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Undercover Agile Boss

Walking in Someone Else's Shoes Changes Your Perception

03/26/2014 by Eric King


Inspiration comes to us in many different forms. We are inspired by our natural surroundings. The shuffling sounds of feet walking on a forest floor may inspire us to appreciate the simple movements in our natural world. The sight of a mountain waterfall may give us the inspiration needed to constantly change. Whether we're at the beach at the height of summer or tucked away in a mountain hideaway for winter, nature reminds us that everything is constantly changing, growing, replenishing, and evolving around us.

People can find inspiration from what they see and hear in daily activities with others. For some, it's the interaction that we have with our immediate colleagues. For others, it's the relationship that we have with mentors who come into and out of our lives. In addition, we are also inspired by publications, books, and magazines that we read. We can also be inspired by the conferences that we attend. And for those of us who are or have been parents of small children, inspiration can be found during a few short hours of the evening when the little ones are sleeping soundly. Such was our experience just a few short months ago, as we settled down with hot tea in hand to watch an episode of Undercover Boss.

For those who are not familiar, Undercover Boss is a television program where executives disguise themselves and then go back into their respective companies in order to work in a position much different than what they normally occupy. The goal of the exercise is to gain a firsthand view of what "good things" and "bad things" are taking place in their companies, from the ground level. As a result of the discoveries, the companies usually make immediate improvements that have long-term implications.

And so it was on a quiet evening at home that the idea for Undercover Agile Boss was inspired by a television program. For us, we were inspired to seek new ways of looking at a business with a definitive focus on people. We quickly realized that our inspiration came in the four categories below:

  • Inspiration to experiment
  • Inspiration to act
  • Inspiration to change
  • Inspiration to evolve

The setting

Going undercover in a family practice medical group isn't the easiest thing to do. This particular medical group has approximately 50 employees and contains an established patient population. For the most part, the primary functions that take place inside any family practice fall into the five categories below, with corresponding team member roles:

Activity Type Team Member
Check-in Office staff
Rooming and vitals Medical assistant
Diagnosis Physician
Outbound processing Billing specialist
Patient scheduling Office staff

The activity types are highly indicative of how most family medical practices operate. Each of the activities has a very specific group of associates who perform important functions as part of the overall patient experience process. One could accurately conclude that the skill sets of the employee base are highly specialized.

After reviewing and evaluating the categories above, the product owner made a decision to go undercover in the second category above: Rooming and vitals. Without sacrificing the overall patient flow, a select number of doctors would "room patients and take vitals" for another doctor's patient . . . and be undercover in the role of the medical assistant.

The sprint duration for this experiment would be two consecutive weeks.

The goal of the sprint would be to allow practice leaders a chance to see how patients perceive medical assistants as part of a cultural empowerment transformation that was starting to take place at the practice level.

Inspiration to experiment

As we all know, agility is all about frequent inspection and adaptation. In addition, from a leadership viewpoint, agility can be characterized as both a desire and a willingness to continually experiment.

The family practice leaders, in this scenario, were the lead physician for the practice and a select number of family practice doctors. The experiment would focus on the perception and processes associated with patient rooming and vitals, which had become a growing area of interest at the practice level. In some aspects, this sprint created its own set of unique logistical challenges as two significant acceptance criteria had to be met:
  1. The overall patient flow process could not be hindered as doctors went undercover in a role commonly fulfilled by medical assistants.
  2. The experiment could not result in current employees being demotivated as doctors went undercover and performed a job function that didn't traditionally fall into their domain.
Note: The willingness to experiment on a sprint-by-sprint basis in a nonsoftware environment may be different than what traditional software development teams can do. We would, however, definitely encourage application development teams to frequently talk about the kinds of experimentation that they would be willing to attempt.

Inspiration to act

In the majority of family practice environments, physicians don't room patients and take vital signs. Physicians definitely have the ability to perform these functions, yet their highest business value to the medical practice is to execute functions such as diagnosis, evaluation, coding, and follow-up. However, practice leaders recognized that they needed a deeper understanding of a key aspect of the patient experience process in order to improve the overall quality of care provided.

Patients, on average, will spend between 80 and 90 percent of their overall office visit time with two primary individuals, the medical assistant and the physician. For this sprint, practice leaders wanted to go undercover in order to experience what medical assistants do on a routine basis.

Inspiration to change

Prior to this sprint, family practice leaders understood that while their clinical skills would fall into the "generalist" category, the role that they served in the practice itself fell into the "specialist" category. A few select individuals saw, with this sprint, an opportunity to change the way that they experienced the patient care process. Practice leaders were cognizant enough to recognize that their filter into their own medical practice needed to change so that a fresh perspective could be obtained.

Inspiration to evolve

Many medical professionals and patients would agree that family medical practices are perceived to be very similar to the retail industry, where customer perception is a key pillar to organizational success. We believe that, as such, family medical practices have five key categories that customers value above others. Those categories are:


Practice leaders embraced the mind-set of creating a culture with a focus on perpetual evolution. The leaders understood how critical this evolution would be for the benefit of their patients and their practice as a whole.

Undercover results

The results of the sprint were eye opening for those doctors who went undercover. They experienced a completely different reaction from patients as the "medical assistant" than what they were used to seeing as the "doctor." Mannerisms such as body language and eye contact were different, in some cases almost unpleasant. The tone and intonation of the communication styles were not at all like what the doctors were accustomed to.

As a result of the sprint, leaders were provided with much better insight into their organization. They agreed that their concentration for subsequent sprints would be on their employees. The cultural empowerment transformation had just begun, and the leaders believed that key aspects of agility would help them create a culture of sustainability and empowerment.

Stay tuned till next time, as Undercover Agile Boss goes forward with more insights on how agility can be used to help organizations recognize significant improvements outside of the traditional software development world.

Until then. . . .

This article was coauthored by Victoria King, MD.