Success Story: Agility and Health Care

A Family Practice Transformation Based on Continual Learning and Adaptation

14 January 2014

Eric King
Davisbase Consulting LLC


Just a few short years ago I began singing the praises of Agile to just about anyone who would give me the time of day. I would talk about the values associated with agility and dig deeply into the various Agile Manifesto principles that resonated with me the most. Having come from a fairly diverse background, I was convinced that Agile methods could be used in a multitude of image-1.jpgbusiness applications, not just software development. At the time, I was a Scrum practitioner and truly embraced the mind-set of continual inspection and adaptation. Unbeknownst to me at the time, I was indirectly sowing seeds that would one day provide the ideas to help take a family practice medical facility to an entirely new level. This is Part I in a series in which I'll share the approach, benefits, and ongoing practices associated with a medical practice that has truly embraced Agile.

For those who may not be familiar, family practice medical facilities see a wide variety of medical conditions every day. Staff members (administrators, doctors, nurses, medical assistants, etc.) are constantly evolving in order to meet the needs of their patient population. The demands placed on these professionals are enormous, and they carry a heavy burden of social and moral responsibility. However, the burden isn't one that is carried by one person alone . . . nor would some say that it's even a burden to begin with. Below is the story of how one family practice, with a mind-set of continual evolution, started its own Agile transformation.

The background

The medical practice, located in the southeastern United States, had experienced tremendous success during the last five years. Initially founded by a small number of providers, the practice is geographically situated in a location that contains an excellent mix of young, middle-aged, and elderly patients. The patient population required that the practice develop and continually enhance an exemplary standard of care.

During the last five years, the practice had doubled in size on two different occasions. At any organization, any time the employee base doubles, procedures and processes need to be revisited. As the practice grew, various leaders understood the definitive need to focus on continual learning in order to provide patients with the best level of care. In addition, due to the geographic location chosen for the practice, leaders knew that they had to be "doing it better than everyone else" so that they could keep their competitive edge. Given these characteristics and with the support of multiple practice leaders, there were certain aspects of agility that the leaders immediately embraced and began to implement.

The approach

Many family practices emphasize maintaining and continually developing standards of care for doctors, nurses, and medical assistants. Regardless of where the team member received his or her initial medical training, constant refinement of medical skills was determined to be the most important item as the family practice created its initial product backlog. In addition, so that a strategic alignment could be created between the front office and the back office, two product owners were selected to represent and prioritize the needs of the practice. The product owners chosen were the family practice administrator and the lead physician for the practice.

Team formation
The practice expressed, from the beginning, a deep desire to create the best teams possible so that significant improvement could be made in the critical skills area. Initially, the practice considered forming Scrum teams of up to seven members before embarking on the first sprint.

However, team members expressed a strong desire for much smaller teams so that continual improvements could be made without negatively affecting the normal work day and the patient "flow" within the office. Therefore a decision was made to create teams of three, based on both peering and pairing. Below is a sample of the smaller team structure:
EK-ARTICLE-IMAGE.png Iteration approach
The product owners for the practice were able to determine that "clinical skills" would be the highest-priority item on their initial product backlog. Clinical skills would include, for example, the ability to obtain an accurate blood pressure, body temperature, respiratory rate, and heart rate. While not the complete listing, these four clinical skills would turn into the user stories that would be worked on during the first iteration. Finally, the product owners were challenged to prioritize their user stories and make the work visible for the entire practice.

image-3.jpg

In total, seven teams of three were created and challenged to take their respective clinical skills to a higher level. A determination was made that their initial iteration would be four weeks in duration so that team members would have the time needed to demonstrate improvement.

Iteration 1 outcome
At the end of the month, the family medical practice had a chance to showcase its skills and to discuss the learnings that took place among the various practitioners. With a definitive commitment from everyone, the results were remarkable and helped set the stage for further iterations.

Several highlights were recognized by the organization. One example is that, in lieu of waiting until the end of the month, each of the seven teams demonstrated their clinical skills multiple times during the month. Respective team members would "demo" their clinical skills to at least one doctor in the practice. These demonstrations were conducted as part of the regular patient experience within the practice, which meant that clinical skill improvements were being demonstrated where they had the most value -- with actual customers. After each demo, doctors would provide immediate feedback to the individual who performed the demo as well as to his or her additional team members.

As highlighted in this short article, Agile isn't just about software development these days. Agile can certainly be about people, managerial, organizational, and executive development. There is a definitive need for agility in many facets of organizational structures, and I hope that the initial success seen by this family practice will give you ideas about how to expand Agile in your sphere of influence. Stay tuned for more Agile-based success stories in the health care space. The next article will review how this family practice incorporated aspects of the "Undercover Boss" and Agile in order to continue its incremental improvement journey. Until then. . . .

This article was coauthored with Victoria King, MD.

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Comments

Robert Weidner, CSP,CSM,CSPO, 1/14/2014 9:12:49 AM
Hi Eric... very interesting article. I also work in the healthcare industry sector. Over many years we have built our own, internally developed EHR, but while we were transitioning to Agile (and in particular, Scrum), it became apparent that it would be very difficult to have Physicians serve in the role of Product Owner (even though they had traditionally served as Project Sponsors in the past). Physicians, and our organization as a whole, makes money when they see patients. Thus, pulling them away from patient activities to provide input on software - though extremely valuable - was a hard sell. We simply could not get the level of involvement that we needed, and thus ended up having to nominate representatives (i.e., Business Analyts and Solutions Managers) to serve in the Product Owner role, and represent the physician groups. Did you experience anything similar?
Eric King, CSP,CSM,CSPO, 1/14/2014 11:42:54 AM
Good morning Robert and thank you for writing. In this family practice situation, the lead physician and the office administrator did become the Product Owners jointly. Yet, at the same time, the lead physician had to determine how much time she was able to commit to the Iteration; especially since she is a highly billable resource. In the end, this practice was able to justify the involvement from both of the product owners as the end result was a higher level of provider care. The other part of this equation that was seen in a very positive light was the family practice's willingness to continually improve the skills of their employee base. I'm happy to stay in contact with you as this practice is still using Agile concenpts for the betterment of the facility. I'll be submitting a few other articles in the near future about what they are doing with Agile. Have a good morning.

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