Pitfalls and Problems Leading to Failures of Agile Processes in Healthcare
Agile practices are widely embraced throughout the business to improve team functionality, shorten product time to market, and heighten innovation and creativity. These all add value to the customer. This paper will examine some key features related to Healthcare stand and incorporate various Agile behaviours to decrease early adoption failures.
A team leader with broad Agile experience or previous work as a "scrum master" is paramount- a real must. Any Agile process should focus and refocus on solving the current problem and keeping an eye on the end goal whilst following steps that cause rapid production cycles to gain traction.
Recent research by McKinsey and Bain and Co in 2019 revealed while over 80% of healthcare executives talk of being more Agile, only 30% are familiar with Agile practices. Being able to react swiftly to develop business ideas will become more critical. Also, having the best product is no longer enough, as customers and patients seek greater engagement, better services and an improved user experience. Adopting agile practices internal to a healthcare organisation can benefit process innovation.
Testing ideas and products (whether software code or any other business products in Healthcare) during this process is essential. At times some of this testing can be automated.
Examples of common problems or issues that should be avoided or actively sought out are:
- Wrong Culture readiness. , Unsurprisingly, executive teams will want to adopt Agile methodology in a misguided attempt to improve corporate culture. This will never work and can be quite detrimental to teams' work. It is always important to address cultural issues first in a company to ensure all staff are aligned in goals, mission and purpose. Work may initially need to be aimed at the executive team, as the workplace culture needs to be ready to adopt agile practices.
- Lack of agile behaviour and mindset. This is a common reason for failure. In some cases, the broader organisational culture hinders the ability to apply the required air. This is related to a need to address work culture, as in point 1. Leaders in the organisation need to be committed to role-modelling agile behaviours, mindsets and processes.
- Not deployed across the entire workforce. In my experience over the last 20 years, where Agile practices have existed in Healthcare, they tend to be sparse or mainly focused on programs for the administrative staff. This includes the institutional arms of the healthcare corporation. This needs to change. The concepts should also be broadened for the entire clinical team, as everyone needs to be involved in teamwork-focused innovative work. That's a must!
- Inefficient, ineffective cross-functional collaboration. Young graduates must harness their creative energies and provide innovative solutions to real-time clinical workflow issues. This will help address the significant disconnect in medicine between the desire to help and the realities of performing onerous mind-numbing clerical and administrative medical recording duties. Don't get me wrong, these are all needed, but we must introduce cross-workforce Agile methodology to harness bright, curious minds in a practical, valuable pathway.
- Top-down hierarchical structures. This top-down methodology is still widespread and tends to be associated with issuing orders rather than asking questions. Also, as previously mentioned in prior posts, concentrating on utilisation rates can devalue staff members, who see themselves as mere resources. Thus, all vertical hierarchical structures must consider a partial 90-degree turn to the right- into a horizontal framework. This could be best initially employed in smaller Agile test subgroups inside the organisation. This should involve the top talent of the organisation. This will engage and develop the skill. This ensures the brightest minds are working on high-value, future-focused initiatives before attempting to roll them out to broader business regions. In doing so, the entire workforce can observe and realise that in smaller groups, they have a voice, will be heard, and can be involved in processes where they can contribute to innovation and creative project formation. How good would that be for staff engagement and retention!!
- Transition from more traditional methods (waterfall techniques) to the agile process. Healthcare companies attempting to adopt Agile methodology may initially get into trouble in the transition. In an agile process, one of the key criticisms is the potential lack of an initial specific overarching planned product design, particularly in a setting with less documentation. This can lead to a need to backtrack on plans to improve the basic structural features of a product. An Agile process can occasionally be seen as achieving rapid initial results and floundering for lack of direction. Thus, an agile mindset needs clear collaborative leadership and frequent open communication between all relevant parties.
- Addition of new work during a "specific iterative sprint" process. This can hinder work throughflow and follow-on for that project. Thus, unique "stories" or work requests must be placed in a backlog and then appropriately re-ordered or adjusted on a priority basis. This is called backlog grooming. An agile team learns to accommodate these new stories because, naturally, project objectives will and should change on the run as further information comes to life. In a sprint, there needs to be clear goals and priorities.
- Overly micro-managed or inflexible team approach. This can lead to a sprint that hinders innovation as team members strive to complete shorter managed tasks regardless of their overall contribution to the whole. This lack of flexibility can harm the project's success and is more likely with less innovative or creative workgroups. Both mindsets must be accommodated simultaneously for the appropriate ability to pivot, adapt and respond quickly if a better method or story is identified. Problems can also arise if agile teams are insular or have a siloed view and don't scan the internal and external environment to understand changing trends and adapt accordingly.
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Lack of in-house sponsor support, insufficient training or inadequate leadership. Additionally, poor team focus, that is, some staff working on other projects or low-value activity, can impact the whole team's effectiveness in delivering high-value work. These aspects can then prevent the cohesive action required of the entire team, leading to inefficient problem-solving in daily standups.
Further problems can occur when attempting to take on too much work in an iteration or sprint. A sprint generally has a relatively fixed time frame per task and resource. This shouldn't cause the quality or scope to be affected. Thus, teams should avoid being over-committed or pushed to do too much in one iteration cycle. Instead, leaders must empower others to make decisions and move quickly to deliver results.
If leaders fail to relinquish control and struggle to allow others to lead, it will derail the agile process. This can be closely related to creating an environment of trust whereby teams become willing to share roadblocks and failures to find learning or additional opportunities to move forward.
- Trying to squeeze too much functionality out of a sprint time frame can cause a *build-up of technical debt***, which must be repaid at a time in the future.
- Inability to embrace failure. If a leader or team becomes caught or hindered by the consequences of failure, the iterative agile process may be derailed. We like to paint procedural visualisation whereby the innovation process is like building a solid broad brick foundation wall. The bricks are the ideas, conceptual plans and innovations becoming a product- or, in effect, *a productive division *. The team acts as the cohesive mortar binding the pictures, creating progress through a united development team. Mortar has known key ingredients- these must be mixed in proportions to attain maximum strength. One of the key mortar ingredients of a team is the ability to tolerate and withstand failure. When this is added, the mortar becomes very strong, very enduring, and highly resilient. These are critical features of adaptability.
The intrinsic key in these values is that functionality is central to the user experience, and functionality is the hub. The end goal is a product with superb architecture and superior efficiency in a technically excellent environment. The process is continuous, applied at the commencement of the project and continued throughout. Teamwork embodies change, encourages change as required, responds quickly, and redirects to new design requirements at any task stage.
Agile Enterprises in the Business of Healthcare
The broader application of the Agile concepts can be applied to many areas inside traditional Healthcare. For example, it could include joint projects with engineering, organisational developers, designers, or any other business, where a new product or service is being created.
These concepts then make or are part of an Agile Enterprise. Such an undertaking encourages on-the-spot experimentation, decentralised decision-making, and wide variations in good clinical application. However, as can be seen, one needs to foster the right balance between the pursuit of innovation and the need to follow standard operations procedures. This has been mentioned previously regarding the importance of using a Hybrid model in Healthcare.
One of the critical areas of development in the agile management process is that the iterative life-cycle process must create specific deliverables. These become set goals that allow teams to set exact time and scope targets that can be delivered to the group. Any agile enterprise and management process must be led and modelled by the executive team.
In conclusion, customer segmentation, pricing guidance, approval processes, tools of reporting and examining financial goals may all be improved using an agile management process. Importantly, it can be most advantageous when healthcare teams tackle small changes and innovations first and test new prototypes with sales operations and sales management.
* Let's embrace a hybrid model in Healthcare together.*
Further discussion blog: Redesigning Healthcare delivery.
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