An organizational assessment of a healthcare company's agile implementation found that while over half of projects used Scrum, very few teams truly practiced Scrum principles and most struggled with adhering to key Scrum practices. Common issues included teams taking on multiple concurrent projects in sprints, lack of retrospectives, and risks not being properly identified and managed. The root causes were identified as viewing the adoption as an IT initiative rather than company-wide, over-reliance on offshore teams with less experience, and a lack of focus on truly adopting Scrum rather than just adapting it. Recommendations included improving training, establishing an agile coaching program, educating leadership, and fully embracing Scrum principles and values.

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

3. AGENDA
• History
• Assessment
• Findings
• Anti-Scrum Patterns
• Root Causes
• Impacts to the Healthcare company
• Fixing the Problems
• Lessons Learned

4. 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. 2011 ORGANIZATIONAL
ASSESSMENT

6. 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

7. 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

8. 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+ wks
Projects 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

9. 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

10. Product Owner
Team
Scrum Master
Simple Scrum

11. Product
Owner 4
Product
Owner 3
Business PM
Product Scrum
Owner 2 Team IT PM
Scrum SME/Arch
Master
Product
Owner 1

12. 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

13. Sprint Models
Model S
DEV-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 UAT
Model D-S-U
DEV SIT UAT
Defects Defects
DEV SIT UAT
Defects Defects
DEV SIT UAT

14. ROOT CAUSES

15. 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

16. 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.

17. EXAMPLE
• Choosing to not have retrospectives hampers:
• Continuous improvement
• Transparency
• Sustainable development
• Not tracking velocity hampers:
• Continuous improvement
• Transparency
• Sustainable development

18. 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!

19. 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?

20. ROOT CAUSE 3:
ACCELERATED OFFSHORE UTILIZATION
• 2008 – 60% company, 40% contractor
• 2011 – 30% company, 70 % contractor
• Source of business innovation cut in half

21. 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)

22. 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. IMPACTS TO HEALTHCARE COMPANY

24. 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. FIXIN’ THE PROBLEMS

26. 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

27. 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

28. 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

29. Coaches Coaches
Coaches Coaches
Coaches
Coaches
Coaches

30. 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

32. Training with Coaching
Coaching

33. 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.

34. “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

35. 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”.

36. 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?

37. TREAT THE ADD
• Guidance of prioritizing projects/features
• Help teams develop self-discipline
• Educate on myth of multi-tasking

38. ADDRESS COLLABORATION ISSUES
• Lack of trust - team building exercises
• Triangulation
• Painters Pyramid
• Matthew 18
• 360˚ Surveys
• Monthly joint meetings

39. ADOPTION LESSONS LEARNED

40. • Involve the Business from beginning
• Utilize external coaches for first year
• Honor Scrum values & principles
• Be transparent
• Be honest

41. MOST IMPORTANTLY: MAKE A DECISION
• Do you want to be a Guppy or an Olympic Swimmer?

42. Product
Owner 4
Product
Owner 3
Business PM
Product Scrum
Owner 2 Team IT PM
Scrum SME/Arch
Master
Product
Owner 1

43. Product
Owner 4
Product Owner
Product 3
Owner 2
Business PM
Lead
Product
Owner
Scrum
Team
Scrum Master
SME/Arch
IT PM

44. QUESTIONS?

45. 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