unplanned leadership changes can be devastating.

I had worked with an organization that did not have a succession plan and lost its leadership. The board of directors was not well prepared for the event, and there was not a clear path for temporary leadership while a long-term solution was developed. The board, which was volunteer, tried to assume the CEO/ED role and obviously was not experienced in the field so that was not a good solution. After the fact they developed a good strategic succession plan.

Lesson 2: Disaster recovery—anticipate the worst, and plan for even worse.

September 11
I had a close working relationship with many CARF-accredited organizations in the Washington, DC, area. One such organization had a contract to clean offices in parts of the Pentagon. When 9/11 happened, this sophisticated and well prepared organization was not actually able to enact their plans to assist persons served by the organization because their procedures were to go to the job site. That was not allowed—and all communication plans were also scuttled because of the event. Fortunately, no one from this organization was hurt; however, it did force them to take a different look at their contingency strategies depending on an event.

Hurricane Isabel
An organization I worked at experienced a hurricane event in the early 2000s that resulted in several homes losing power for multiple days and programs not being operational due to downed trees and power lines. While the event was unpleasant, the team I worked with was well prepared because of the various health and safety contingency plans we had put into place and as a result into practice. Once it was safe, programs that could be operational expanded to accommodate the needs of the persons served who were displaced, as was planned.

Many organizations busy with their day to day operations do not focus on risk. The CARF standards allow organizations to at least annually review their areas of risk and discuss plans to prevent or mitigate the risk, which allows a team to be responsive should something happen.

Lesson 3: Compliance is about more than red tape.

While preparing a prior employer for accreditation, Dave realized they weren’t performing exclusion-database checks required by Medicaid. He initiated them, and the organization had just completed them when it came under an unannounced Medicaid audit for database checks. With funding at stake, the organization had dodged a bullet.

Good corporate compliance processes are critical to ensuring a strong business foundation, and the CARF standards provide an excellent roadmap to address this often complex topic. CARF has helped my organizations understand both the value and requirement of having a solid code of ethical conduct. This includes making sure we are in compliance with Medicaid fraud requirements, including checking the exclusion database regularly. Many organizations are simply not aware of this requirement.

Lesson 4: You have to keep ‘seats filled on the bus.’

With the national average turnover rate for direct support professionals (DSPs) approaching 45% by some estimates and DSP replacement costs around $5,000 per employee, the importance of employee retention is easy enough to see. Managing it is among the most vexing endeavors of the industry. Dave’s strategy has been to follow the data generated through his outcomes management systems.

Human service organizations are made up of people supporting people. Human resources are a critical part of that equation for successful organizations.

My experience with building performance improvement data around turnover and retention has proved invaluable in helping my organizations meet the expected outcomes of the person served and the organization. This performance data has also helped me identify trends around turnover and address those so we can keep the ‘seats filled on the bus.’ While the entry-level wage is low, one way we were able to increase retention and also focus on organizational outcomes was the introduction of performance-based pay for DSPs. This was implemented based on the use of data and input from stakeholders of the organization.

Preparing for opportunities to thrive

The human service organizations Dave Wilber worked with did more than survive. He and his teams were able to harness systems, find creative ways to mine and use data, and build confidence to thrive.

I have found over the last 10 or so years that growth is less organic in our industry and more strategic in nature. To continue to be a viable and competitive entity, an organization must think strategically. CARF accreditation helped the organizations I was with respond to new business opportunities because much of the performance outcomes data that was requested by funders or for proposals was in place and being tracked.

One organization I was with received an RFP to provide services to persons experiencing traumatic brain injuries. Our accessibility and service access data developed through the accreditation process told us this was a viable population for the organization to support and the market (Virginia Beach) was an important and strategic market location for us to enter. This program opportunity would be the opening for further market access.

As a result of having the data, the organization was able to prepare for this and respond successfully to the RFP. Additionally, as a result of our service access data and operational need surveillance for our area, we also moved into other markets in Hampton and Chesapeake and were strategically prepared for the expansion. This resulted in starting residential services as a new business line as well as supporting an additional 90 individuals in those markets.

Performance metrics and strategic planning rooted in the CARF process repeatedly helped my organizations expand and grow and made the team feel comfortable that it was the right decision.

Earlier this year, Dave Wilber left Virginia for Tifton, Georgia, to accept the executive director position at Diversified Enterprises. His board recently approved transitioning to CARF accreditation for its business advantages. He is leading the effort and is optimistic:

“While growth may happen, ‘Chance favors the prepared mind,’ as Louis Pasteur said. Our organization is prepared for growth and anticipates what will need to be in place to succeed.”

photo of David WilberDavid Wilber has served as chief operating officer for The Arc of the Virginia Peninsula (now VersAbility Resources, Inc.) in Hampton, VA; vice president of Developmental Disability Services at Community Alternatives, Inc., in Norfolk, VA; and chief operating officer of Eggleston Services, also in Norfolk. He was a contributor to BB&T’s white paper.

About the white paper:
BB&T Capital Markets recently published Developing sophisticated systems for success: How CARF accreditation exposes organizations to the systems necessary to thrive. Written by BB&T’s John Franklin, a member of CARF’s Financial Advisory Panel, the white paper explores sophisticated systems as a cornerstone of business success in health and human services.

(Behavioral Health,Employment and Community Services,Performance Management and Improvement)

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