An Agile Journey in Healthcare

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  • 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

AGENDA HistoryAssessment Findings Anti-Scrum Patterns Root CausesImpacts to the Healthcare companyFixing the ProblemsLessons Learned 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 2011 ORGANIZATIONAL ASSESSMENT 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 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 Attribute Team Distribution Product Owner Product Complexity True Sprint Length Projects per Team Scrum Experience XP Experience Team StructureLowest RiskLower RiskHigher RiskHighest RiskCollocatedCollocated Part-timeDistributed OverlapDistributed No Overlap1Lead PO2multiple POs (no lead)1 system2 systems3 systems4+ systems2 wks4 wks6 wks8+ wks1234+ProficientAdvance BeginnerNoviceProficientAdvance BeginnerNoviceExpertExpert Truly crossfunctionalSpecialized roles 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 Product OwnerTeamScrum MasterSimple Scrum Product Owner 4Product Owner 3 Business PM Product Owner 2Scrum TeamScrum MasterIT PM SME/ArchProduct Owner 1 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 Sprint Models Model S DEV-SIT-UATDEV-SIT-UATDEV-SIT-UATUAT.DEV + SITModel DS-U DEV + SITUATUATDEV + SITModel D-D-D-S-U DEVDEVDEVSIT.SITUATUATModel D-S-U DEVDefects DEVDefects UATSIT Defects DEVDefects SITUAT ROOT CAUSES 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 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. EXAMPLE Choosing to not have retrospectives hampers: Continuous improvement Transparency Sustainable development Not tracking velocity hampers: Continuous improvement Transparency Sustainable development 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 releaseWith Agile, the Business is in the drivers seat! 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? ROOT CAUSE 3: ACCELERATED OFFSHORE UTILIZATION 2008 60% company, 40% contractor 2011 30% company, 70 % contractor Source of business innovation cut in half LOOK AT THE NUMBERS US health care insurance experience 160+ years as an industry Over 80% of Americans with healthcare insurance today Indias health care insurance experience 12 years experience in industry Less than 6% with healthcare insurance (as of 2010) 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 IMPACTS TO HEALTHCARE COMPANY 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) FIXIN THE PROBLEMS 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 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 RE-BUILD THE AGILE COMMUNITY Coachs 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 CoachesCoachesCoaches Coaches CoachesCoachesCoaches 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 Training with Coaching Coaching 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. 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 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. 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? TREAT THE ADD Guidance of prioritizing projects/features Help teams develop self-discipline Educate on myth of multi-tasking ADDRESS COLLABORATION ISSUES Lack of trust - team building exercises Triangulation Painters Pyramid Matthew 18 360 Surveys Monthly joint meetings ADOPTION LESSONS LEARNED Involve the Business from beginning Utilize external coaches for first year Honor Scrum values & principles Be transparent Be honest MOST IMPORTANTLY: MAKE A DECISION Do you want to be a Guppy or an Olympic Swimmer? Product Owner 4Product Owner 3 Business PM Product Owner 2Scrum TeamScrum MasterIT PM SME/ArchProduct Owner 1 Product Owner 4Product Owner 3Product Owner 2Business PMLead Product Owner Scrum TeamScrum MasterSME/Arch IT PM QUESTIONS? CONTACT ME alstonehodge@gmail.comAlstons Awesome Agile Blog (free coaching and advice!)Twitter: @alstonhodgeJoin 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