Slidedeck used at the HR innovation workshop in Zabrze (Poland). Zabrze is an industrial city that is rethinking itself to be a dynamic digital government starting from HR development.

1. 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

2. 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

3. 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

4. Change management and projects

5. 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

6. 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”

7. Change is normally played in phases
Conception Pilot Roll-out
Performed by:
Working group or
project
Performed by:
Project
Performed by:
Project
Daily operations

8. Change goes in two directions
Top-down changes (PUSH)
Engagement Commitment
Changes arising from the line (PULL)

9. 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)

10. 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

11. HR innovation in
Healthcare Delivery Organizations

12. 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

13. 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
• …

14. 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

15. 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

16. 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

17. 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

18. HRmanagementprocesses
andsystems
Changeenablement
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)

19. 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

20. 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
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

21. APSS case reflection # one:
The importance of WHY

22. Horizontal components
Vertical components
Role and competency profile
Specific
activities in a
particular
specialty –
subspecialty
Commonly
performed
activities in all
physicians’
specialties
Competency model

23. 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

24. AREA “Basic / core activities”
GROUPS OF ACTIVITIES / PROCEDURES:
-Attending patients in a setting
-“Perform consultations”
-“Advanced ambulatory care”
Catalogue of performed activities by specialty

25. 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

26. Competency Gap Analysis based on
- organization objectives / targets
- practitioners clinical performances
- poor outcomes
- etc.
Competency Gap Analysis

27. •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

28. 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

29. 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

30. APSS case reflection # two:
HR split is not inevitable

31. 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

32. 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

33. 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

34. 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)

35. • 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

36. APPENDIX
APSS HRMS Highlights

37. 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

38. POSITION
STRUCTURE
CONTRACT
HR Data - employee record (+8,000 employees)
ROLE

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

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

41. Employee self service – on line request (internal transfer)

42. Process Automation – Recruiting

43. Workflow – Travel approval
Request
Approval

44. Expense report
Approval
Workflow – Expense approval

45. “change brings opposition, and opposition is
much easier to advocate than change”
Tony Blair – A journey (Knopf, 2010)
Conclusion

46. Questions