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When Choosing Agile or Waterfall Development for Healthcare, Take a Pragmatic Approach

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IT project development usually proceeds down one of two development paths: Agile or Waterfall. But those involved with developing process improvement and project management understand that taking a more pragmatic approach is required when determining which path is best. It’s not a single-path environment where Agile has replaced Waterfall, nor is Waterfall the one-and-only legacy option. Depending on the project, both may be viable at different points along the timeline. The speed to value of Agile is attractive to organizations seeking quicker returns on the work in progress. It also minimizes documentation. Waterfall is valuable when risks must be minimized and when the development path and end product are familiar. Sometimes, a blending of Agile and Waterfall is appropriate for different stages in the development process. Ultimately, organizations should remain open regarding both approaches and apply the one that will work best for any given circumstance.

Published in: Healthcare
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When Choosing Agile or Waterfall Development for Healthcare, Take a Pragmatic Approach

  1. 1. When Choosing Agile or Waterfall Development for Healthcare, Take a Pragmatic Approach
  2. 2. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Waterfall vs. Agile Development It may not be the epic rivalry proportions of Pepsi vs. Coke, iPhone vs. Android, or Chevy vs. Ford, but if you want to watch a group of developers (healthcare or otherwise) get intense, bring up the topic of Waterfall vs. Agile development. Each side has its ardent advocates and evangelists, and as a rule they rarely, if ever, cross the aisle. At Health Catalyst, we often find ourselves caught up in the same debate.
  3. 3. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Waterfall vs. Agile Development A quick review of our Knowledge Center would have you believe that we want everyone to become Agile in healthcare. It’s what we talk about and promote the most. For much of what we do for our clients, it is the superior choice. It was specifically designed to overcome issues in the Waterfall development that preceded it.
  4. 4. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Waterfall vs. Agile Development The reality is Waterfall versus Agile isn’t an either/or, all-in choice. Both development methodologies have their benefits and drawbacks. What’s important is under- standing the circumstances where each works best and then apply the methodology most appropriate for the job at hand. In other words, understand the principles and be prag- matic in their application.
  5. 5. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Navigating the Whitewater of Waterfall Waterfall works very well when there is a clear vision and understanding of what the end product should look like. It’s well suited to projects which follow a known path, and has very little need for variation or creative deviation.
  6. 6. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Navigating the Whitewater of Waterfall Waterfall development is also valuable when the tolerance for imperfection is very low. It may be the preferred method when the benefit of risk mitigation justifies the cost of extensive upfront planning. In many ways it’s like performing surgery. You want know exactly what you’ll do at each step to produce the desired outcome.
  7. 7. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Navigating the Whitewater of Waterfall A great example of where this works well with the work we do at Health Catalyst is in the implementation of a Late- Binding™ enterprise data warehouse (EDW). We have years of experience and vast knowledge about what steps are needed to establish a robust and well-performing data warehouse.
  8. 8. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Navigating the Whitewater of Waterfall The EDW has a core set of capabilities that maximize the value of the data assets in driving outcomes improvement. Analytic solutions are best derived from an environment of iterative learning, which leads to early and frequent value. Waterfall development requires all contingencies be considered upfront, so it is ill-suited for this type of work.
  9. 9. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Navigating the Whitewater of Waterfall Think of attempting to develop an analytics application to improve throughput in the emergency department (ED). No matter how hard the team works up front to determine all the steps required, there will always be variances. One new regulation or software tool alone could disrupt the entire workflow. In this case, using Waterfall development will likely lead to frustration and failure.
  10. 10. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Getting Agile Situations such as the emergency example on the previous slide are exactly why Agile methodologies were created. With Agile, the organization doesn’t need to know everything about everything up front. It just needs to have a general idea of where it wants to go and how it wants to get there.
  11. 11. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Getting Agile Some business intelligence groups believe that they can anticipate and plan the design before they are even requested. If clairvoyance is your strength then it might be possible to deliver a nice, pristine, finished product. But this thinking underestimates the importance of front-line involvement in the successful adoption of the end product.
  12. 12. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Getting Agile It is far more effective to have those closest to the problem provide constant feedback in iterative cycles to ensure that value is delivered frequently and on target. This methodology enables an organization to hypothesize and develop solutions, test and make adjustments, and take iterative steps until the desired outcome of improvement is achieved.
  13. 13. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Getting Agile Consider this real-world example: A group of young men ages 14- 18 were planning a five-day, fifty- mile wilderness adventure on the Appalachian Trail. The adult leader determined it would not be very effective to hold a series of meetings to discuss everything they would need to pack, and then send them on the trail for five days.
  14. 14. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Getting Agile Instead, they held a meeting, discussed what was needed and then took an overnight camping trip. Afterward, they met again to discuss what they forgot as well as what they brought, but didn’t use. They did a series of these short meeting/trip combinations over the next four weeks.
  15. 15. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Getting Agile By the time they went on the long trip they knew from experience how to be prepared and be self-sufficient. Despite not knowing everything they needed to know in the beginning, the trip down the Appalachian Trail was a huge success. They attribute this success to the short preparatory camping trips.
  16. 16. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Getting Agile This sort of agility is important in any business intelligence. But in the rapidly-changing world of healthcare, where new discoveries are being made and introduced daily, and with constantly shifting regulations, it is highly critical.
  17. 17. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Getting Agile A common misperception of Agile development is that it doesn’t require documentation or advanced planning. That is simply not true. Regardless of methodology, there must be a plan. But, instead of comprehensive, up- front documentation and planning, Agile methodology calls for documentation and planning in each iterative step.
  18. 18. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Getting Agile Quality control and all the other rigors of development must also be included if Agile is being applied properly. In a sense, the Agile development methodology incorporates the exact same steps and elements of Waterfall development, it simply applies them in small bite-size chunks.
  19. 19. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Blending the Two Development Styles In our experience, the best solution to an organization’s issues requires a blending of both methodologies. We will use Waterfall to ensure rapid implementation of the EDW to aggregate data from all the disparate systems. We will then use Agile methodologies to create the analytics themselves.
  20. 20. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Replace “Sides” with Pragmatism Clearly, what’s called for is a change in thinking. Rather than continuing the Holy War over which methodology works best, or being tied to any particular dogma, we believe pragmatism should rule the day. Organizations can take a best practices approach to every- thing they do and select the methodology that’s most appropriate for their challenge.
  21. 21. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic The 4 Clinical Teams Needed to Drive Sustainable Improvement Susan Easton, Kathleen Merkley, Tracy Vayo and Kirstin Scott Getting the Best Business-Intelligence Solution for Healthcare (Executive Report) Mike Doyle – Vice President 4 Options for Choosing the Best Healthcare Analytics Solutions (Executive Report) Dale Sanders – Senior Vice President, Strategy Data Warehouse Tools: Faster Time-to-Value for Your Healthcare Data Warehouse Doug Adamson – Vice President of Architecture Link to original article for a more in-depth discussion. When Choosing Agile or Waterfall Development for Healthcare, Take a Pragmatic Approach
  22. 22. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information:
  23. 23. © 2014 Health Catalyst www.healthcatalyst.com Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Dan LeSueur has been developing and implementing the core products and services of Health Catalyst since February of 2011. He started as a data architect, moved into a technical director role and is now a Vice President of Client and Technical Operations. Prior to joining Health Catalyst, Dan owned and operated a management consultancy for five years that assisted ambulatory practices in the implementation of electronic health records and data-driven management methodologies. In this venture he served as data architect, business-intelligence developer, and strategic advisor to physicians and practice owners in the strategic management and growth of their practices. Dan holds Master’s degrees in Business Administration and Health-Sector Management from Arizona State University and a Bachelor of Arts degree in Economics from Brigham Young University. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com

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