Over the past twenty-five years, Celina Scally has seen Apria Healthcare go through a world of change.
Scally, the senior VP of human resources, has been with the provider of home respiratory services through tremendous changes since 1990. Since then, compliance and regulatory requirements have increased exponentially, competitors have gained access to Medicare contracts by underbidding and driving down reimbursements for some products by 40 percent, and, at one point, companies that used fraudulent business practices tarnished the reputation of the entire industry.
To adapt, Apria has gone through an extensive transformation. The company used to employ fourteen thousand people, but divesting its infusion business moved five thousand jobs. Additional downsizing in its remaining core business eliminated another two thousand positions over the course of several years.
“We had to rethink everything we do to become more efficient,” Scally says. “To stay vital, you explore everything you do from every possible angle to find new ways to operate in this entirely new world.”
Her experience in nearly every operational aspect of the company has been an asset throughout all these adjustments. For example, when Apria implemented new order-processing technology, she had insights into the specific requirements, responsibilities, and institutional knowledge that would be impacted. As a result, the technology was modified to appropriately address those areas.
“Having held many different company positions, I understand the day-to-day challenges and the disruption that even improvements in processing or procedures can cause,” she says. “That helps inform my decision making and, I think, gives me some added credibility.”
Apria used to be what Scally characterizes as a command-and-control organization. Business practices and strategies were all dictated from the executive suite with little or no explanation. That changed in 2012 when Dan Starck rejoined the company as CEO after a six-year absence. He believed in creating a more open culture, which led to the introduction of employee engagement surveys.
The surveys revealed that employees wanted more information about objectives, strategies, decisions, and company performance. That information is now provided through quarterly updates—videos Starck uses to address employees’ concerns and an annual business alignment model that summarizes current customers, objectives, and implementation strategies.
“We had to rethink everything we do to become more efficient. To stay vital, you explore everything you do from every possible angle to find new ways to operate in this entirely new world.”
“We communicate now with much greater frequency and transparency about what we’re trying to accomplish,” Scally says. “It helps people feel more engaged and better understand how their work is connected to the bigger picture.”
The shift away from command and control is also empowering local managers to make decisions that are best suited to their individual markets. For example, based upon decision criteria that are shared throughout the organization, local teams can make decisions that are tailored to the particular characteristics of their patients and customers.
“Local leaders understand their markets, so they know the most appropriate practices for a given situation,” Scally says. “That might mean overriding certain standard guidelines to make sure a customer is being taken care of in the best way possible.”
As the company has shifted away from a command-and-control culture, Scally has helped shift the human resources department toward becoming a business partner.
To help support local field leaders, HR provides training and development specifically targeted at decision making. This covers specific criteria for various levels of management and other business and compliance factors that need to be taken into account. “Each situation is unique in terms of the patient’s condition, their coverage, and the terms of reimbursement,” Scally says. “We have to hone field leaders’ decision-making capabilities to ensure that the right decisions are made every time at every level.”
She is aware that, in many companies, HR is viewed as the “no group,” but works hard to prevent that at Apria. The department is positioned to guide, advise, provide insight, and help suggest alternate paths to yes whenever necessary. One example of this mind-set was when the company eliminated a low percentage cap on salary increases that was associated with promotions; the cap was applied to all situations, regardless of employee level, expertise, or change in scope of responsibilities. By educating all departments on the change, HR was able to ensure that the best job candidates would not be lost due to inappropriate compensation.
HR and senior leadership have begun implementing data analytics to address various issues. Their first project is to find explanations for a gap between fast churn (less than six months) and long-tenured sales staff. The technology might be used in the future to address other issues related to demanding positions, such as delivery personnel who interact directly with patients and customer service staff, who handled 9.2 million inbound and outbound calls in 2016 for 1.8 million patients.
From her long-term perspective, Scally predicts that Apria will continue to stay agile and flexible regardless of what new changes the industry faces. “In both healthcare and HR, it’s hard to tell what’s coming,” she says. “We just have to monitor how things are evolving and change along with them. We’ve already proven we know how to do that.”