DEVELOPING A COMPETENCY BASED HR MANAGEMENT SYSTEM

IN A HEALTHCARE DELIVERY ORGANIZATION

A CHANGE JOURNEY

VI International Conference on HR Innovation

Zabrze (Poland) - 25th November, 2016

Ettore Turra, APSS Trento

ettore.turra@apss.tn.it

Ettore Turra http://www.linkedin.com/in/ettoreturra

ettore.turra@apss.tn.it

AREA DIRECTOR – APSS Trento

Director of Management Systems and Member of the APSS Board • more than 10 years in the General management of

one of the largest Italian public Healthcare Delivery Organizations (8,000 employees, +1B € budget) • Manager of

increasingly complex organizations, processes and projects

PROFESSIONAL EXPERIENCE

Director of the Management Systems Area, APSS, Trento (2011– present)

Director, Innovation and Change Management, APSS, Trento (2007- 2011)

Director, Organization (Office of the CEO), APSS, Trento (2003–2006)

The APSS Management Systems Area employs more than 60 individuals, it is organized on three management layers

and it has a financial responsibility of 16+ millions Euros.

OTHER SELECTED PROFESSIONAL EXPERIENCES

Siebel Systems, Senior business manager, Alliances (2001–2003)

Arthur Andersen Business Consulting, Director, Principal (1998–2001)

EDUCATION

Degree in Business Administration, 1989 • Università Bocconi, Milano

CERTIFICATIONS

IPMA Certified Senior Project Manager (LEVEL B) by pma Projekt Management Austria (7/2004 – 7/2012)

Certified Scrum Product Owner (CSPO) by Scrum Alliance (9/2016 – 9/2018)

SKILLS (top five in Linkedin, 1000+ followers)

Change management, management/consulting, strategy, business process re-engineering, IT strategy

Topics

• Introduction: change management and projects

• HR innovation in Healthcare Delivery Organizations

• APSS case reflection one: the importance of why

• APSS case reflection two: HR split is not inevitable

• Appendix: APSS HRMS highlights

• Conclusion

Change management and projects

Why organizations change ?

Organization can survive in a dynamic environment if

their speed of learning and changing meets the dynamic

of their environment

Reasons for changes can be either:

Interventions from the relevant environment (clients, suppliers,

shareholders…)

Internal dynamics, based on the self-organizational capabilities

(strategic planning and controlling, monitoring the

environments…)

Change management allows to deal with the dynamics

of organizations

Projects as a way for organizing change

Source: R.Gareis, M.Heumann - International Journal of Project Management 26 (2008) 771–772

• Projects are functional to change and innovation

• Projects provide an impetus to overcome resistance

• Projects as “learning organizations”

Change is normally played in phases

Conception Pilot Roll-out

Performed by:

Working group or

project

Performed by:

Project

Performed by:

Project

Daily operations

Change goes in two directions

Top-down changes (PUSH)

Engagement

Commitment

Changes arising from the line (PULL)

Overcoming the Resistance to Change

Source of resistance

Strategy

Loss of control Involve those most affected to change in make choices, in the

planning, giving them ownership

Excess uncertainty Create certainty of the process, with clear and simple steps,

and timetable

Surprise (no time to prepare for consequences) Avoid to keep change in secrets and then announce them all

at once; it’s better to seek inputs and feedback..

Everything seems different To minimize the number of unrelated differences by a central

change, to remain focused on the important things

Loss of face (for people associated with the past, with

what did not work)

Celebrate those elements of the past which are worth

honouring, the world is changed

Concern about competence Over invest in information, training, support, systems…

More work

Reward and recognize participants

Ripple effects, interferences to distant activities which

are not directly related to the change itself

Considered all affected parties, however distants

Past resentments Heal the past before sailing into the future

(I’d say also to gather information about the pre, before to

treat it..)

Sometimes the threat is real Be honest, transparent, fast and fair

Adapted from: Rosabeth Moss Kanter, “10 Reasons People Resist Change. Which ones are hurting your company?”

Harvard Business Review (25/9/2012)

Change requires alignment

Alignment of organizational design elements

VISION

VALUES

STRUCTURE

RESOURCES

RESULTS

CONFUSION

RESISTENCE OR

RESILIENCE

ANXIETY

FRUSTRATION

From: F. Lega in “Strategia e Performance Management nelle Aziende Sanitarie Pubbliche” EGEA , 2012

VISION

VALUES

STRUCTURE

RESOURCES

VISION

VALUES

STRUCTURE

RESOURCES

VISION

VALUES

STRUCTURE

RESOURCES

VISION

VALUES

STRUCTURE

RESOURCES

HR innovation in

Healthcare Delivery Organizations

HEALTHCARE – CHANGE DRIVERS

EXTERNAL ENVIRONMENTS

• shifts in healthcare demand (ageing population)

– growing incidence of disability and chronic disease

• new healthcare financial realities

– public and private payers struggling to hold down healthcare costs,

increase access and shift to new strategies

• technological change

– medical technology and science advancements, enabling changing treatment approaches (in Information Technology, we are moving toward real-time, situationally aware, mobile, on demand communications and collaboration)

• social

– The rise of consumerism and the changing role of the patient, with expectations of participation in healthcare decisions and access to an expanding array of online information and real-time support

HEALTHCARE – CHANGE DRIVERS

INTERNAL ENVIROMENTS

• hospital consolidation and re-orientation (the current focus is the episodic treatment of illness and hospital based care for a single patient)

• integrated care for clearly distinguishable groups, across sectoral boundaries (i.e. primary, ambulatory and hospital care as well as social care)

• process orientation

• new professional geography (skill mix) and competency development

• …

From drivers to priorities to implications

• In services companies people are a key competitive advantage

• Even more true in healthcare companies, as the workforce

competencies directly affect the health of their constituencies

• The changing nature of healthcare drives clinical transformation

• The financial reality requires to work better on the existing

workforce

• A strong case results for reshaping and aligning the various HR

capabilities:

– HR processes, structures, systems and policies

Strategic Priorities

Business Implications

HR

Implications

External drivers

Internal drivers

The APSS HR development program

THE PERFORMING ORGANIZATION

• The “Azienda Provinciale per i Servizi Sanitari” (APSS) is the regional

healthcare provider in the Provincia Autonoma di Trento (Italy)

• APSS serves 500.000+ citizens/patients

• 8.000+ employees (85% in healthcare delivery) – the APSS most important

asset

• It provides its patients with all care services:

– Health promotion

– Preventive medicine

– Primary and hospital care

– Rehabilitation and long term care

– Mental health

• 2 hubs and 5 spokes acute hospitals; 4 districts, agreements with private

hospitals, outpatient clinics and nursing homes

• Annual turnover: EUR 1.1B

APSS HR development program: strategic objective

To evolve the existing human resource methods

and systems, that are administration focused, by

adopting a new model, centered on the role and

on the corresponding competencies of each

individual

APSS HR development program - context and facts

– A multi-phased change program, made of three projects

– Involving the three main actors of the HR process: the HR

department, the APSS (line) managers and all the APSS

employees

– Program start: February 2007

– Duration: 36 months

Main operational objectives

“organization design” to include the definition of the HR management processes, methods and tools

APSS competency model defined and piloted on selected key roles

realization of the HR change elements according to the organization design

an enterprise HR information system selected and implemented to respond to the specified functional and technical requirements

complete solution (processes and systems) adopted by the organizations and roles impacted by the change

HR

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Realization of Personal Development Plans (PSP)

10 months 9 months 18 months

“Conception project”

for assessing the

proposed

organization design

“Change Implementation”

project for realizing the new

HR capabilities:

processes, structures and systems

(Phase 2)

Legenda: Project/Program Change enablement activity

Alignment of the individual and organizational capabilites

Approval/decision

“Organization design”

project for designing

the new HR capabilities

(Phase 1)

Change enablement – “Champion” role description (25 people)

obiettivo

facilitare l’adozione dei nuovi sistemi e modelli di gestione delle risorse umane a livello locale, svolgendo un

ruolo di supporto e nei confronti della linea e di collegamento con i servizi centrali della direzione del

personale

posizione nell’organizzazione

individuato dal responsabile di Ospedale / Distretto, designato dalla Direzione aziendale

selezionato tra i servizi della direzione dell’ospedale / distretto (servizio infermieristico, servizio

amministrativo,….)

non appartiene all’organizzazione del progetto, ma riferisce funzionalmente ai responsabili dei processi RU,

in funzione delle tematiche affrontate di volta in volta

attività

supporto alla linea nell’applicazione dei nuovi strumenti di gestione delle risorse umane (finalità, contenuti,

applicazione dei nuovi strumenti)

partecipazione alla formazione sui nuovi processi e metodi di sviluppo delle risorse umane

gestione del cambiamento a livello locale (in particolare per la comunicazione - bidirezionale - tra il livello

locale, la direzione del personale e l’organizzazione di progetto)

raccolta informazioni circa le situazioni critiche, identificazione delle soluzioni, collegamento con il team di

gestione del progetto e/o i referenti dei processi RU per la risoluzione dei problemi

ambiente rilevante relazione approccio

Tutti i dipendenti di APSS Livello di interesse / motivazione variabile tra coloro che hanno partecipato alle precedenti attività del progetto (+) e coloro che non vi hanno partecipato (-)

“Roadshow” – evento aperto in ogni distretto/ospedale

Pubblicazioni aziendali: Leaflet/Poster / Articolo APSS Notizie / post-it per avviamento

eTraining (soluzione UPK Oracle)

Responsabili Risorse

•Direttori di AOF

•Altri responsabili risorse (responsabili U.O/servizio – coordinatori.)

Livello di interesse / motivazione variabile tra coloro che hanno partecipato alle precedenti attività del progetto (+) e coloro che non vi hanno partecipato (-)

Per i direttori di AOF workshop processi e demo (0,5 g) + incontri individuali di approfondimento

Per gli altri responsabili di risorse lo stesso approccio adottato per tutti i dipendenti (sono numerosi)

Valutatori

•Distretto di Trento

•Distretto di Fiemme e Fassa

Interessati / motivati a proseguire la sperimentazione anche nel 2009(+)

Preoccupati dal carico di lavoro aggiuntivo e dalla novità dell’approccio (-)

Aggiornamento monotematico (1g * 2/3 edizione)

Manuale aggiornato (per strumentazione semplificata in Peoplesoft e in XLS)

Specialisti RU

•Utenti chiave e altri utenti

•a livello centrale e locale

Per gli utenti chiave e gli altri utenti del sistema (a livello centrale e locale) la relazione è da costruire (non ancora identificati)

Formazione Oracle (integrata da introduzione ai processi) (2gg. + 2gg.)

Formazione APSS (altri utenti): necessità da confermare

Organizzazione di progetto

•Team di sviluppo

•Amministratori di sistema e processo

Compartecipe del successo del progetto Formazione sul campo, differenziata per ruolo

+ Formazione Oracle (sopra specificata)

Ruoli di supporto

•“Champion” (referenti) locali

Relazione da costruire, ruolo da assegnare

“Champion” da individuare

Workshop processi e demo (insieme ai direttori AOF)

Aggiornamento monotematico (1 g.) sulle tematiche di “sviluppo RU” e in generale sui modelli introdotti dal progetto

Help Desk

•I livello

•II livello

•Referenti di processo

Relazione da costruire, ruoli da definire (da documentare il modello di supporto per il primo rilascio, per i successivi e per la fase di post-implementazione)

Da definire

Gruppi di dipendenti, di rappresentanza e assessorato alla salute (PAT)

Variabile a seconda dei casi, ma in generale di bassa consapevolezza

Incontri / presentazioni ad-hoc (separati) corredati da documentazione specifica appositamente predisposta

Change enablement

Stakeholder analysis +

Communication Plan

APSS case reflection # one:

The importance of WHY

Horizontal components

Vertical components

Role and competency profile

Specific

activities in a

particular

specialty –

subspecialty

Commonly

performed

activities in all

physicians’

specialties

Competency model

Methods

– a catalogue (group or sets of clinical competencies / privileges)

– a standardized, objective process to evaluate the individuals in

terms of competency levels

– a skills / competency analytical system

•horizontal development (cross boundaries)

•based on specialties / pathways/ teams (not on

organizational silos)

• with the participation of the clinicians

how

AREA “Basic / core activities”

GROUPS OF ACTIVITIES / PROCEDURES:

-Attending patients in a setting

-“Perform consultations”

-“Advanced ambulatory care”

Catalogue of performed activities by specialty

To document (or to grant) the level of autonomy in which the activities are

performed in a specific context

Livello Descrizione

0

N/a

Al momento il professionista non è assegnato all’attività / procedura nel

proprio contesto lavorativo o non ne ha mai fatto esperienza

1

Esecuzione

affiancata

Al momento il professionista esegue l’attività / procedura in affiancamento

di un professionista esperto

2

Esecuzione

autonoma

Il professionista esegue l’attività / procedura in autonomia mantenendo il

collegamento con un collega esperto per problemi nuovi, complessi,

urgenti

3

Esecuzione

avanzata

Il professionista esegue l’attività/procedura in piena autonomia e risolve

problemi, nuovi, complessi, urgenti, anche supervisionando i colleghi

Grading categories

Competency Gap Analysis based on

- organization objectives / targets

- practitioners clinical performances

- poor outcomes

- etc.

Competency Gap Analysis

•to understand which actions can be performed in practice

to fill the gap in a specific hospital structure (recruiting,

development, training…) in the new financial reality

•incomplete / polarized adoption and satisfaction by the

different physicians’ groups

Main outstanding issues after implementation

MAIN NEEDS

to protect the patient safety

to advance the quality of clinical services

ADDITIONAL BENEFITS

for the physician

-to document his/her professional growth in a time period

for the departments/wards:

-to identify gaps in the competence distribution (as is / to be)

-to inform training and development plans

for the Company :

- to support organization development plans, based on HR competency data

(where the competencies are vs. where they should/will be…)

Why mapping the clinical competencies

1. Organization presentation

2. Past years review

3. Organization and personnel:

• clinical competences

distribution - analysis

4. Prospective scenarios

5. Impact and action plan

Demonstration - Use of the Gap Analysis in a HR master plan

Lesson learned – the importance of why

APSS case reflection # two:

HR split is not inevitable

Structural changes recommended for implementing the change

A new structure for the HR department was defined for better supporting the

delivery of future results in a way that aligns the structure with the other elements

of the organization (i.e. processes and systems)

AS-IS

TO-BE

Reasons for structure alignment

• The structural changes proposed for the HR department (100+

people) were based on the following considerations regarding the

existing structure:

– “Support” sub-processes dispersed between two organizations and

several locations (centralized – decentralized), with no single point of

contact for the employee

– “Development” sub-processes (mostly new to the organization) not

integrated within the existing structure, lacking of efficient and effective

workflow

– Insufficient attention to the organizational planning, which is currently

performed by the same unit focused on the more operational and

administrative tasks

– Not emphasizing horizontal tasks, collaboration across units, focus on

processes

– Skills related to the new sub-processes to be created

Reflections by the project team

Structural Options Benefits Limitations

a) “New HR structure upfront” Less time to introduce change

On the field training for those people

who look after the new sub-processes

Immediate accountability of the HR

managers for the new sub-processes

and for the change

Lack of skills for guarding the new

sub-processes

Risk of confusing the employees

on what HR services are offered by

whom in the transition phase

Anticipated resistance to change

by the HR department employees,

also for the additional workload in the

transition phase

b) “Incremental approach” More incremental approach

Better integration among all the design

components

Gradual “absorption” of the required

skills

Piloting the new sub-processes and

changes in the project sub-teams,

representing the structure “to be”

More time for realizing the change

Higher risk of “disengagement” to

the change process by the HR

functional leaders

Project Team agreement:

to proceed with the option (B) – more incremental approach

to “use the project as a bridge to the future organization design”

incremental approach considered to offer a higher potential for involvement and learning

What’s happened, then ?

• The transition to the new HR organization it was never

performed

• HR capabilities are now dispersed (split) among the staff

and the Line (not an infrequent situation)

• changing an organizational structure inevitably involve

people’s emotional reaction to change

• in recognizing that different levels of “change readiness”

exist within the organization, a change readiness

assessment should be accurately performed before

implementing a HR innovation

• inclusion of key HR stakeholders in the project does not

ensure the results

– Leaders should overinvest in structural reassurance;

they also need to consider all affected parties, however

distant

Lesson learned

APPENDIX

APSS HRMS Highlights

Organization Planning and Measurement

Process

Improvement

Performance

and Skills

Development

HCM

system

• To decrease paper flows

• To integrate processes

• To automate workflows

in realizing processes

• To increase the

efficiency / effectiveness

of the recruitment

process

• To provide direct access

to data and functions

(via self-service)

• To formalize APSS organization structure (structures,

roles, positions, people)

• To analyze and plan the organization based on roles and

skills requirements and not (only) on contractual levels

• To provide data integration for performing HR analysis

• To increase employee

satisfaction

• To increase individual

and team performances

• To structure competency

evaluation and

development activities

• To increase the efficacy

and personalization of

the Training and

Development activities

HRMS at APSS – why an enterprise application

POSITION

STRUCTURE

CONTRACT

HR Data - employee record (+8,000 employees)

ROLE

Manager Self Service – Performance appraisal (5000+ per year)

Fascicolo Virtuale – profilo personale (fascicolo virtuale) Employee self service – Credentials

Employee self service – on line request (internal transfer)

Process Automation – Recruiting

Workflow – Travel approval

Request

Approval

Expense report

Approval

Workflow – Expense approval

“change brings opposition, and opposition is

much easier to advocate than change”

Tony Blair – A journey (Knopf, 2010)

Conclusion

Questions