The Agile Methodology is not inherently evil. For those of you who’ve been under a rock for the past 10+ years, or lucky enough to sit very high in the ivory tower indeed, Agile is a system for the project management of software development. Or at least, that’s how it started. Agile is focused around a lot of really great ideas such as:
- Be flexible and open to change and improvement
- Be collaborative
- Regularly push out product so that stakeholders stay engaged in the project and have real understanding of where the project is at
- Do not let the perfect be the enemy of the good
If you’re thinking to yourself “those ideas seem really obvious,” you would be right, but just because something is obvious doesn’t mean it’s easy to do well. It’s hard to be collaborative and not feel like you’re wasting time in too many meetings. It’s hard to make regular changes, even if those changes are clearly an improvement. Change increases stress, requires even more collaboration and communication, and creates uncertainty. Uncertainty often equals risk.
All this is to say that there are elements of Agile that should also be incorporated into healthcare project management or indeed one’s general life philosophy.
But let’s get two things straight.
- Healthcare is not a product; it is a service.
- The primary measure of “value” is increased health, not increased profit.
Philosophically, Agile is not compatible with healthcare. Agile is also meant to be literally that – agile. Flexible. Adjustable. The product and the project scope are subject to change based on availability of time and resources. There is a limited planning phase to any project, because you know things are going to change once you get coding.
Absolutely none of the above is true for healthcare. Compliance requirements are not flexible and they are certainly not optional. A project plan submitted to a health department and the budget that goes with it are near impossible to change. And perhaps most importantly, my project plans affect things like whether a patient with schizophrenia gets case management services. It’s not Fruit Ninja.
Agile is about getting stakeholders who understand each other into a room together to build a thing. Any project affecting patient care requires the input of widely diverse stakeholder teams who do not remotely understand what the other teams do. Doctors do not know anything about billing. Social workers do not know anything about health record databases. Also, here’s an obvious thing you may not realize if you’re in the software industry – healthcare providers can’t just take a half hour meeting during their shift. People in healthcare don’t have the same 9 to 5 shift and they’re not in the same place. It takes a flabbergasting amount of prep just to get the appropriate stakeholders on the same conference call. Don’t bother trying for the same room. There will be lag and things move slowly in the healthcare industry. That’s OK. It’s just that a project manager needs to use that time to plan and mitigate risk in any way possible, because they may only get one implementation.
I know how the healthcare industry appears to the software industry – a giant financial opportunity, a problem to fix, a treasure trove of data, and a fossil. They’re not wrong. But Software and Heatlhcare do not speak the same language, and what’s worse, the leadership of both industries don’t even realize it’s not the same language. They think they’re communicating just fine, in the universal language of cash and public offerings.
This will be an ongoing issue for project managers or any public health professionals going forward. Always remember that patient health is the metric that matters.