An Agile Journey in Healthcare

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  • Here’s a sampling of some of the companies I’ve assisted in the past. They represent a spectrum of Agile maturity and successes. Some are just starting in Agile adoption, and some have over 10 years of Agile experience.
  • An Agile Journey in Healthcare

    1. 1. AN AGILE JOURNEY IN HEALTHCARE Alston Hodge, Enterprise Agile Coach A presentation at the 2012 Cincinnati Day of Agile (University of Miami) May 19,2012
    2. 2. AGENDA • History • Assessment • Findings • Anti-Scrum Patterns • Root Causes • Impacts to the Healthcare company • Fixing the Problems • Lessons Learned
    3. 3. HISTORY • Nov 2007 – IT dept established Agile charter • Feb 2008 – IT dept created Agile implementation plan, training campaign, pilot projects • Oct 2008 – IT dept created Agile Community of Practice • Oct 2009 – consulting firm recommended coaches • Apr 2010 – IT dept created Agile Maturity Model • Oct 2010 – BP survey highlighted Agile issues • Apr 2011 – hired first Agile coach, conducted organizational assessment • Oct 2011 – BP survey highlighted Agile issues
    4. 4. 2011 ORGANIZATIONAL ASSESSMENT
    5. 5. ASSESSMENT FINDINGS • 53% of projects use Scrum • 55% of people trained (mostly IT) • 70% global partner utilization • Sampled 35% of Scrum teams (47/136): • Only 13% (6 teams) practice “true” Scrum • 87% (41 teams) struggle with 4 or more key Scrum principles and practices
    6. 6. ANTI-SCRUM PATTERNS • Scrum-> Scrum-lite-> O-gile • Mini-waterfall approach • Multiple concurrent projects in Sprints – 83% have 3 or more projects • Teams with few or no retrospectives • Risks not being identified and managed
    7. 7. Attribute Team Distribution Product Owner Product Complexity True Sprint Length Projects per Team Scrum Experience XP Experience Team Structure Lowest Risk Lower Risk Higher Risk Highest Risk Collocated Collocated Part-time Distributed Overlap Distributed No Overlap 1 Lead PO 2 multiple POs (no lead) 1 system 2 systems 3 systems 4+ systems 2 wks 4 wks 6 wks 8+ wks 1 2 3 4+ Proficient Advance Beginner Novice Proficient Advance Beginner Novice Expert Expert Truly crossfunctional Specialized roles
    8. 8. MORE ANTI-SCRUM PATTERNS • SM assumes some responsibilities of PO • Stakeholders not attending demos • Inconsistent use of VersionOne • New teams adopting anti-Scrum habits of early adopters • IT PM, Business PM • No lead Product Owner
    9. 9. Product Owner Team Scrum Master Simple Scrum
    10. 10. Product Owner 4 Product Owner 3 Business PM Product Owner 2 Scrum Team Scrum Master IT PM SME/Arch Product Owner 1
    11. 11. AND SOME MORE…. • Individual performance measures • Workload exceeds capacity • Start most/all stories at same time • No sprint goals • No tracking velocity • Teams larger than 12 members • Separate testing from development
    12. 12. Sprint Models Model S DEV-SIT-UAT DEV-SIT-UAT DEV-SIT-UAT UAT …. DEV + SIT Model DS-U DEV + SIT UAT UAT DEV + SIT Model D-D-D-S-U DEV DEV DEV SIT …. SIT UAT UAT Model D-S-U DEV Defects DEV Defects UAT SIT Defects DEV Defects SIT UAT
    13. 13. ROOT CAUSES
    14. 14. ROOT CAUSE 1: ADAPTING VS. ADOPTING SCRUM • “We need your help to adapt Scrum to fit our culture” – PMO Program Manager • “Perhaps we need to adopt the Values and Principles, and adapt the techniques and practices instead.” – Alston
    15. 15. AGILE VALUES AND PRINCIPLES • Already complement our corporate values and principles. • Guide us in our daily decisions. • Are foundational, the core of what we believe to be true about us. • Generally accepted Scrum practices are based on Agile values and principles • Changing the values and principles de-stabilizes our Scrum framework.
    16. 16. EXAMPLE • Choosing to not have retrospectives hampers: • Continuous improvement • Transparency • Sustainable development • Not tracking velocity hampers: • Continuous improvement • Transparency • Sustainable development
    17. 17. ROOT CAUSE 2: ADOPTION VIEWED AS AN IT CAMPAIGN, NOT A COMPANY CAMPAIGN • Initiated and supported as IT campaign • Business partners not fully understanding the implications: • PO develops the backlog • PO prioritizes based on business value • PO approves story completion • PO decides when to release With Agile, the Business is in the driver’s seat!
    18. 18. IT LEFT WITH UN-ANSWERED QUESTIONS • Service Provider vs. Business Partner • IT projects vs. Business projects • What to do with PMs? • Scrum-> Scrum-lite-> O-gile?
    19. 19. ROOT CAUSE 3: ACCELERATED OFFSHORE UTILIZATION • 2008 – 60% company, 40% contractor • 2011 – 30% company, 70 % contractor • Source of business innovation cut in half
    20. 20. LOOK AT THE NUMBERS • US health care insurance experience • 160+ years as an industry • Over 80% of Americans with healthcare insurance today • India’s health care insurance experience • 12 years experience in industry • Less than 6% with healthcare insurance (as of 2010)
    21. 21. ROOT CAUSE 4: ADD – AGILE DEFICIT DISORDER • Symptoms • Difficulty in focusing • Hard to develop self-discipline (team & organizational) • Commitment issues • Scrum Buts • Resistance to Transparency
    22. 22. IMPACTS TO HEALTHCARE COMPANY
    23. 23. COLLABORATION CHALLENGES • Agile Community of Practice stalled • Increasing collaboration issues • Increase turnover (company, vendors) in some areas • Decline in Partnership survey scores • Innovation • Communications • Ownership • Increased use of PMs (IT and Business)
    24. 24. FIXIN’ THE PROBLEMS
    25. 25. UPDATE THE TRAINING • Use experienced SMs and POs • Lots of new resources available now • Address the common Anti-Scrums • Introduce eXtreme Programming • Continuous integration • Paired programming • Automated testing • Focus more on the “Why” of key Scrum concepts
    26. 26. KEY CONCEPTS OF SCRUM • Transparency • Prioritize Business Value • Commitment • Incremental development • Continuous Improvement • Minimal documentation • Collaboration • Sustainable pace • Discipline • Iterative development • Stop.Inspect.Adapt • Swarming • Cross-functional teams • Sprint planning • Retrospectives • Product Demos
    27. 27. RE-BUILD THE AGILE COMMUNITY • Coach’s Corner • BUZZ • Tips and Tricks (12 guidelines) • Agile tract in Learning Week • Monthly Corporate Scrum Gatherings • Agile Team of the Year Award • Louisville Agile Forum • Partner with regional Agile groups
    28. 28. Coaches Coaches Coaches Coaches Coaches Coaches Coaches
    29. 29. PROMOTE VALUE OF COACHING • organizationally agnostic - not subject to the same pecking order, enabling them to tell the hard truths that may need to be said • Help teams develop self-discipline and good habits • provide needed on-the-job learning and mentoring opportunities soon after training
    30. 30. Training with Coaching Coaching
    31. 31. PROMOTE VALUE OF COACHING • Challenge teams to address the difficulties they face rather than sweep them under the rug. • bring both tried and new practices and processes to the team and organization reducing the degree of trial and error. • bring an outside view of the organization, team and individuals and remove intrinsic bias and interpersonal issues.
    32. 32. “GROW YOUR OWN” COACH • Internal coach program • 6 months to “coach the coach” • Full time commitment • Workload of 12-15 teams • Already knows the business • Limitations • Agile experience limited to one company • Not organizationally agnostic • No previous coaching experience
    33. 33. EDUCATE BUSINESS LEADERSHIP • Find the champions • Educate top down and bottom up • 30 minute intro to Scrum • Provide Product Owner learning map • Solicit their help to champion Scrum • Sell the idea of external coaches • Help Business “take back the reins”.
    34. 34. EDUCATE IT LEADERSHIP • Find the champions • Provide Agile PM learning map • Address the unanswered questions: • Are we a Service Provider or Partner? • How to develop Agile PMs? • Do we understand and accept the risk of offshoring? • Are we serious about Scrum adoption?
    35. 35. TREAT THE ADD • Guidance of prioritizing projects/features • Help teams develop self-discipline • Educate on myth of multi-tasking
    36. 36. ADDRESS COLLABORATION ISSUES • Lack of trust - team building exercises • Triangulation • Painters Pyramid • Matthew 18 • 360˚ Surveys • Monthly joint meetings
    37. 37. ADOPTION LESSONS LEARNED
    38. 38. • Involve the Business from beginning • Utilize external coaches for first year • Honor Scrum values & principles • Be transparent • Be honest
    39. 39. MOST IMPORTANTLY: MAKE A DECISION • Do you want to be a Guppy or an Olympic Swimmer?
    40. 40. Product Owner 4 Product Owner 3 Business PM Product Owner 2 Scrum Team Scrum Master IT PM SME/Arch Product Owner 1
    41. 41. Product Owner 4 Product Owner 3 Product Owner 2 Business PM Lead Product Owner Scrum Team Scrum Master SME/Arch IT PM
    42. 42. QUESTIONS?
    43. 43. CONTACT ME • alstonehodge@gmail.com • Alston’s Awesome Agile Blog www.alstonhodge.com (free coaching and advice!) • Twitter: @alstonhodge • Join me each month at the Louisville Agile Forum meetup • Farm Credit Services office (1601 UPS Drive, Louisville, KY) • 4th Wednesdays (6:30PM) • Call me at 309-531-0611

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