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  • Client Adoption – Measure on how quickly it is to the clinician/end-user not on how quickly Cerner delivers a package or a package is installed by a client. Key is the time to the end-user.

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  • 1. Big Bang Agile Roll-outCerner’s Journey from Pilot to Mass AdoptionMatt Anderson, PMP, PMI-ACPDirector, Program Management February 21, 2012
  • 2. Objectives Provide strategies for doing a Big Bang Agile roll-out Provide foundation for a successful plan Help avoid potential pitfalls Create a sustainable model© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 1
  • 3. Cerner Corporation Started in 1979, based in Kansas City, MO Leading global supplier of healthcare solutions, healthcare devices and related services Focus on creating a safer and more efficient healthcare system Key solutions include: • Computerized Physician Order Entry (CPOE) • Electronic Medical Records (EMR) • Personal Health Records (PHR) Clients in 25 countries serving more than 9000 unique facilities Hospitals Physician Practices Retail Pharmacies NASDAQ – CERN $2.2B revenues in 2011© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 2
  • 4. Cerner Development Profile 7 Global Development offices England, Ireland, France, India, US (MO, VA, CA) Majority of development in Kansas City, MO and Bangalore, India 70+ unique solutions 1600+ associates on development teams Core technologies Java, C++, C#, VB6, JavaScript, iOS, ObjectiveC, HTML5 Oracle AIX, Linux, Windows Server© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 3
  • 5. Migration to AgileCerner’s Journey
  • 6. Cerner’s Challenges to Agile FDA regulated healthcare environment Had to prove we could be Agile and meet compliance FDA, CE Mark, ISO guidelines perceived as very waterfall centric Culture change Command and control style – just get it done Development Ecosystems Some legacy code still on Visual Studio 6 so difficult to fully adopt in legacy ecosystems© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 5
  • 7. Why Agile? Business Speed to Market • Major innovations took an average of 30 months from concept to client adoption • Retain market leadership Return on Investment • Too many projects adopted at only a small subset of client base – “Shelfware” Improve Quality • Develop the Right Solution • Develop the Solution Right Support “Edge” teams • Core solutions released together, but “edge” teams unnecessarily held up by inflexible methodology  Analogous to core web browser versus plug-in for browser© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 6
  • 8. Grassroots Movement September 2008 Several teams express frustration with rigid process • Cerner culture is “kill a snake”, so alternatives sought Recommendations to “look into agile” as a possibility from a couple engineers • General feeling was that due to FDA regulation, it could not happen Q4 2008 Small group of teams begin discussions to start unofficial agile pilots January 2009 5 teams kick-off pilots with minimal support Group meets together weekly to discuss progress and share ideas April 2009 Development executives hear about pilots and are exposed to the positive results© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 7
  • 9. Top Down Support July 2009 CEO Neal Patterson states intention to “Blow up the Waterfall” to entire company • Based on positive results of pilots Q3-Q4 2009 Pilot program expanded to 8 teams and several key initiatives to determine if it could scale High executive visibility Tooling pilots to plan for scale Education provider pilots held FDA and other regulatory impacts mitigated Jan 2010 Key business leaders trained in Agile principles March 2010 Plan and budget presented for a planned incremental training and coaching roll-out After reviewing options, decision from Senior VP of Engineering to go big bang instead of incremental – “Go fast” Back to the planning board…© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 8
  • 10. Big Bang Plan Elements Agile Center of Excellence Education and Coaching Development Process Tooling Ecosystem Metrics Partnerships Manage Expectations Engineering Rest of Cerner Clients© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 9
  • 11. Agile Center of Excellence Created a virtual center for “all things agile” Web 2.0 technologies One stop shop for Agile questions, coaching requests and general information Accountable for Agile success Named “Agile Champions” from pilot teams Respected engineering associates who could speak “Agile” and “Cerner” Training Coaching Community participation Manage vendor relationships and budget© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 10
  • 12. 2010 Agile Training/Coaching Plan Real-time learning with team’s actual projects, goals, and members Agile Essentials Agile Agile Agile Agile Boot Camp Session / Coaching Coaching Coaching Recording (2.5 days) (1-2 hrs) (1-2 hrs) (1-2 hrs) (2 hrs) Agile Center of Excellence available throughout Train the Trainer model with 50% External / 50% Internal; KC and India© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 11
  • 13. Cerner 2010 Agile Timeline 26-Apr-10 27-Jan-10 Agile Essentials RecordedCore Leadership Training Agile Center of Excellence Launched 26-Apr-10 - 10-Sep-10 Agile Boot Camp Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Jan-11 1600 development team associates trained in less than 5 months All Global development offices included © 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 12
  • 14. Development Process Update Plan Major overhaul to support Agile Worked closely with FDA, ISO and other regulatory groups to reinterpret regulations from an Agile mindset Determined where “additional process” would be required from Agile applications in other industries Audits Initial internal audits performed on pilot teams to find potential gaps Early roll-out of planned changes (March 2010) Follow-up internal audit of pilot teams prior to official launch Official launch July 1, 2010© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 13
  • 15. Tooling Ecosystem Defined approved tools and guidelines for new tooling Created education and “brown bag” discussions to promote appropriate usage Metrics Set expectations that they would significantly change Eliminated most existing metrics in favor of a few key metrics© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 14
  • 16. Partnerships Develop vendor relationships to build and supplement internal expertise Tooling Training Coaching Learning from other’s experience is significantly less expensive in the long-term© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 15
  • 17. Setting Expectations Create training materials for each audience Development and Business executives C-level Executives Clients Tailor Agile message to support their goals Follow-up with results to maintain trust Use terms they understand • “Capability” versus “Epic”© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 16
  • 18. Slide for Executives –Agile Executive Establish, maintain and communicate vision Enable and trust teams to deliver Empower and inspire Agile Business Unit teams Provide ongoing solution input and direction ahead of iteration planning Prioritize, Adapt and Embrace Servant Leader Remove Obstacles Identified by the teams Obstacles not seen by the teams Protect the high performing teams Measure what is needed© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 17
  • 19. Slide for C-Level Executives –Cerner Adoption Measurements Training Records Coaching Assessments Quarterly Team Assessment Baseline at Boot Camp Measurement of Success Criteria Speed to Market Client Adoption Team Performance Delivery against commitments Client Demos Lead Time Time from Investment to Adoption© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 18
  • 20. Slide for Clients –Success Measures Value & Experience Client Interest Client benefits quantification User Experience & Usability Client Adoption Time to put major release into production Time to activate capabilities into production Solution Quality Client Found Defects Ratio Client Found vs Release Validation Defects© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 19
  • 21. Slide for Clients –Key Client Responsibilities Engage with Cerner ABUs regularly to provide feedback As a Development Partner… Work with the ABU and Development teams to create prioritized list of Capabilities Attend client demos at the end of each development iteration Provide regular feedback on progress and ensure proper priority Test Capabilities and take them live as soon as they are available© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 20
  • 22. Results – Review Cerner’s Drivers Business Speed to Market • Major innovations took an average of 30 months from concept to client adoption • Retain market leadership Return on Investment • Too many projects adopted at only a small subset of client base – “Shelfware” Improve Quality • Develop the Right Solution • Develop the Solution Right Support “Edge” teams • Core solutions released together, but “edge” teams unnecessarily held up by inflexible methodology  Analogous to core web browser versus plug-in for browser© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 21
  • 23. Results Business Average client adoption time reduced from 30 -> 10 months Return on Investment – virtually eliminated “shelfware” • Direct increased by 429% • Indirect increased by 1000% Improved productivity by 24% Development costs reduced by 14% Quality improved by 6% Independent process and release for “edge” teams enabled by agile principles Culture “Agile” and “Lean” used in everyday vernacular (most of the time correctly) Leaders challenge each other to be more servant leaders in executive sessions • Some “command and control” tendencies surface from time to time, but other leaders are the check and balance Associate attrition for satisfaction issues reduced by 80% 95%+ adoption by development teams (2000+ associates)© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 22
  • 24. Keys to Cerner’s Success Strong Grassroots and Top Down support Engineering momentum Vision and funding Connected to key associates within organization early in the process Mavens* – Distinguished Engineers, PMO Connectors* – key pilot teams, PMO Associates with high trust within organization Leveraged current culture to change future culture Build on the past, don’t “throw it under the bus” Excellent Training Partner Business driven implementation Agile to “win the game” not just to be Agile* - “The Tipping Point” by Malcolm Gladwell© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 23
  • 25. Drawbacks from Big Bang Coaching post training Large scale enabled only 3 visits per team and some teams fell into less than optimal practices • Some teams “adapted” before “adopting” so they are not consistently getting the results • Some key items to Agile have lower adoption  Burndown charts  Physical tasks board (favor electronic tooling instead) • Team “depth” in Agile principles is shallower on teams that had only the minimal recommended coaching Hiding behind the tool Early electronic adoption over physical led to some less effective practices© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 24
  • 26. 2012 and Beyond Development course offerings expanded Lean Software Development Scrum to Lean Transition Coaching, coaching, coaching Lean Portfolio Management Continue to drive down adoption timelines Focus on value stream and find and eliminate bottlenecks Moving Agile/Lean into non-development applications Lean Process Improvement • Entire organizations are having all their associates trained Culture change continued 2012 Corporate Core Values – across all 10,000+ associates • Flawless – personal commitment • Empowered – freedom to do the right thing • Value – satisfying a need, exceptionally© 2011 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner. 25
  • 27. Additional TopicsQuestions and Answers