On Wednesday, October 19th Brigham Innovation Hub was joined for our October Innovation Hour by Jeff Sutherland – the inventor of Scrum and co-author of the Agile Manifesto. As a West Point graduate, former Air Force aviator, mathematician, computer scientist, massively accomplished entrepreneur and physician, Dr. Sutherland spoke not only about how his experience led him to develop Scrum (a flavor of Agile), but also about its importance and applicability in all industries and in healthcare in particular. He asked at one point, “What if a department like orthopedics implemented Scrum and treated 50 percent more patients with better quality and outcomes?”
Agile originated as a software development approach but has been applied to other forms of product development, project management, and even education. Small groups self-organize and work on manageable chunks of agreed-upon, priority work. It includes a feedback loop component where teams can say “what’s working, what’s not working and what have we learned?” This iterative component thus defines and directs the work, rather than a big project plan created at the beginning of the initiative. Scrum adds a component of time, the “sprint” concept during which teams commit to a certain set of deliverables.
Dr. Sutherland encourages us to think about how Agile can be better employed in healthcare as both an alternative and a peer to traditional, “waterfall” project management, where the entire initiative is planned out in detail before any work gets started. Yes – we use Agile and other “lean” management methodologies in developing and managing healthcare technology projects, but what if we were to directly apply it operationally within the hospital? Hospitals all over the country are changing the way we operate due to a slow-but-consistent, nationwide shift toward pay-for-performance, rather than service-based payments. Changing processes to more closely align with the Institute for Healthcare Improvement’s (IHI) “Triple Aim” means changing the way we do things, and offers us the opportunity to adopt an Agile approach in places we may not have before.
Using Agile in guiding process re-engineering initiatives could, in some cases, allow us to use an iterative and adaptive methodology to achieve all three of these aims. We could deliver value to patients, clinicians and scientists earlier and make changes more rapidly when things aren’t working perfectly.
Of course, Agile isn’t perfect in every case. It works best in situations with high-uncertainty – where a “learning organization” is important – and in situations where patient/customer feedback is vital to the success of the initiative. But Dr. Sutherland’s discussion asks us to think about when an Agile process may work better than a traditionally scoped and managed project.