Scrum Journey In Healthcare Day Of Agile

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A presentation at the Cincinnati Day of Agile Conference on May 19, 2012.

A presentation at the Cincinnati Day of Agile Conference on May 19, 2012.

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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.


  • 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. AGENDA• History• Assessment • Findings • Anti-Scrum Patterns • Root Causes• Impacts to the Healthcare company• Fixing the Problems• Lessons Learned
  • 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
  • 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. 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. Lowest Lower Higher Highest Attribute Risk Risk Risk Risk Team Collocated Distributed Distributed Distribution Collocated Part-time Overlap No Overlap Product Lead multiple POs Owner 1 PO 2 (no lead) Product Complexity 1 system 2 systems 3 systems 4+ systems True Sprint Length 2 wks 4 wks 6 wks 8+ wksProjects per Team 1 2 3 4+ Scrum Advance Experience Expert Proficient Beginner Novice XP Advance Experience Expert Proficient Beginner Novice Team Truly cross- Specialized Structure functional roles
  • 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. Product Owner Team Scrum MasterSimple Scrum
  • 10. Product Owner 4 Product Owner 3 Business PMProduct ScrumOwner 2 Team IT PM Scrum SME/Arch Master Product Owner 1
  • 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. Sprint Models Model SDEV-SIT-UAT DEV-SIT-UAT DEV-SIT-UAT …. Model DS-U DEV + SIT UAT DEV + SIT UAT DEV + SIT UAT Model D-D-D-S-U DEV DEV DEV …. SIT UATModel D-S-U DEV SIT UAT Defects Defects DEV SIT UAT Defects Defects DEV SIT UAT
  • 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. 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. EXAMPLE• Choosing to not have retrospectives hampers: • Continuous improvement • Transparency • Sustainable development• Not tracking velocity hampers: • Continuous improvement • Transparency • Sustainable development
  • 17. ROOT CAUSE 2:ADOPTION VIEWED AS AN IT CAMPAIGN, NOT ACOMPANY 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. 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. ROOT CAUSE 3:ACCELERATED OFFSHORE UTILIZATION • 2008 – 60% company, 40% contractor • 2011 – 30% company, 70 % contractor • Source of business innovation cut in half
  • 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. 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
  • 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)
  • 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. 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. 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. Coaches CoachesCoaches Coaches CoachesCoaches Coaches
  • 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. Training with Coaching Coaching
  • 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. “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. 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. 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. TREAT THE ADD• Guidance of prioritizing projects/features• Help teams develop self-discipline• Educate on myth of multi-tasking
  • 36. ADDRESS COLLABORATION ISSUES• Lack of trust - team building exercises• Triangulation • Painters Pyramid • Matthew 18• 360˚ Surveys• Monthly joint meetings
  • 38. • Involve the Business from beginning• Utilize external coaches for first year• Honor Scrum values & principles • Be transparent • Be honest
  • 39. MOST IMPORTANTLY: MAKE A DECISION• Do you want to be a Guppy or an Olympic Swimmer?
  • 40. Product Owner 4 Product Owner 3 Business PMProduct ScrumOwner 2 Team IT PM Scrum SME/Arch Master Product Owner 1
  • 41. Product Owner 4 Product OwnerProduct 3Owner 2 Business PM Lead Product Owner Scrum Team Scrum Master SME/Arch IT PM
  • 42. QUESTIONS?
  • 43. CONTACT ME•• Alston’s Awesome Agile Blog (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