Going Agile
PMI India

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

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 Medicine: 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.)

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