title: The ideal of consumer choice in social services: challenges with implementation in an Ontario injured worker vocational retraining programme.
abstract: OBJECTIVE
  Social service programmes that offer consumer choices are intended to guide service efficiency and customer satisfaction. However, little is known about how social service consumers actually make choices and how providers deliver such services. This article details the practical implementation of consumer choice in a Canadian workers' compensation vocational retraining programme.
  
  
  METHODS
  Discourse analysis was conducted of in-depth interviews and focus groups with 71 injured workers and service providers, who discussed their direct experience of a vocational retraining system. Data also included procedural, policy and administrative documents.
  
  
  RESULTS
  Consumer choice included workers being offered choices about some service aspects, but not being able to exercise meaningful discretion. Programme cost objectives and restrictive rules and bureaucracy skewed the guidance provided to workers by service providers. If workers did not make the "right" choices, then the service providers were required to make choices for them. This upset workers and created tension for service providers.
  
  
  CONCLUSIONS
  The ideal of consumer choice in a social service programme was difficult to enact, both for workers and service providers. Processes to increase quality of guidance to social service consumers and to create a systematic feedback look between system designers and consumers are recommended. Implications for Rehabilitation Consumer choice is an increasingly popular concept in social service systems. Vocational case managers can have their own administrative needs and tensions, which do not always align with the client's choices. Rehabilitation programmes need to have processes for considering what choices are important to clients and the resources to support them.
authors.affiliation: Institute for Work & Health , Toronto , Canada .
authors.forename: Ellen
authors.initials: E
authors.lastname: Maceachen
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Kosny
authors.forename: Sue
authors.initials: S
authors.lastname: Ferrier
authors.forename: Katherine
authors.initials: K
authors.lastname: Lippel
authors.forename: Cynthia
authors.initials: C
authors.lastname: Neilson
authors.forename: Renee-Louise
authors.initials: RL
authors.lastname: Franche
authors.forename: Diana
authors.initials: D
authors.lastname: Pugliese
mesh_terms: D000062:Accidents, Occupational; D000328:Adult; D000368:Aged; D002170:Canada; D003256:Community Participation; D003258:Consumer Behavior; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009864:Ontario; D016730:Program Development; D015397:Program Evaluation; D012050:Rehabilitation, Vocational / Q000379:methods*; D012947:Social Work; D012959:Socioeconomic Factors; D014942:Workers' Compensation / Q000458:organization & administration*