Royal Institute for Deaf and Blind Children (RIDBC) is Australia’s largest non-government provider of education, therapy and cochlear implant services for children and adults with vision or hearing loss, their families, and the professionals who support them.
The range of specialist services available at RIDBC is unique in Australia and benefits thousands of people each year. Chief Executive Chris Rehn spoke with The Australian Business Executive recently to explain the aims of the organisation, to achieve the best outcomes for people of all ages with hearing or vision loss throughout Australia.
“When I first studied, I actually studied to become a registered nurse,” Mr Rehn says, “and found my way into hospital management, both public and private. In the process, I also did a business degree and an MBA, and found myself as an executive running private hospitals.”
Mr Rehn eventually left hospital work to become an accountant, which he says was an unusual choice for him. This career turn did not last particularly long, as he admits that he wasn’t particularly good at it.
“I then decided to re-enter and go into an area of health that I knew nothing about, and that took me to a very small start-up organisation called the Children’s Cochlear Implant Centre, and that’s where the cochlear implant technology was in its absolute infancy in Australia.”
This resulted in Mr Rehn becoming part of the evolution of an important service known as the Sydney Cochlear Implant Centre, considered the second largest of its type in the world, which became part of RIDBC under the new name SCIC Cochlear Implant Program in 2014.
“I had worked alongside RIDBC in my capacity running the Sydney Cochlear Implant Centre, and when the vacancy for Chief Executive came up here in 2010, I moved across with every intention of bringing my previous organisation into the fold in the years ahead.”
Mr Rehn admits that working in healthcare for so long has taught him many important lessons about how to go about running a business where the needs of patients are so great, and the outcomes so important.
“When I worked in corporate health,” he says, “I had to deliver on 70-80 KPIs on a daily basis. And what it taught me was, it gave me no freedom to design the care model which I thought was important, that would ultimately lead to the best possible patient outcomes.”
From this experience, Mr Rehn learned that a business putting its focus on superior client care can easily make a profit model work in conjunction, but a business focusing solely on profit will find it very difficult to deliver superior care alongside it.
“I’ve learned that. Obviously as a not-for-profit organisation our reason for being isn’t to make profit, but we have to be sustainable. We focus on getting it right for the client first and foremost, and make the business model stack up behind it.”
When this model is laid out in the best possible way, it can work incredibly effectively, but Mr Rehn admits it can diminish outcomes not only for clients but also for the future of the organisation itself if not.
“One of the great things about having moved from the corporate world into the not-for-profit space is, we get the ability to go into the areas and deliver care in a way that we believe is the right way. We really focus on getting it right at that client level.”
RIDBC is a growing organisation, seeing more clients and providing more services each year. The secret to this, Mr Rehn explains, is to make sure that the core services and activities offered to clients are of the very highest quality.
“The Royal Institute for Deaf and Blind Children started in 1860,” Mr Rehn tells us, “so it’s the second oldest charity in Australia. Our reason for being is to achieve the best outcomes for people with hearing and vision loss.”
In the past, the organisation was more centralised and focused particularly on education, but in recent years it has become a multidisciplinary service provider, looking after anything from education through to disability and health services.
“We operate out of eighteen sites across Australia,” Mr Rehn explains, “we’re in all states and territories, and where we’re not physically in those states or territories, we provide services remotely by leveraging technology.”
Changes in the running of the organisation since Mr Rehn’s arrival have been focused around a new strategic direction consisting of three main elements. The first of these elements is the aim to reach more people across Australia.
“We do that by building more sites and services across Australia. That could be physical shopfronts where we can provide a range of services from. We’ve also acquired, or merged in with, other organisations that perhaps are strategically evaluating their future.”
By bringing other organisations into the fold in this manner, forming lasting partnerships beneficial to all parties, RIDBC has been able to increase its footprint across the country, helping it offer a greater range of services.
“The second [element] is, we’re in the process of designing a new future at Macquarie University. We’re going to relocate our Head Office, which is at North Rocks at the moment, and the HO of SCIC Cochlear Implant Program, which is at Gladesville.”
This relocation will help RIDBC become an integral part of the Australian Hearing Hub, sharing in work done by the university and other partners, building centres of excellence in hearing and blindness and deaf-blindness.
“The third foundation of our strategic plan is really about ensuring that we’ve got a vibrant brand,” Mr Rehn says, “and that we are a sustainable organisation and we’re here for the long run. We owe it to our constituents to be around for another 157 years.”
This is one of the most important elements, as Mr Rehn notes that issues relating to hearing and vision loss are not going away. RIDBC needs to make sure it continues to build its organisation to remain relevant and meet the community need.
The organisation is currently undertaking a brand review project as a response to the general misconception that RIDBC is only involved with helping children with vision or hearing loss, a misconception that has proved hard to shake.
“Within our name there is a whole heap of challenge points. The ‘Institute’ part speaks of our earlier days, where we were an institution where children lived onsite and received services onsite, which was the way disability was dealt with in a big part of our past.”
In the modern day, the way treatment is given is completely different, with almost all programs offered by the RIDBC now being day programs, and services provided in a school environment or in a as-needed, hour by hour basis.
“‘Deaf and Blind’ speaks to the problem. We’re more about hearing and vision, and equally we look after people with low vision or some levels of hearing who wouldn’t necessarily associate themselves with being blind or deaf.”
The most significant part of the name seems to be the use of the word ‘children’. Although the organisation deals with a significant amount of young people, it also services a large number of adults, especially those with hearing loss through its cochlear implant service.
“There’s a lot that isn’t current in our name,” Mr Rehn says, “and we’ve been very carefully going through a discernment process to work out whether a re-brand’s in order. We’re also conscious of not losing our identity with existing donors and supporters.”
In terms of hearing loss, Mr Rehn says Australia should count itself amongst the luckiest countries in the world, as it has the best services, technology, good levels of private health and government support. Yet not all Australians are using the services as they should.
“The amount of Australians that need hearing devices, be it hearing aids or cochlear implants, we’re really just scratching the surface. We’re seeing something like 8-10% of the known population that could benefit from cochlear implantation actually accessing one.”
RIDBC is focused on building the infrastructure around the country to make sure the technology is accessible, working with government, private health and philanthropic support to make sure there aren’t financial impediments for people needing to access the service.
“Australia,” Mr Rehn adds, “even at 8-10%, would be one of the highest uptakes of cochlear implantation around the world. I think, for me, the job is done on hearing loss when all Australians who need this technology have had access to it and are receiving it.”
National Disability Insurance Scheme
Similarly, in the new National Disability Insurance Scheme (NDIS) landscape in the country, it is important for RIDBC not to get lost in the mix with so many new brands popping up, and not to lose its status as a historically trusted organisation.
“The NDIS is a bit of a game changer, because it invariably removes funding from organisations that provide services and [puts] that funding in the hands of people who are users of the service, so it’s really about giving a person with disability choice.”
Mr Rehn strongly supports the commitment to offering more choice to disabled people, but admits that the reality of the scheme for many not-for-profit organisations is that they are now required to compete with lots of other services in a tougher environment.
“Instead of receiving block funding from government, then going and finding clients that need service, they have to compete in an open market environment for delivery of services, and only get paid at the point where the client has elected to come with that service.”
For a large organisation like the RIDBC, government funding represents just 25% of revenue. Although it will face significant changes due to the rigmarole of the NDIS, it won’t struggle as much as many smaller organisations, some of which just cannot cope.
“We will suffer as a result of a drop in block funding,” Mr Rehn says, “and having to establish marketing activities and a lot of administration that is required to deal with the NDIS agency, it certainly puts us through administrative difficulties.”
Smaller organisations, those looking at about 4 or 5 million dollars in turnover a year, are more likely to be 80-90% block funded by the government, meaning they must find and compete for clients in an increasingly tough market.
This change has meant many smaller organisations have had to look carefully at their future, faced with a choice between going it alone in the open market, winding up the business altogether, or merging with bigger organisations in order to stay afloat.
“We’ve seen, as an industry, a lot of organisations approach us saying would we consider their service coming in under our umbrella, and we’re looking at it very carefully. We want to make sure that there’s a high quality response to people where they fit within our mission.”
The unintended consequence of the NDIS is that it is likely to limit the amount of not-for-profits able to deliver service. According to Mr Rehn, some would argue there are too many organisations out there, and that a change in funding would be good for the industry.
“We’re probably blessed,” Mr Rehn says, “as a result of good governance, and I mean that at a board level, where in our 157 years we’ve actually accumulated a fairly healthy balance sheet, and we have a very strong donor base that supports our work.”
This means that RIDBC is in a good position to take on other entities, but the truth is that when merging with other not-for-profit organisations there is a good chance they will be companies that are making a financial loss.
“Loss in the not-for-profit world is not a bad thing,” Mr Rehn explains, “if it means a bigger impact on mission. But it’s got to be sustainable. If an organisation loses money every year, it won’t be around for a long time.”
This means one of the main challenges is that some loss making organisations are looking for some kind of rescue by bigger organisations, coming to the realisation that the business model is not sustainable in the long term.
“The challenge for us is, how do you re-calibrate those services to ensure their ongoing sustainability and viability, and most importantly, a high quality of service to the constituents who are reliant on them?”
For organisations like RIDBC, one of the most important considerations in acquiring not-for-profits is that the process is done entirely on good will, meaning the alignment of cultures and missions is absolutely vital to achieving a smooth process.
“You actually have to really be a trusted partner organisation, because essentially they gift their assets to you in the hope that you will take what they have developed over many years and further their work.”
This is in stark contrast to a commercial acquisition, where payment would be made for a business before the parties go their separate ways. Trust is therefore the most important aspect of deals where a not-for-profit is being absorbed.
“It is absolutely key to get the relationships between the two organisations—the management structures, the boards—well aligned on the intent of what would be a merger. We’re doing this at the moment, with a very good organisation in Victoria.”
The organisation RIDBC is merging with has been focused on hearing services for years. Its board has been strategic in looking at the future and identifying organisations that would be suitable for a merger, a process which identified RIDBC as the best candidate.
“It requires a lot of work, a lot of trust, but at the end of the day it’s a very efficient model of how to expand services, how to bring more high-quality services to more people, and not see that market failure that would happen should an organisation decide to close up.”
One of the key strengths needed in the not-for-profit space is to have serious, high-calibre leadership, and for there to be no excuses for second class business practice merely because there is no commercial profit being made.
“It is more important that we show full accountability for the uses of our funds. It is absolutely mission critical that organisations that are not-for-profits are better than corporate in terms of their responsibility to use funds wisely and achieve sustainability.”
Mr Rehn explains that a lot of the focus for the board and senior leadership team at RIDBC is to make sure it behaves better than corporate and commercial companies, making money go far and wide and having a real impact on its mission.
“RIDBC has a very comprehensive fundraising department, and it does everything from running a rainbow lottery, through to working with corporate Australia and partnering with them, to community events like City2Surf and the Coleman Greig Challenge.”
In addition to this, the department oversees individual donors that have been generous enough to leave money to enable the organisation’s work to continue past their own lives, which is a wonderful commitment to make.
“It’s a really diverse portfolio of activities,” Mr Rehn says, “everything from direct mail to corporate Australia to individual giving. It’s amazing, the types of levels of support we receive. Today, about 50% or thereabouts of our revenue has come from the community.”
Mr Rehn admits that the dynamic is changing, and many donors are now too spoilt for choice in the amount of organisations they can donate to. RIDBC is in a positon where, as a longer serving charity, it has retained many donors over the years.
“The giving patterns of Australians [are] changing, and the newer generations are not necessarily giving in the same way as their predecessors, so we’ve had to adapt and evolve to much more peer-to-peer fundraising activities.”
These activities seek support from a friendship network, with the charity often remaining in the background. Mr Rehn believes fundraising makes the difference between a good level of service and a great level of service, and will always be part of RIDBC’s activities.
“If you looked at children with vision or hearing loss, giving them the best start to life requires a lot more activity in those formative years, and fundraising really means that we can pull out all stops and give them the services they need in the most comprehensive of ways.”
Mr Rehn admits, despite being CEO of the organisation, he has been very lucky over the years to have worked closely with clients, and to have seen first-hand the kind of life-changing work RIDBC performs on a daily basis.
“We are a very comprehensive service provider,” he says, “so we do everything from diagnostic work to running early intervention services, pre-schools. We run three schools, we run tele-practice services, we have a professional development arm.”
No matter the vision or hearing needs of an individual, RIDBC is perfectly placed to provide them, with the wherewithal to make a significant positive difference in people’s lives. One such case is that of a young girl called Olivia.
“I met Olivia when she was about three months of age, when she was diagnosed through screening as having a profound hearing loss. She was assessed for a cochlear implant, and received that as one of the youngest children in the world at eleven months of age.”
Seven years later, Olivia received a second implant, meaning she now has what is called bilateral cochlear implantation. With Australian technology and an extensive rehabilitation programme, Olivia’s hearing improved, and she developed age-appropriate speech.
“As she got into her teen years, she was diagnosed with Usher’s Syndrome, which meant that she would become legally blind, she would lose all peripheral vision and she would really struggle with things like crossing the road and mobilising herself.”
Once again, RIDBC was able to help Olivia, supporting her through its vision services to help her attend a regular school with itinerant support teachers. In 2015, she completed her HSC, achieving an ATAR of 97.5, and is now studying Arts Law at Macquarie University.
“Olivia was a very bright child, and despite the multiplicity of her disability, she applied herself very thoroughly. She had the support of a wonderful family, and we were able to journey with her at every juncture, with services from our organisation that supported her.”
Mr Rehn uses Olivia as an example to show how far the quality of service has moved on. In the 1960s, there was no expectation that children with these disabilities would have access to an education. RIDBC has been providing education to deaf children since 1860.
“Now we look at a child like Olivia,” he says, “who demonstrates that her disability has been no impediment for her reaching her potential, and that’s just terrific, and it sets the benchmark that we aim to achieve for as many of our children as possible.”
Not all children achieve this outcome, but the approach of RIDBC is to try and get the children to be the best version of themselves they can possibly be. With the support of families and the individual concerned, the organisation continues to push for this goal.
On the back of such a successful history, it is important that RIDBC’s success continues long into the future, and Mr Rehn admits that the advancements of the 21st century will be key to the organisation’s longevity.
“Technology is the real game changer,” he says. “If you look at the cochlear implant, one of the biggest challenges for a deaf child learning to speak was that it’s near impossible for them to repeat sounds they can’t hear.”
Even with high-powered hearing aids, which work like a microphone to amplify sounds to a point where those parts of the ear not damaged can still relay a message to the brain, there are some conditions that are so severe that they will never produce any level of hearing.
“No matter how much amplification you make you won’t get a decent signal to the brain in order to develop spoken communication. The cochlear implant, Australian-invented in the 70s by Professor Graeme Clark, really changed the world.”
In its early days, the cochlear implant was used primarily as a tool to help adults to lip-read. Through pioneering work at SCIC Cochlear Implant Program, they are used on children born profoundly deaf, changing the scene worldwide for perfect speech production.
“Whilst our organisation focuses on sign communication for a small cohort of children, the vast majority will be detected at birth with hearing loss, they will go through an early intervention program and receive cochlear implantation under 12 months of age.”
Children with cochlear implants are generally expected to reach age-appropriate speech and language by the time they reach school age, which is an incredible achievement and shows exactly how important the technologies are.
“On the vision loss side,” Mr Rehn says, “we don’t have a cure for vision loss. We don’t have a bionic eye in mass production at the moment, and generally speaking vison loss is usually a cortical issue as opposed to an eye issue.”
Technological changes in the vison loss field can be seen in areas such as personal navigation apps on mobile phones, and other accessible functions that come with new technology, which are changing the lives of those with sight loss.
“For instance, an iPad can be an interface between anything and anything. You can have a Bluetooth Brailler attached to an iPhone that will decode a text message and send it into braille, or it will read it to a person who has vision loss.”
Similarly, satellite navigation allows blind people to traverse cities without getting lost, a significant issue for many blind people that usually means they stick to routine and are unable to travel easily to different places.
Handheld portable devices and the technologies they provide are making a big difference in terms of accessibility. Even something like reading the newspaper can be made easy, through the online screen-reading technologies built into most media platforms nowadays.
“We have technology consultants here and one of them, Mike, he’s a person who was born completely blind—he will show you apps that tell him whether his tie matches his shirt colour, whether he’s left a light on at night before he goes to bed.”
Even something such as choosing the correct currency to pay for services has been turned into a mobile phone app, where the person can scan a note and have it read back to them what currency and denomination it is.
“This technology is making a huge difference in the lives of people with vision loss and hearing loss. Our job, increasingly, is to align the right technology with people as they journey through their educational years, and then beyond.”
Written by Nicholas Paul Griffin.