Iterative development, adaptability, flexibility, and rapid deployment are some terms you commonly hear in agile project management methodology. Manage India picks practitioner stories that illustrate how agile techniques can be applied in different industries and scenarios to solve some unique challenges
Agile Techniques in Emergency Medicine Management
Regeena Pereira, Sujith N. Rai and Suchitra Joyce Bontha have combined their passion for agile project management techniques with their experience and interest in hospital management to recommend ways to improve the everyday management of the emergency department of hospitals using agile techniques
A smooth operational flow is critical to maintain high service quality in the complex yet often chaotic Emergency Department (ED) in hospitals.
Common obstacles to smooth operations in ED include delay or lack of adequate patient information, errors in patient details, inefficiency or lapse in information transmission, and faulty flow of material which may compromise patient safety, cause financial losses, and result in regulatory issues. Hospitals need to manage these challenges well to achieve patient and employee satisfaction, patient safety, risk reduction, evidence based outcomes, and profitability.
Hospitals have adopted new technology to enable automation, quick response, improved clinical decision-making, efficient healthcare delivery and administration, and adherence to compliance.
Agile techniques in project management, practiced widely in the IT industry, offer solutions to a number of ED workflow challenges by identifying limitations in existing systems, use of generic development tools, increased transparency, and enhanced collaboration between working teams, product owners, and end-users. The impetus is on quick delivery turnaround time without compromise on quality and consistency in the end result.
Emergency Department Flow
When an emergency occurs, the ability to respond to the uncontrolled event with maximum speed and coordination of resources can save billions of dollars in damages and prevent the unnecessary loss of life. Emergency medical service dates back to the 1860s French Revolution when speeding carriages of the French flying artillery transported the wounded from battlefields to centralized field hospitals. However, emergency medicine as a medical specialization is only about 70 years now. Over time, strategies to address and improve patient flow in emergency care developed with increased support from the hospital.
Hospitals invest in the training of ED workforces to help them manage critical care patients. ED comprises of multidisciplinary teams who follow set protocols. They are trained to identify problems that impede an ED flow. A few commonly employed ED strategies include engaging intensivists' or intensive care specialists to manage patients, increased nursing and physician staffing at various levels, creation of admissions or triage units adjacent to ED, and the use of technology to optimize workflows.
Agile Emergency Management:
Emergency agile management in many ways incorporates the flow and process of ED - triage in order to prioritize, no queue, minimal wait time, clear lanes and seamless movement, backup and short turnaround time. The primary goal of this approach is the ability to reasonably absorb uncertainty, thereby striking a balance between robustness and speed that aligns with the agile approach.
Triage - Pick, Perform and Reject:
Triage in EM refers to sorting of the injured or sick according to their need for emergency medical attention. The conventional EM classification of triage is immediate, immediate but not urgent, and not urgent. A similar approach of categorization is employed in agile techniques in project management to prioritize a list of tasks. However, the fundamental problem in agile units rises in prioritization primarily due to constantly changing client requirements, varied nature of tasks, and the magnitude of sheer numbers.
Triage plays a critical role in sorting, prioritizing, picking, and rejecting issues to be fixed by the team. Customarily triage efforts revolve around factors that influence priority rather than the task of prioritizing itself. Judicious triage allows for shorter, yet comfortable iterations to absorb in-line tasks as quickly as possible. Triaging holds the key to streamlined flow in emergency situations. Yet another factor that contributes to emergency management are emergency swim lanes in agile units that may be restricted to a minimum number, thus preventing overload and revisiting of precision prioritization and prioritization criteria, much like the bed strength in hospital emergency units which are limited, allowing for concentrated medical efforts and smooth flow through the various facilities in the healthcare setting.
Clear Lanes for Uninterrupted Movement:
An emergency case from the ED gets a thoroughfare across all the services in the hospital. Clear lanes may simply imply standing back to make way and avoiding being a hindrance, and in a few cases, it may mean lending a hand to remove an impending hurdle or even probable foreseen obstacles, essentially allotting additional resources, reducing wait time, and prioritizing. Agile teams should be primed for preparedness to take up an emergency with a principal focus of creating a freeway and directing effective resources should an emergency occur. Factors such as severity, dependence, and the number of patients decide whether lanes must be switched from emergency to regular or vice versa. A specified emergency protocol permits such transition efficiently.
Buffer for Emergencies:
Hospitals with an ED need backups for diagnostics, including laboratory and radiology service resources, who can take up unexpected emergency testing or equipment maintenance in case of breakdown in order to stay committed to the turnaround time (TAT) from sample registration to result reporting.
To account for emergencies, agile teams advocate pair programming that provides scope for on-time delivery. Buffers that are used in software development planning approaches help manage the risk of estimation overruns. Feature buffer places mandatory items on priority so that iteration planning accommodates those items. Schedule buffer is used to reflect and accommodate uncertainty at the project level.
Analysis - Trends and Root Cause:
Crowding poses a strain on ED, often resulting in a breakdown in services. EDs work around diverse methods to avoid disruption including input-throughput-output models, efficient triaging, and root cause and trend analysis that agile practitioners advocate. A thorough analysis of the defect root cause or trends pertaining to the team's delivery and efforts is critical for successful triage and prioritization that impacts the delivery of the rest of ED services.
Agile project management methodology emphasizes flexibility, informal cooperation, and time driven deliveries. Various industries have adapted and found success in these methodologies. Agile emergency methodologies employ project management principles on a highly advanced platform in order to overcome the challenges that come with the unpredictable. Agile emergency teams must adopt practices that allow appropriate resolutions, commitment to timelines, resource management, preservation of quality, and process compliance.
An emergency cannot be accommodated by overlooking or delaying regular tasks, and therefore, an emergency necessitates an independent process and flow. Emergency medicine management on agile techniques should ensure teams have the right capabilities and capacity, and possess clear direction and focus. Preparedness is the way forward in agile management of emergency medicine. Factors that significantly contribute to managing emergencies include triage and prioritization, short iterations to absorb in line defects, speedy movement through clear lanes by reduction in wait time and unnecessary processes, pair programming in order to shift resources in time of need, and root cause analysis.
(Ms. Regeena Harsha Pereira, PMP, is a subject matter expert who works with various teams to help them adopt agile project management methodology. Mr. Sujith N. Rai has been working in the fields of avionics and healthcare with a strong passion for implementing agile techniques in software development. Ms. Suchitra Joyce Bontha, PhD, has been a part of the hospital/healthcare industry for almost 15 years.)
Rapid Deployment in ERP Environment
Pallavi Kelapure and Vikas Gupta recommend the right approach to speed up Enterprise Resource Planning (ERP) implementation, a business necessity in today's world
Organizations are today aiming at rapid deployment to reduce time-to-market. Concepts like agile project management methodology, iterative Conference Room Pilots (CRP) and developments, and automated release management are being adopted based on the organization's size, business characteristics, and readiness to adopt.
Complexities around ERP Implementation:
ERP has been prevalent for more than two decades. Many players, starting from product vendors to system integration partners, have joined the fray.
Business models and dynamics are changing rapidly, leading to the evolution of redefined technology paradigms. Traditional business models are getting a rejig due to new ways of doing business such as e-commerce and the increased focus on customer experience. Moreover, organizations are under pressure to expand globally, reduce time-to-market, and reduce total cost of ownership. To keep pace with these changes, organizations find multi-year implementation programs less feasible and are looking towards rapid deployment.
ERP product vendors and system integration partners are recommending methodologies like Oracle Unified Method (OUM) and agile project management techniques to support rapid deployment to stay in line with business goals.
Key parameters which impact rapid deployment in ERP:
- Dependency on legacy data: Complete data conversion cycles cannot run as frequently as it may lead to business disruption.
- Complex IT landscape: End-to-end business process integration has complex interfaces with in-house and trading partner's applications. Testing activities are planned keeping in view trading partner's readiness and release schedule.
- End-to-end solution: Deployment success is linked to the end-to-end business process functionality getting delivered and associated integration touch points.
- Instance strategy: In tradition Software Development Life Cycle (SDLC) waterfall model, instance strategy is focused on reusing instances by staggering test cycles. Testing cycles are also planned based on business user availability.
- OCM and training: As ERP implementation leads to business transformation, thorough planning is required for OCM and business user's enablement.
Keeping above considerations in view, the agile or waterfall model can be used in business situations mentioned in a table (Figure 1) in an effective way (with green indicating higher suitability than red).
Traditionally, the SDLC waterfall method has been prevalent in ERP implementation. In recent times, to meet the business requirement of reduced time-to-market and lower total cost of ownership, rapid deployment techniques are being embraced.
With increased maturity, organizations are seen implementing hybrid models which are a combination of techniques from these two project management methodologies.
Based on our experience, the rapid deployment approach applies to the below business scenarios.
Scenario 1: Vanilla implementation with lower customization level (< 20%)
With increased maturity in off-the-shelf ERP products, organizations prefer standard product implementation, also called 'vanilla implementation', that saves them the cost of customization and allows them to leverage industry standard processes. Key activities in vanilla implementation are configurations and data conversion.
We can use the agile project management methodology for requirements elicitation, solution design, validation, and development activities, and conduct rapid deployment. Iterative conversion runs are executed in parallel to sprints. The number of conversion cycles depends on parameters such as data quality and functional scope. Testing cycles like System Integration Testing (SIT), User Acceptance Testing (UAT), and cutover can be executed in the waterfall way after the solution is built completely through agile techniques.
This hybrid approach helps in reducing the overall duration of implementation, besides reducing the risk by building and implementing business critical requirements in earlier sprints.
Scenario 2: Implementation with higher customization level (>20%)
Global organizations and organizations that operate in niche business areas struggle to find an ERP product that fits their entire business requirements. Multiple parameters like trading partner's integration, regional processes, and complex IT landscape are the primary challenges. It leads to higher customization and testing needs.
In this scenario, agile techniques are useful for requirements elicitation, solution design, validation, and development activities, with development of customizations being a key activity. Iterative conversion runs are executed in parallel to sprints. The number of conversion cycles depends on parameters such as data quality and functional scope. SIT is done in an iterative way, with the number of SIT cycles depending on the customization level, complexity, and planned logical grouping of customizations for testing. Post that, UAT and cutover can be executed in the waterfall way.
This approach helps to a great extent in reducing risks by building and testing business critical requirements early in the implementation.
Scenario 3: Production maintenance and functionality upgrades
Organizations need to implement new functionalities and expose them to end users in a short span of time without disrupting day-today business. They try to develop and deploy the functionalities in releases at a pre-defined frequency. If there is inadequate focus on activities such as regression testing, training on new functionalities, and support, business gets disrupted after the release.
Agile techniques can be used as the development methodology in releases to ensure rapid releases with quality outputs. An additional UAT cycle can be planned depending on the release size and availability of end users.
Based on our experience, it becomes clear that the cycle time of ERP implementations and support projects can be shortened, unless popular belief. The adoption of either agile or hybrid approach can be used in most ERP scenarios for rapid deployment. The hybrid approach includes usage of techniques such as agile, iterative development, and iterative testing. For continued success, organizations must invest to build these skills in their resources.
(Ms. Pallavi Kelapure has 17+ years of experience in manufacturing and finance domain, and has managed large business transformation and sustenance programs based on Oracle products. Mr. Vikas Gupta has 15+ years of experience in manufacturing, engineering & procurement, defense & aerospace domain, and has managed large business transformation and sustenance programs based on ERP products.)
Hybrid Approach for Automobile Industry
M. Parvez Alam talks about the advantages of a hybrid agile project management approach in projects around new product development in the automotive industry
Project management in the conventional sense requires relatively complete initial definition of outcomes and scope. However, Research and Development (R&D) projects around new product development in the automotive industry are characterized by complex, interrelated activities and large uncertainties about the solution path. Though conventional project management methodologies can be applied to many automotive R&D projects, some projects, especially those involving knowledge workers, involve uncertain scope and time-constrained environments. These projects call for an agile project management approach.
Many automotive organizations follow Advanced Product Quality Planning (APQP), which is a framework of procedures and techniques used to develop products. A few automotive companies have, however, customized and developed their own project management system. Of late, we have seen the emergence of a hybrid agile project management approach that combines traditional project management methods with newer methods.
Paradigm Shifts in Automobile Projects
An automobile is powered and controlled by a complicated system that is composed of several sub-systems that are intricately interconnected. Figure 1 shows the parts of a car with various systems. Today, there has been a shift in approach from product development to system development. In system based projects, the need for software is growing. Software development projects are often troubled by time and budget overruns, resulting in a system that does not fulfil customer requirements. In system based R&D, both tangible product development and intangible software development takes place simultaneously.
Figure 1. Various systems of a car
Traditional Project Management in Automobile Industry
APQP, the traditional project management methodology followed in the automobile industry, has been developed by a supplier quality requirements task force set up by automobile giants Chrysler, Ford Motor, and General Motors. The task force's charter was to standardize project management procedures and reporting formats to be followed by their suppliers.
Some of the expected benefits in using these guidelines are:
1. A reduction in the complexity of product quality planning for customers and suppliers
2. A means for suppliers to easily communicate product quality planning requirements to subcontractors
Figure 2 depicts a typical program. The various phases are sequenced to represent planned timing to execute the functions described.
The product quality planning cycle illustrates the never-ending pursuit of continual improvement that can only be achieved by taking the experience in one program and applying that acquired knowledge to the next program.
Challenges in Traditional Project Management
The traditional project management method, with its structured task definition and software tools, is useful for managing system based projects. But, as discussed earlier, in some areas, system based projects are characterized by complex, interrelated activities and large uncertainties about precisely which solution path will be taken, with the result that the project cannot be fully scoped out. Also the development of the system software needs to be integrated with tangible products.
The development team that follows traditional project management for products finds it difficult to develop the software in the same approach. There is a growing need to follow the agile project management method for software development. The challenge then is project delay due to developing a system with two different approaches.
Hybrid Agile Approach
A hybrid approach that combines elements of traditional and agile project management technique is increasingly being utilized, particularly for a system based environment where both tangible product and intangible software development takes place in parallel.
This is an innovative approach that can be deployed in any automobile company. This approach is being implemented effectively in UCAL Fuel Systems Limited that is into system development for major automobile vehicle manufacturers.
Case Study - Fuel Injection System
UCAL Fuel Systems Limited applies the hybrid agile project management approach for the development of a fuel injection system for two-wheelers. This R&D project consists of system development for both tangible products and intangible algorithms, and control strategies to be embedded in the electronic control unit. The system consists of four major components.
Figure 2 Product Quality Planning Cycle
1. Throttle body assembly
2. Fuel delivery module
3. Fuel injector
4. Electronic control unit
The traditional project management approach is suitable for the development of the first three components, whereas the agile project management approach is suitable for the development of the electronic control unit. By applying the hybrid approach, UCAL Fuel Systems Limited completed the project on time, within budget and according to client's expectations.
Advantages in the Hybrid Agile Approach
- Extreme Programming: With this approach, the teams found it easy to implement extreme programming. The approach allowed customer collaboration, work processes for handling defects, learning in pair programming, thinking ahead for management, focusing on current work for engineers, and estimation.
The teams balanced a high level of individual autonomy with a high level of team autonomy and corporate responsibility. They preserved the quality of their working life, displayed strong interpersonal skills, and developed trust among team members.
- Kanban Pull System: The teams found the Kanban Pull System to be highly productive. The work items were pulled into the queue as they completed tasks in order of priority, enabling the delivery of work as it becomes available and as part of a minimum viable product. It helped the teams to understand how their time was being spent. The productivity data helped the team to identify problem areas and act upon them.
After having applied the methodology in a few projects, we now want to make a few adjustments for a second version with all the lessons learned. We have reduced the total project execution time but the biggest benefits have been observed in the redesign cycles where we have saved both time and money since the team could quickly test the usability of the functions.
It has been found that the hybrid agile project management approach benefits projects as changes can be incorporated easily and business value is demonstrated more efficiently.
(Mr. M. Parvez Alam, PMP, PMI-ACP, is an agile practitioner with nine years of experience in the automotive industry. He is a hybrid agile evangelist and expert in Lean and Kanban. Currently, he is head - business development at UCAL-JAP Systems Limited, a company into unmanned aerial vehicles.)