Reimagined technology and clinical workflows transform home care for members
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Kaiser Permanente is one of America’s leading not-for-profit health care providers and not-for-profit health plans serving 12.5 million members.
Driven by new technologies and evolving expectations for patient convenience, the golden age of care at home may be just around the corner. Reimagined technology and clinical workflows will transform coordinated and patient-centered care for Kaiser Permanente members in the comfort of their own homes.
In this video, Agile coach Steven Archer and IT leader Kari Powelson share their SAFe journey and the “ART” of making SAFe work at KP. They will describe how their Care Delivery Technology Services and Clinical Operations development teams came together to build new software and workflows and set out to prove that KP Care at Home is the future of healthcare and that it can be a great experience for members and clinicians alike.
Presented at the 2021 Global SAFe Summit, October 2021 by:
Kari Powelson, Executive Director IT Leader Home Care /Kaiser Permanente
Steven Archer, Principal Agile Coach /Kaiser Permanente
How SAFe and Business Agility helped FedEx respond to the impacts and opportunities of COVID-19
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In this interview with Dean Leffingwell, FedEx CIO Rob Carter shares a rare look inside the world’s largest express transportation company. Rob describes their seven-year journey with SAFe and Agile, their approach to business agility and Lean Portfolio Management, and why alignment between the business and IT is so critical. Turning to the business impacts of the pandemic, Rob described how the company quickly responded to a dramatic increase in package volumes and application demand with a workforce working largely from home with the help of SAFe and Business Agility.
“One of the things that the pandemic has really presented to us is a set of rapid changes in marketplaces and needs, and frankly, you can’t fake it in the face of something like what we’ve all been through in this crazy world.” —Rob Carter.
Presented at the Global SAFe Summit, October, 2020.
Customer Interview: What Pandemic? Chevron Trades in Stickies and Yarn and Improves Productivity With a Fully-supported Remote Workforce
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In this interview, Chevron’s Popov Konstantin and Rochelle Tan discuss their SAFe journey and how Chevron was able to successfully navigate the challenges of COVID-19 and improve productivity at the same time. They’ll discuss how SAFe improved employee engagement and accelerated the speed of a massive cloud migration initiative, and how they had to quickly transform from an office-centric environment to a fully remote workforce. You’ll hear about their experiences as an early user of SAFe® Collaborate, lessons learned, and why they may never fully return to the office.
Presented at the Global SAFe Summit, October 2020.
Customer Interview: SAFe at American Express — What it Means to Keep the Trains on Track While Still Debating Value Streams
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Director of Enterprise Agility Success, Oden Hughes sits down with Dean Leffingwell to talk about what it takes to manage and nurture a large-scale application of SAFe at a company like American Express focused on providing the world’s best customer experience. She’ll discuss the challenges of establishing alignment between organizations with conflicting views, and why they run their Lean-Agile Center of Excellence (LACE) as a cost center. She’ll share patterns of success, how they’ve created a tailored approach to agility for improved results, and why success depends on much more than courses, workbooks, and SAFe principles.
Presented at the Global SAFe Summit, October, 2020.
“We began seeing value within weeks or months of launching the first release train. Leaders and business owners could very quickly see we were working on the things that were important to them.”
—Jeff Hallett, VP, Product Management
Challenge:
Tighten alignment between the business and IT in order to bring mission-supporting applications to users sooner.
Industry:
Healthcare, Non-Profit
Results:
Higher quality on a more predictable and reliable timeline
Lower defect levels
The highest employee engagement score in the company in the IT group
Best Practices:
Use a ‘velvet glove’ approach – Easterseals got leaders and business owners accustomed to the mindset and practices before introducing it as SAFe, which provided low-friction engagement for business stakeholders
Tie efforts to principles – They connected everything back to principles and shared values
Staff smartly – They put change leaders in key positions
Keep an eye on progress – Retrospectives with metrics demonstrated results
Introduction
Nonprofits are better known for their compassion than their innovation. But Easterseals Northern California is proving that being Agile contributes directly to its mission—to responsibly disrupt and transform home- and center-based health care.
For 90 years, the Bay Area nonprofit has been helping people with autism and other developmental disabilities address life’s challenges, achieve personal goals, and gain greater independence for everyday living.
In doing so, Easterseals Northern California administers an impressive level of care:
7,500 clients in an average month
96,000 clinical appointments per week
25,000 claims per week
1 million managed treatments a year
10,000 active health practitioners
To manage that volume, Easterseals depends on front- and back-office applications for clinical operations, case management, billing, and more. And it must do it all in a HIPAA-compliant security and privacy environment.
For the IT team, staying ahead of business needs has often proven daunting. In the past, staff and contracted team members across the U.S., Ukraine, and Vietnam used “scrum-like” practices, however, the different geographic groups didn’t work together or identify dependencies with other teams. And in the absence of stated priorities, teams were always tackling the most urgent ad hoc requests.
“It was a tyranny of the urgent,” explained Jeff Hallett, VP, Product Management. “Ad hoc requests were taken with no oversight or triage. We knew we needed better alignment.”
The Right Time for Real Transformation
For technology leaders, the vision was clear…
Tighter alignment between business owners and teams
Fewer surprises and reactive work requests
Less work-in-progress
More transparency
Consistency in portfolio intake, prioritization, and backlogs
And better accounting for capacity and business value
But the path to reach those objectives was littered with obstacles. Over the years, IT had pushed to adopt Lean-Agile practices, which included experimenting with the Scaled Agile Framework® (SAFe®). However, early efforts at applying the Framework fell short—likely due to a variety of reasons, such as lack of business support and training.
But in 2018, the timing seemed right to try again. At that time, the nonprofit was beginning the transition from paper-based processes to electronic management systems. Concurrently, leadership was pushing for decentralized decision-making and network-based management. IT leaders believed in SAFe, but this time, they would take a different approach to rollout.
“Technology leadership liked the scalability and the business engagement of SAFe, and believed that it would make a difference,” said Hallett, who joined Easterseals at that time to help drive the transformation as a SAFe® Program Consultant (SPC).
First, Cultivating Mindset
For a renewed effort at transformation, Easterseals would introduce some of the practices of SAFe to members of the business, but leave out some of the SAFe-specific terminology early on. Transformation leaders emphasized mindset—using the Agile Manifesto—to get the business on board and begin changing the culture.
Instead of training leadership immediately, the organization first began involving them in activities such as portfolio management, prioritization, and epic grooming. Only later did they double back to train leadership and begin using terminology and practices with them. That was key to their phased, incremental approach to preparing for and holding the first Program Increment (PI).
Training started with the technology group and moved on to business roles. A few business members took SAFe® for Teams and SAFe® Product Owner/Product Manager to build understanding and excitement. When they offered SAFe® for Teams, they explained that this was the exact process they had already been following.
A Phased, Incremental Rollout
Easterseals took a phased approach to the SAFe transformation, like building layers of a cake. It all rested on a foundation of Lean-Agile leadership. To that end, they filled key positions with “change leaders,” which included dedicated Portfolio managers and Scrum masters.
They layered the rest on top of that firm foundation: Lean-Agile principles; teams and Agile Release Trains (ARTs) that embrace the core concepts of SAFe; cadence and synchronization; DevOps and releasability; an architectural runway; PI planning; system demos; inspect and adapt practices; and IP iterations.
To pave a path for success, they began with the Portfolio SAFe configuration to secure commitment from internal business partners, standardize requests, gather needs from the business, and analyze for value. About 75 people joined the first Program Increment (PI) planning event, from technology, clinical programs, business excellence, and the PMO.
At that first event, some grumbled about having to spend two days away from their regular work. However, by the second PI, they were so engaged that some people said two days wasn’t enough time. From the start, progress was clear. “I noticed an immediate benefit,” recalled Trista Travis, IT Program Manager and the nonprofit’s Release Train Engineer (RTE). “Because the second someone put a Post-It note that had a dependency up on our Program Board, they realized, ‘Oh, we really do need to collaborate across teams.’”
As teams became accustomed to the new way of working, some learned the hard way. After one team committed to 150 story points, they soon found themselves in over their heads. “We let them get to the point where white flags were raised,” Travis said. “Then we had a session where we took a step back, erased the white board, and started figuring it out from scratch. It was a lot of making the hard choices and throwing stuff over the side of the boat.”
Today: Excitement and Buy-in from Top to Bottom
In less than a year, Easterseals Northern California has successfully changed the organization’s mindset and way of working, and started seeing the fruits of their efforts.
“We began seeing value within weeks or months of launching the first release train,” Hallett said. “Leaders and business owners could very quickly see we were working on the things that were important to them.”
They now run two Agile Release Trains and five Value Streams. They are committed to holding ceremonies on cadence. Sprint goals are aligned with PI objectives. Teams are collaborating. They regularly use metrics and retrospectives to assess progress.
As Easterseals expanded its SAFe practices, leaders found that they lacked the tooling they needed as current configurations didn’t match the new ways of working. Thus, as they established a regular cadence and ceremonies, they implemented new tooling that worked in step with their practices.
Most importantly, they’re seeing excitement and buy-in across most teams and leadership. In fact, leaders have started asking to participate more after hearing positive feedback from teams.
In less than a year, they have achieved strong cross-team and cross-Value Stream collaboration, alignment, and management of dependencies—reducing unexpected requests for the IT team.
Business partners are involved in planning and conversations from the beginning, ensuring solutions are more on the mark—upping the satisfaction in delivered solutions and increasing value delivered:
Easterseals hit 83 percent for achieved objectives in its first PI
70 percent or more of the delivered story points in releases are directly traceable to items on the Portfolio strategic roadmap agreed on with the business
IT delivers also higher quality on a more predictable and reliable timeline
Defect levels are down
IT has the highest employee engagement score in the company
Ultimately, getting quality applications sooner enables staff and clinical practitioners to focus more on transforming home- and center-based health care.
“Now, there’s a direct line-of-sight between work in progress and how it helps with the Easterseals mission,” Hallett said.
Gaining C-Suite support for SAFe Enterprise Agility
MetLife is one of 12 Fortune 500 companies to thrive for over 150 years. Met has scale and a proud history … and the many challenges of incumbency including legacy systems and challenges to speed. Agile is quickly being embraced as the way to achieve speed in innovation.
In this 45-minute video, Cheryl Crupi shares the story of how a small team sold MetLife’s new CEO and his new executive group on SAFe Enterprise Agility. This short, immersive session enabled this executive group to experience Agile for themselves and resulted in a third of the group requesting individual follow-up on how they can embrace Enterprise Agility, including HR, Legal, Marketing and regional business presidents.
Lockheed Flying the F-16 into the Future with SAFe: Evolving the Falcon Factory
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Presented at the 2019 Global SAFe Summit, San Diego Oct. 2, 2019, The F-16 Fighting Falcon is the world’s most successful, combat-proven multirole fighter with approximately 3,000 operational F-16s in service today in 25 countries. In 2014, new production orders were drying out, and the F-16 production line was in danger of shutting down. Our solution to that problem was the adoption of SAFe to streamline the F-16 Product Development and Engineering in 2015. We overcame a lot of challenges along the way, and made rapid progress initially, but have plateaued. That should come as no surprise though. Our limited SAFe implementation showed us limited results. But we are turning this ship around! This year we have really taken stock of our Agile Transformation and implemented several ground-breaking initiatives that are changing our landscape. Lockheed has now started a new F-16 production facility in Greenville, South Carolina that is producing F-16s expected to operate to 2070 and beyond!
Presented at 2019 Global SAFe Summit, San Diego Oct. 2, 2019
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How do the User Design (UX) principles of Simple, Human and Connected guide an ART to interpret and incorporate user-centric design (UCD)? What is the ideal operating model for UX design that includes discovery, design and delivery tracks? This talk will provide an overview of the hypotheses applied to deliver user-centric design within the Scaled Agile Framework® at PepsiCo.
Anthem chose to apply the Scaled Agile Framework incrementally, rather than a big bang rollout. Approaching the problem from both top-down and bottom-up, the SAFe transformation for the enterprise concentrated on one vertical slice at a time working with both Business and IT leaders in an area to enable Lean-Agile practices and provide hands-on coaching and education to drive the adoption of the Agile mindset.
They chose to apply the Scaled Agile Framework incrementally, rather than a big bang rollout. Approaching the problem from both top-down and bottoms-up, the transformation for the enterprise concentrated on one vertical slice at a time working with both Business and IT leaders in an area to enable Lean Agile practices and provide hands-on coaching and education to drive the adoption of the Agile mindset.
They worked closely with their partners to go beyond just the mechanics of training and coaching with a focus on sustaining the change and moving towards true enterprise business agility.
Nearly 140 million Americans rely on Medicare, Medicaid, the Children’s Health Insurance Program, and the health insurance exchanges—all programs administered by the Centers for Medicare & Medicaid Services (CMS). The agency pays out approximately $767 billion in benefits annually and employs 4,100 people to administer programs in partnership with state governments.
Challenge:
Isolated Scrum teams didn’t make much progress within a deeply ingrained waterfall culture and against long-range planning and budgeting.
Industry:
Government, Healthcare
Results:
CMS shifted the budget from 100% dedicated to system maintenance to a 40/60 split between maintenance and innovation
Help desk tickets decreased by 55%
Surveys show a 27% increase in employee satisfaction
Best Practices:
Prepare for face-to-face events – CMS found the SAFe Implementation Roadmap and training invaluable to smooth-running PI planning events
Establish transparency – Stress the importance of open, honest discussion and engagement
Communicate the vision – In opening remarks at PI events, CMS reminded team members that their work directly impacts people’s health and lives
Introduction
Amid the pressures of increasing citizen expectations, the CMS environment is complex and ever-changing as budgets and legislation fluctuate—making for a perfect setting to introduce Lean-Agile principles. A few isolated programs had begun using Scrum practices, but given the size and complexity of programs at CMS, Scrum did not lend itself well to longer-range planning and the identification and mitigation of dependencies among the Scrum teams. In addition, the organization still had cultural battles to overcome.
“We were still suffering from a ‘throw-everything-over-the-wall’ mentality,’” explained Brent Weaver, Director of Systems Implementation at CMS. “The few Agile teams were requiring more of programs and that created more frustration on both sides. There was no vision or framework where everyone saw how they fit together. As a result, what they delivered was late, with defects—and not what the market needed.”
SAFe: Systems Thinking for a Complex Organization
In 2017, Weaver arrived with the charge of improving the Agile transformation for the Center of Clinical Standards and Quality (CCSQ) within CMS. In the search for a new approach, the Scaled Agile Framework® (SAFe®) resonated as the right option.
“SAFe brought a much-needed approach to scaling Agile and systems thinking that was critical to an organization of our size and complexity,” Weaver said.
In preparation to obtain buy-in and funding, Weaver built his knowledge of SAFe by taking some initial courses: Leading SAFe®, and later, Implementing SAFe®. Following the Leading SAFe® course, he made the case for the Framework for leadership and earned the full support of Steve Davidson and Mark Plaugher, Directors of the Information Systems Group within CCSQ. Additionally, Debra Santos, Director of Hospitals, ASC, and QIO Systems was also willing to support the SAFe adoption for one of her systems.
For help, Weaver tapped Scaled Agile Partner, Agile Six Applications, Inc. With Agile Six, CMS decided to implement SAFe first in a group brand-new to Lean-Agile concepts, rather than with those already using Scrum, for a chance to start from scratch. The first teams on SAFe would be those working on CMS’s Hospital Quality Reporting (HQR) system, which healthcare facilities use to report data to CMS.
With leadership backing, they secured the budget and marked the calendar for the first face-to-face Program Increment (PI) planning event—to take place just six weeks in the future.
PI Planning Day One: Messy and Chaotic
To meet the timeframe, CMS decided to shortcut the recommendations from the SAFe Implementation Roadmap and skip SAFe training—a decision that created significant challenges and that, in hindsight, they wouldn’t recommend to other organizations. The fact that many team members were located outside the area, and many were contractors, played into that decision.
To help prepare for PI planning, HQR conducted a four-hour, half-day mock PI session with about 20 percent of team members to give them an idea of what to expect.
For the actual PI Planning event, CMS brought together more than 120 people, with approximately a quarter of them coming from out of town. The first day, unfortunately, proved to be chaotic and more challenging than expected for several reasons, according to Weaver and Ernie Ramirez, President of Agile Six Applications:
They underestimated the refinement status of the backlog and didn’t follow all relevant parts of the SAFe Implementation Roadmap
They had a single Certified SAFe® Program Consultant (SPC) in Ramirez (the recommendation is 3 – 5 per 100 development practitioners)
The agency skipped Leading SAFe®, SAFe® for Teams, and SAFe® Product Owner/Product Manager training
They did not identify Value Streams
CMS simultaneously created the implementation plan and prepared for the Agile Release Train (ART) launch
“It cannot be overstated how horrible day one of that PI went,” Ramirez said. “We didn’t lay out an implementation plan as well as we should have, and the development contractor didn’t have the resources or roles we thought they did.”
PI Planning Day Two: ‘Quarter-Million-Dollar Conversations’
Day two, however, could not have played out more differently. “At the end of day one, rather than throw in the towel, we rolled up our sleeves, and resolved to do better in day 2. We came out of day two with a plan that the teams would ultimately deliver on over the next 12 weeks,” Ramirez said.
Ramirez points to a few reasons for the turnaround. After the first day, people returned knowing more of what to expect and came more prepared. Also, the two-day format created a sense of urgency to make progress. Additionally, Ramirez walked around troubleshooting any issues immediately as they arose.
“After the first day, everyone had an opportunity to ‘sleep on it,’” he said. “A lot of the frustration at the end of the first day kind of washed out and everyone came back with a renewed focus and commitment to get the plan done,” Ramirez said.
Team members and program managers alike left the event more hopeful than ever before, believing they could actually hit the plan’s targets. Most promising, Weaver and Ramirez noticed productive discussions happening throughout the room—often between people who had worked together for several years, but had never actually met one another in person.
“We witnessed a lot of team and cross-team bonding that just cannot be replicated over WebEx, Hangouts or Zoom,” Ramirez said. “There is something immeasurably valuable about being in the same room with someone, laughing, joking and yes, respectfully arguing. A lot of trust was earned and built on day two.”
“Quarter-million-dollar conversations were happening all over the place,” Weaver said. “That’s what it would have cost to fix problems down the road if those conversations had not happened.”
Communication, Collaboration across CMS + Contractors
Following that first PI, CMS began adhering to the SAFe Implementation Roadmap. They delivered Leading SAFe®, SAFe® for Teams, and SAFe® Product Owner/Product Manager training. Unlike the first PI, they identified Value Streams.
“For the second PI, we found a lot of value in identifying Value Streams and ARTs, which helped people understand where they fit in and how teams fit together,” Ramirez said.
Agile Six also delivered training to external contractors, including Leading SAFe®, SAFe® for Teams, and SAFe® Product Owner/Product Manager. Several people at contractor organizations earned their SAFe® Program Consultant (SPC) certification and began training their own people—knowing that it is likely to give them one more strength to promote as they seek to win future contracts with CMS.
During RFPs, contract organizations routinely compete against each other. However, once on contract, they must work with team members from competing firms. As an unexpected benefit, SAFe helped unify CMS team members and contractors, as well as contractors from various companies. Face-to-face, they collaborate more effectively and come to personally know the people behind the roles, developing comfortable working relationships with each other.
“It’s fundamentally better for American taxpayers that teams work together and break those walls down,” Weaver said. “I’m really proud of contractors’ ability to collaborate, share information, and work as a single team. Doing so has helped us reduce trouble tickets, so we know we’re delivering higher-quality solutions.
Because of CMS’s heavy use of contractors, each ART is comprised of people from numerous organizations. That required transformation leaders to be sensitive to job functions and responsibilities across the different companies on a single ART to foster trust and teamwork instead of competition. Having a single backlog for an ART creates further harmony among diverse team members.
27% Boost in Employee Satisfaction
So far, CMS has trained more than 200 people, including 25 – 30 Certified SAFe® Program Consultants (SPCs). The agency has also since launched four more Agile Release Trains (ARTs).
With training and preparation, participants have been more engaged in PI Planning events after that first learning experience. Communication, says Weaver and Ramirez, has been critical to the acceptance of the new way of working. Especially in the early days, they had to communicate clearly and persistently to convince people to join in the effort and assuage fears about what this meant for their futures.
“We really had to do a lot of selling on SAFe to get people comfortable,” Weaver said. “People were genuinely apprehensive about changing the way they have worked for so long, but as they have seen results, they have embraced it.”
And over time, HQR has implemented other SAFe concepts such as Weighted Shortest Job First (WSJF). Well ahead of a PI, the primary stakeholder has time to weigh the value of work and prioritize—which takes some of the emotion out of the decision, Ramirez says.
They are also in the process of adjusting budgets to fit more with shorter-term planning. Instead of years in advance, they began thinking in terms of three-month increments, in which Ramirez called a halfway step between the traditional approach and the ‘wild west’ of Scrum.
Higher Quality, Happier People
After a bumpy beginning, CMS points to measurable progress:
Budget shift to modernization versus maintenance – Instead of 100% of the budget going to maintain the existing HQR system, now only 40% is dedicated to it. A full 60% of the budget goes toward innovation for the system, helping the agency deliver on citizen expectations.
Higher quality – The HQR group reports a 55% decrease in help desk tickets from hospitals—demonstrating a direct impact to customer satisfaction.
Happier people – Surveys conducted before and after SAFe show a 27% increase in employee satisfaction.
While CMS can’t yet measure customer satisfaction gains directly, they know that fewer quality issues and more innovation contribute to that goal.
“SAFe provided a map that enabled us to shift to modernizing versus just maintaining the status quo,” Weaver said. “Beneficiaries will ultimately benefit from more user-friendly, human-centered design systems, which will allow us to reduce the burden on our providers.”
The group’s success has caught the attention of others, with trains now starting in other CMS groups. “Other programs within CMS have approached HQR asking us how to drive the same outcomes,” Santos said. “It’s a testament to how far we’ve come in the past year.”
Transformation starts with leadership – Ideally, you need two to three leaders who are fully committed to the change. If possible, send them through SPC training.
Coaches are a MUST – CMS found substantial value in them
Agile contracting is necessary – Rigid contracts that have highly specific deliverables can be an obstacle to agility and to embracing shifting priorities as new data emerges
Use contractors that understand Lean-Agile principles – Hire teams that truly understand what this means, not just those who can talk the talk
Find collaborative work space – From PI planning events to day-to-day work, collaborative work space enables teams to capture the value of face-to-face interaction
Just do it! – “If we could time-travel and do it again, we would emphasize a sense of urgency to get going,” Weaver said. “Set a near-term date and follow the roadmap.”
Engage employees – Any effort is only as strong as its people. Approach the change with empathy for what your team is undergoing and leverage the support of management and coaches to keep employees engaged and excited.
Start with Essential SAFe® – CMS found it valuable to simplify as much as possible and started with a program that lent itself to Essential SAFe. The learnings they achieved will influence larger programs, which will require multiple Value Streams.
