The cost of healthcare administration is crushing Americans. According to the National Institutes of Health, it was projected to be $315 billion in 2018. One of the invisible and indirect ways that average people are paying for more than just medical care is the onerous processes that healthcare providers have to go through just to do their jobs.
In this article, I want to share my experiences helping a major healthcare provider see the value of transforming to a business agility mindset so that they could achieve their desired outcome of making it easier and less painful for doctors to process claims and get paid.
It all started with an ART.
When the client brought me on, they had already spent a few years rolling out agility to their enterprise, with greater or lesser success. The provider organization had a number of Agile teams and the organization had decided to implement the Scaled Agile Framework to be better able to release software faster, making it easier for doctors and administrators to work with the organization. I was a part of the client coaching office when I was sent to launch a single Agile Release Train (ART). As you and I know, it takes far more than simply launching an ART to get to real business agility outcomes.
Over the next six months, I created and maintained a strong, trusting relationship with one of the key stakeholders of the transformation initiative, a man named Dan. While the client started out looking to launch a train, we were able to demonstrate the need to think bigger, more strategic. Over the course of six months, we launched a truly cross-functional virtual organization that cut across traditional functional towers, divisions and specialties that would focus on removing barriers for doctors to make their experience with our client easy and painless.
It would take much more than one blog to capture the grit and magic that I experienced during the transformation effort, but I want to focus on three key events that really drove home the value of Agile and of a comprehensive business agility transformation for the client:
- Standing up the Executive Action Team (EAT)
- Finding the Why
- Portfolio Planning
Our first step toward business agility was to form an Executive Action Team (EAT), which would steer the transformation efforts. This included members from 7 business groups, 4 IT groups and 3 vendors. To quickly visualize the relationships between the different participants, we did a simple exercise with some string. The new EAT was able to gain deep insights, including:
- Who the bottle necks were
- Which critical people were left out of conversations
- How many dependencies still existed outside the group and who they were
These insights helped the EAT to create a set of working agreements for how the group would work and learn together. Next they worked on forming the deep bonds that would allow them to transcend their individual groups. One of the first steps was for each member of the team to create and share a journey line. This allowed the team not only to start building psychological safety, but it also revealed a number of hidden skills that would help this team of leaders create a stickier transformation.
Who are You? What’s Your North Star?
It was around this time that the EAT identified the need to focus on provider experience. Except they did not have a shared understanding of Why they were doing the work that they were doing – never a good sign. We shared with them Simon Sinek’s Golden Circle2, which helped them gain a shared understanding or their “Why.” Then they could share that understanding with the development teams, product owners, business partners, and stakeholders.
As the EAT began to communicate into other parts of the organization, different groups began reaching out to learn how they could benefit from the same techniques and thinking. This had the unintended effect of muddying the waters. The EAT decided they needed to define this new organization’s identity. Dan and I created a branding workshop and the Advanced Provider Experience (APEX) group was born. From then on, communications became focused on telling stories that reflected the values and personality of the group. This provided a platform for gaining support from other parts of the organization and enrolling more teams into this new way of working.
Big Room, Small(er) Plan
As the product and portfolio capabilities started to emerge, it became apparent that the APEX group did not have a strong definition of what their products were or a good understanding of how value flowed through the organization. So we held a Product Definition and Value Stream mapping workshop based on the Scaled Agile Framework. We used the info from the workshop to create a plan to launch not one but five Agile Release Trains (ARTs) focused on their products. Each train included members and teams from multiple business groups and IT groups, so their work was focused on creating the desired outcomes for doctors and other medical providers while minimizing handoffs, dependencies and delays.
Value Stream Mapping and Product Definition
Looking at the work, through a number of meetings between the Portfolio stewards, myself, Dan, and a variety of stakeholders, the EAT developed an Agile-Lean portfolio management process to ensure business and IT were working on the highest value work together as one group. Previously, priority was determined by “whoever yells the loudest” and business and IT each had separate backlogs, intake processes and priorities.
In the new portfolio structure, priorities are focused on creating the most value for their customers, providers, in the shortest amount of time. Some existing projects were canceled or put on hold indefinitely to free up teams to focus on completing the highest priority product work and reduce multitasking and split commitments.
Work prioritized using new portfolio structure
As a result of our partnership, the organization stands to drastically simplify antiquated processes in healthcare, which all of us benefit from in the form of happier, less stressed healthcare providers. In my work with Dan, I focused on helping the leaders who would steer the transformation to not only claim an identity for their team and the organization they were steering, but also to clearly define why they exist, and why their work processes need to change. With all of this in place, leadership could strategize a launch of several ARTs guided by a shared vision.
And the results speak for themselves. By removing barriers between the siloes, we were able to reduce the time and human intervention required for new providers to join the organization from months to days. That kind of positive change provided much business motivation for continuing to transform their organization, which can have an impact on its competitiveness and maybe even cause a shift in the American healthcare system. And that certainly makes me feel better.
- Institute of Medicine (US) Roundtable on Evidence-Based Medicine; Yong PL, Saunders RS, Olsen LA, editors. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. Washington (DC): National Academies Press (US); 2010. 4, Excess Administrative Costs. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53942/
- Sinek, Simon, The Golden Circle Presentation, https://simonsinek.com/commit/the-golden-circle
Hear from the Author at Agile2019!
Agile coach and Accenture | SolutionsIQ Community Lifecycle Co-Lead Emilia Breton will be presenting with co-presenter Daniel Scalfaro on “Transforming Healthcare with Business Agility” at Agile2019 in Washington, D.C. You can learn more about Emilia’s experience and connect with her on LinkedIn and Twitter.