| | October 20179UTLOOK Healthcare Tech `Radicalizing' Agile for Strategy and Managementuncertainty: builders use waterfall project management, projecting the entire schedule for construction prior to starting to build. Ask them how long it will take for your new home, and they can answer "six months." Because so much of what we do in healthcare IT is new, agile is a good fit. We make a much rougher estimate of the work and we continually reprioritize. Work is organized in such a way that you can always stop at the end of an iteration and you will still have delivered something of value by chopping things up into one releasable feature at a time. Even though someone in management might have said, "I want these 10 things on my wish list," it's possible that when they get their first three, they are satisfied, and it's time to rethink priorities.Our first big success with agile was in implementing our electronic health record. We'd been customizing an old EHR for 12 years; it was time for a replacement. We couldn't recreate 12 years of customization in an implementation. We embraced an agile concept of "minimum viable product." Our approach was to get something useable delivered as soon as we could. Everyone would be able to do their jobs, even if it lacked some of the features and enhancements from before. There were workarounds, but staff were able to get things done. We then began a release cycle where each month we released the highest value enhancements. What would help the greatest number of people; what would help us meet new external requirements? As part of that process, we convened two groups of stakeholders: the recipients of the enhancements and our organizational leadership.The first stakeholder group ensured the work completed met the end-users' requirements. We'd do a two-week sprint and meet with end-users to show them the results, making sure that we captured what they were asking for. By getting feedback before a feature went live, we made sure we didn't get too far of course, that we weren't releasing something that failed to solve the problems at hand.The second idea was organizing a work queue. Every month we met with VPs across the organization. We'd ask them to advocate for prioritizing their work ahead of other projects and have a discussion on which were important and which could wait. Instead of just me making the decision on what's important, we had feedback, input, and transparency. The entire organizational leadership made decisions about where to focus our time and effort. A natural question is why doesn't every organization use agile all the time? One answer is that a lot of people don't really manage projects that tightly. They do their work and try to do their best, and work gets prioritized based on who the squeakiest wheel is. At the same time, bigger projects end up getting over-planned. People pretend to know too much about how it's going to play out. They map it out in painstaking detail and pretend to know exactly how much time people will take to get things done. At the CIO level, it's been tremendously valuable to me to invest in a consistent tracking methodology for all the work we're doing. It wouldn't be possible to do as much as we're tasked with without putting this organizational structure in place. It allows me to look and report on the status of as many as 60 different things without knowing it off the top of my head. And it allows me to set realistic timelines for when work will get done, while still allowing us to be nimble and adjust, which is important with everything going on in healthcare these days. HTSome of the key features of agile are increased transparency, the ability to shift directions, and measuring productivity
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