Children’s Mercy Hospital

Courtney Fisher-Lewis

During a weekly leadership meeting for our IT team, a concerned project manager raised an issue about a large project she was managing for the organization.

This project had been stalled early on; the frustrated development team was having difficulty defining allthe requirements and potential solutions and project team meetings were constantly left at a standstill. When talking with the project team, the project manager and I continued to hear the same themes: “We don’t know what we don’t know,” from the software developers, and “We need to hash out all the possible requirements,” from the team leaders. It was time for us to call a new play. Several of our development teams had reduced backlog significantly, improved quality of each deployment, and strengthened team collaboration with agile. We were confident in our ability to extend the methodology to other project teams.

Ultimately, David Chou, Chief Information and Digital Officer at Children’s Mercy Kansas City, and I wanted to see these results replicated in all areas of IT to drive value at an appropriate cadence with happier stakeholders and teams. To realize results in an agile methodology, as the Chief Information Officer or senior leader in IT, your most important role is to remove obstacles for the project team. It is no different when implementing an agile approach. “The implementation of agile itself can be challenging with potential obstacles. It’s important to be aware of what you may face when introducing these methods and to bring the change at the correct pace for your organization,” says Chou. Here we have broken down two common obstacles you might encounter in your agile implementation.

Obstacle 1: Agile requires change in culture, team roles, and leaders.

Initially presenting the four tenants of agile to a traditional enterprise PMO, supply chain or legal department may cause them to recoil; the principles are to put individuals and interactions over process and tools, working software over comprehensive documentation, customer collaboration over contract negotiation, and responding to change over following a predetermined plan. Ensure these stakeholders see how the application can aid in driving their best interests. “At Children’s Mercy our culture was more prepared for the change. We were several years into the implementation of a hospital-wide lean daily management system. All employees were accustomed to daily huddles, True North metrics, and raising and resolving issues as quickly as possible by breaking them down,” says Chou. It is important to implement agile iteratively, moving from group-to-group and showcasing the value of your methods to these business leaders before proceeding to the next area.

"Empowering the team and creating more opportunities for collaboration are the important steps to make Agile drive speed to value improve quality and build relationships"

Empowering the team and creating more opportunities for collaboration are the important steps to make Agile drive speed to value improve quality and build relationships. The most important role of the leader in agile is to simply remove any obstacle the team may face that will block progress to deliver value. Autocratic leaders will not be successful unless they can change their leadership style to one of a servant leader. The team must be allowed to work undisturbed, without intervention and tops-down direction during their development cycle. Focus of the team is key, so the leader must not distract with other projects that pop up.

David Chou, SVP & CIO, Harris Health System & Ex-Chief Information & Digital Officer, Children’s Mercy Hospital

Obstacle 2: Agile is not a one-size-fits-all project management approach either.

For an IT department working with a variety of stakeholders and vendors on a daily basis, agile or lean methods will at some point need to be blended with waterfall project management methods. “There are times when timeline, scope, and/or cost may need to be fixed at the onset of a project due to business drivers, contract requirements, or budgets,” says Chou. From our perspective, it is important to view each approach as a tool in your team’s toolbox; provide them with a variety of process flows, templates, methods, and technology and allow the team to determine for each project which tools will create the greatest result (speed to value).

A good place to start is with the project intake and governance process, which must be designed to solicit from all levels of the department, ultimately gaining a final approval from a small committee of leaders. For example, stakeholders from clinical and operational departments should present problems that may be solved with technology to their counterparts in IT. The problem is broken down and examined carefully—process improvements are identified to remove waste and possible technical solutions are investigated. Information about the problem, idea, or potential solutions is made available to the IT team for collaborative review and input during a short window of time, and if the idea gains enough traction, it is taken to a small governance committee where the final decision to proceed is made. Stakeholders will most certainly become frustrated if the wait for an answer is too long, so it is crucial that the review and governance process turnaround is quick.

When using an agile methodology, work is broken down and the goal is to fail early and often. “If you stop to think through the risk of this approach, it is very minimal,” says Chou. “With long, waterfall methods, issues will arise throughout the project, but failure is not identified until days or even months after go-live when the solution is not adopted. With an agile approach, this is discovered after two weeks instead of two years.” Even if the team is using a waterfall approach to project management for a specific implementation, the design, build, testing and demo efforts can be completed in iterations to reduce the project timeline. If features and functions can be broken down into manageable chunks and stakeholders areableto see thesecapabilities showcased throughout this phase of the project, rework at the end of the project can be avoided.

Results

The iron triangle—timeline, budget, and scope—are still important measurements of success for an IT project; however, it is important to add another dimension to the triangle to measure success in today’s competitive technology landscape. Measuring quality, the concept to release timeline, and most importantly business value are key outcome metrics in which to focus attention. “Your efforts may help the organization achieve its strategic plan, push innovations to more technology savvy consumers, or help you gain brand recognition,” says Chou. As you implement agile in your organization, do so iteratively and by identifying and removing any obstacles. Start small and spread your success at the right pace, showcase the results you achieve, and most importantly commit to continuously adjusting and improving. The work to drive value to your stakeholders can never be complete.