What is Agile?
Agile is an approach to product development that is based on iterative and incremental development. In 2001, software developers met in Utah and drew up with the Manifesto for Agile Software Development. The aim of the manifesto was to find better ways to develop software as a product. Is the business of healthcare delivery (another kind of product) much different?
Agile development for software includes four core principles:
- Individuals and interactions over processes and tools
- Working software over comprehensive documentation
- Customer collaboration over contract negotiation
- Responding to change over following a plan
From my experience, this is parallel to the business of healthcare, especially to those of us who have survived 20-30 years in the industry. The two things we can count on are change and iterative development.
The second principle of the Manifesto was, working software over comprehensive documentation. In the context of the healthcare industry, that might upset the accreditation and quality documentation writers. After all, with less documentation what happens to their jobs?
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But wait. Is there another way to look at things? Could less documentation actually be better?
A look at Agile Documentation?
Rather than launch into a lengthy exposition about Agile Documentation, let me show you what it looks like. Here are some examples. My consulting competitors will think I’ve gone daft, because they earn a fair amount of revenue by scaring clients into thinking that the documentation is what it’s all about. Healthcare clients rarely want to get bogged down in documentation or writing the documentation of a new practice, a new procedure, a new policy – so they hire out the drudgery to a consultant – often for hundreds of thousands of dollars.
What I am suggesting is that perhaps those documentation engagements need not be so “excessive”, or costly. (Now, for sure, they are going to vote for my expulsion from the Consulting Club as a traitor and infidel!)
So here’s a list of essential points of how Agile documentation works better for healthcare:
- Communication, not documentation – Talk to people, not paper.
- Write documentation only if it’s the best way to achieve a goal – but first really identify the “goal”. Is the goal to have something documented or to actually provide better, safer care?
- Document stable things, not speculative things – Is a best practice really best? Is evidence-based really applicable in the given situation? or just close enough?
- Allow documentation to evolve: seek feedback by those involved in the process – This is similar to the Ringi Method1
- Assign ownership of a document to a person; not a department
- Be concise: choose roadmaps and overviews instead of detail – instead of trying to document the “what”, document the “how”
- Aim for documentation that is just barely good enough – not a novel or an academic thesis – this is especially true in business plan creation
- The documentation’s benefit’s much outweigh the cost of creating and maintaining it – especially in litigation or compliance defense (i.e., “better to have and hope you never need”)
- Practitioners rarely trust documentation, especially if it’s detailed as it can be out of sync with actual practice and current techniques and methods
- Each system and process has its own documentation needs- respect their nuances rather than try to standardize them
- Ask whether you need documentation, not whether you want it. (That one will get me kicked out of the old timer’s consulting club, for sure!)
- Create documentation at the appropriate point in the life cycle of the process or procedure – when all the bugs are worked out.
‘Ringi‘ is a process used in Japanese organizations which ensures that all people who will be involved in implementing a decision have a say in making that decision in the first place. Ringi is a collective decision-making process involving the circulation of a document (the ‘ringi-sho’). This document is annotated and amended as it circulates, and continues around the decision-making loop until everyone signs up to it using their own stamp.
My purpose of writing this was not intended to provide exhaustive explanation of the topic, but instead to introduce you to the concept and hope that you will investigate it further.
We apply Agile planning and documentation for healthcare business startups in a lot of healthcare project engagements. I’ve had excellent results applying Agile principles to new medical practice startup, medical tourism business startups, ACO development, even hospital and ASC accreditation preparation in anticipation of an upcoming survey.
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