What does it really mean to be Agile in the healthcare workplace?

Dr. Brendan O'Brien

In Healthcare today, companies are increasingly faced with growing pressures to innovate faster in medical services, to improve customer experience and shorten product development timespans. To obtain these outcomes, Healthcare organisations have had to shorten their innovation cycles, listen intently to their patient’s needs and develop rapid adaptive business models. Like so many other businesses, the Healthcare industry has had to read the room, identify areas to change and do so in large organisations, somewhat resistant to altering course.

It is noteworthy that overall, healthcare companies have been somewhat slow to take on this required change or to exhibit Agile management practices over the last decade. Some of the reasons for these low-agility practices will be explored in this and future discussion papers and include rising healthcare costs, the increased focus on clinical governance, required but “overly” complex managed business plans and non-integrated IT development.

In the setting of the increasing strength of the well-known digital natives- such as Amazon, Apple, Netflix, Spotify etc there are mounting competitive forces and ever-growing challenges to the more traditional Healthcare companies. The older more recognisable healthcare practice models have understandably responded to the need for organisations to minimise risk, predict expenditure and be accountable to governmental, stakeholder and health insurance bodies for their funding.

But this will need to change somewhat, as adherence to these formulaic models has and is coming at a cost. A human cost. Where staff members have been increasingly locked out of the innovation / creativity / decision making processes. Some healthcare organisations have tended to follow a path that has been inflexible and reluctant to be adaptive. In an attempt to avoid errors, with careful strategic stepwise planning (known as the waterfall methodology), healthcare organisations, steeped in tradition, have been slow to deliver transformation.

But in our current technological age, transformation is what is needed, not small incremental changes, but evolved inclusive cross organisational change. Whilst healthcare organisations have adopted the “patient centric “ rhetoric, they have not been able, in the past, to respond quickly with nimble adaptive processes that keep pace with modern workforce requirements and workplace practices. In the Creative Thinking Institute, it is our contention, that the traditional organisational models in healthcare have been in part, responsible for the high levels of medical and allied medical staff burnout and disengagement. This needs to change and we can do so together in a collaborative process. Let’s do just that…

There will always be some aspects of healthcare that require the traditional waterfall approach. However, in the interests of medical staff wellbeing and engagement, as well as increased productivity, the time is now for the ongoing redesign of healthcare. So that it is more adaptive, more responsive and more proactive. At Creative Thinking Institute we believe a hybrid model is most appropriate- using traditional management practices with newer Agile methodology. The transitioning healthcare models have been rapidly demonstrated this year with the advent of Covid 19. The rise of Telehealth has also been amazingly swift and has catalysed the next wave of change, which will be a decentralised delivery of medical care. This will now inevitably occur over the next 5-10 years.

Historical Development of Agile Methodology

So, what is the Agile method and how has this come about? We should look at agile practices in a historical context. The term of agile methodology or to be exhibiting agile work practices is commonly heard in the current modern workforce. Thus, whilst this has become a common catchcry of corporate teams and business groups, this was not always the case and is rarely heard of (at least by the medical staff) in the Healthcare industry- that needs to change.

In an attempt to implement new ideas or try to get ahead of their competitors in the corporate marketplace, the Agile process initially evolved through the 90’s. This was firstly seen in the field of software engineering and development. Related to project management, Agile in this context, means a process characterised by the division of tasks into short phases of work with frequent reassessment, testing, adaptation and rapid redesign of plans. This is in order to maximise innovation and improve the speed to market of a deliverable working product.

As the goals of software development transitioned, it became essential to be more rapidly responsive to the project’s needs and more aligned to the purpose of intent. The customers’ requirements were established as the central important hub and cycles of development were guided by principles of simplicity, worker interactivity and constant appraisal / reappraisal. These techniques have been best seen as a response to time critical workflows and the progressive evolution of design iteration, creating highly functional outcomes. Teamwork was and is central to Agile methodology. Where involvement is repeatedly shared across many layers of a project, to improve and enhance efficient outcomes. The specific Agile “creed” was initially articulated after a meeting of seventeen like-minded software luminaries in Snowbird, Utah in 2001.

The group collectively summarised their collaboration and declared in a written statement at the end of the meeting:

“We are uncovering better ways of developing software by doing it better and helping others do it better. Through this work we have come to value:

  1. Individuals and interactions over processes and tools.
  2. Working software over comprehensive documentation.
  3. Customer collaboration over contract negotiation.
  4. Responding to change over following a plan.

That is, while there is value in the items on the right, we value the items on the left more” (Manifesto for Agile Software Development 2001)

The Agile Business World

This joint meeting further consolidated these practices throughout software design processes in the early 2000’s. The Agile business world, a common (but not the only) project development methodology became widely practiced and understood. This involves breaking tasks into smaller incremental components, done in time-blocks or “sprints”- ranging from 1-4 weeks. Progress is assessed frequently in stand-ups, where face to face (or “face to zoom”) discussions occur on a frequent basis. The stand-ups (also called the daily scrum in the scrum framework) may be daily and usually no longer than a week apart. Teams need to share often and transparently.

Such teams are usually cross functional and include components such as planning, designing, testing, analysing and repeating these principles for the next sprint or product lifecycle phases. This can give more efficiency with very short feedback loops and adaptation to purpose, which is shared repeatedly within the team. Teams consist of many complementary functions that accelerate product development.

The particular focus is on building-in quality to the product from the very beginning and being readily able to show software to customers at any desired point. The Agile methodology can be seen as more adaptive than predictive, although naturally involves components of both. Interestingly, in being a team that values Agility, it isn’t essential to have sprints, stand-ups or scrums. In fact, in the 2020’s many companies are moderating their use of these structures and are being more flexible in the approach to Agility.

Next discussion post: The how and why- to increase the adoption of Agile processes in Healthcare.

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