Easterseals Northern California – SAFe for Healthcare

Easterseals Northern California -  SAFe for Healthcare

“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.

SAFe for Healthcare

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

SAFe for Healthcare

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.

Easterseals Northern California -  SAFe for Healthcare

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.

Training At-a-Glance

Watch the Easterseals presentation from the Global SAFe Summit – October, 2019

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Suggested Case Study:

Center for Medicare and Medicaid Services

Easterseals – A Unique SAFe Journey in Healthcare IT

Presented at 2019 Global SAFe Summit, San Diego Oct. 2, 2019

Share:

Easterseals Bay Area, as a non-profit provider of behavioral health therapy, provided a unique challenge and environment for the adoption of SAFe for its IT department. In order to overcome some of the unique challenges of our environment, we embarked on a year-long incremental approach rather than a traditional implementation, adopting techniques and practices as they supported our growth and learning in scaled agility. Additionally, due to the large number of conflicting and dynamic inputs to the teams, we started our SAFe journey at the Portfolio level to get our flow and capacity under control while we developed the knowledge and maturity of our agile teams underneath. At Easterseals we will share with you how we took this innovative trail by focusing on mindset and principles that would enable the business and teams to partner with us without the initial intimidation of a radically new framework and terminology.

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Next: Standard Bank Customer Story

LIC – Adopting SAFe in Agriculture

LIC - Adopting SAFe in Agriculture

“The fact that we delivered for the biggest industry event of the year was hugely motivating and moved us from a negative to a positive spiral. The business was a bit surprised and shocked that we did what we said we would do on something that was quite big and complicated. There’s no way we could have done it without SAFe.”

Paul Littlefair, CIO, Livestock Improvement Corp.

Challenge:

Six months before the biggest annual industry event, IT leadership recognized that it would likely not deliver a new release as planned.

Industry:

Agriculture

Solution:

SAFe® 4.0

Results:

  • Time to market – A 75% reduction in the time to get features to market
  • Customer value – With more frequent releases, customers see value much faster
  • Quality – A 25% reduction in defects in production
  • Predictability – 98% accuracy on the delivery predictability
  • Morale – A 60% jump in employee engagement survey results

Best Practices:

  • Deploy SAFe by the book – “Adopting an industry best-practices system like SAFe off the shelf has forced us to transition and change in the way we needed to,” Littlefair says.
  • Be lean with SAFe – To implement quickly ahead of an industry event, LIC used only what was essential.
  • Focus on the business outcome – Look beyond the implementation at the objectives for implementing SAFe/Agile. “This will then allow the business to be ruthless in getting early wins, and shift from a cost-driven culture to one of value,” Clark says.

Introduction

In New Zealand, Fieldays is billed as “the biggest agricultural trade show in the Southern Hemisphere.” Every June, more than 115,000 farming industry visitors come to purchase equipment and learn about the latest in farming advances.

LIC - Adopting SAFe in Agriculture

For Livestock Improvement Corporation (LIC), it’s a can’t-miss opportunity to connect with current and prospective customers—farmers. One of the oldest farming co-operatives in the country, LIC provides a range of services and solutions to help farmers be more prosperous and productive: genetics and information to create superior livestock; information to improve farmer decision-making; and hardware and systems to improve productivity. To achieve those goals, more than 700 employees are based in offices around New Zealand, increasing to around 2,000 for the peak dairy mating season

As Big Data and other technologies begin to heavily influence farming practices, LIC is riding a wave of growth. As LIC prepared for Fieldays 2016, the co-op planned a new release of MINDA Live, the company’s proprietary herd management system. Yet the organization’s IT leadership lacked confidence about delivering as planned—and with good reason. Historically, IT had rarely delivered on time or budget.

“Every time we failed to deliver we did a post-mortem, but didn’t learn from our mistakes, and it would happen again a few months later,” says Paul Littlefair, CIO.

Deploying Essential SAFe®

LIC was an early adopter of Lean-Agile team practices. However, they still performed most IT work with a waterfall governance process.

“We still had incredibly large, multi-year projects, and detailed analysis to write business cases,” Littlefair says. “In typical waterfall fashion, we didn’t test until the end or consider quality from the beginning. It took a lot of rework to get it right, leading to overruns.”

With the Fieldays deadline looming, Littlefair decided to call in Gillian Clark for an assessment of their readiness. To Clark, it was unclear whether teams would deliver as needed for the big event.

To expedite progress, Clark recommended that LIC implement the Scaled Agile Framework® (SAFe®). Given the short timeframe and the team’s unfamiliarity with the Framework, they chose to deploy Essential SAFe, a subset of SAFe that includes 10 major elements necessary for a successful implementation.

“The approach was, get everyone into a room, align teams into a single Agile Release Train (ART) with a focus on integration, and focus on delivery of the program with a single program backlog, with one person coordinating the project managers and pooled budgets. Up to that point they had three project managers fighting for budget and resources, so we merged them,” Clark says.

Given the approaching deadline—just six months out—Littlefair and Clark encountered some resistance to trying something new. They asked everyone to participate in the PI planning, including Operations, which had not participated in planning previously. The CEO likewise attended, which set the tone for the importance of the launch.

“Putting everyone in a room together to talk about stuff—instead of building it—was seen as something we should not do,” Littlefair says. “But we made it mandatory for everyone to attend.”

In spite of initial misgivings, some of those who had been unsure began to recognize the value of face-to-face collaboration during the first day of Program Increment (PI) planning. Specifically, they saw how their roles and their work tied to others.

“It slowly dawned on them that they were on the same critical path as everyone else in the room,” Clark says. “They also began to realize the project outcomes were at risk and that SAFe practices were providing more understanding of what needed to happen to be successful.”

For the first time, teams were working on the same cadence, an essential step in synchronizing everyone across the organization. Soon, they fell into a flow and started to self manage. Communication and transparency improved; instead of making assumptions, individuals started identifying dependencies with others, and making sure those dependencies were discussed and accepted.

Delivering for Fieldays and Beyond

When Cerno first introduced DevOps practices, the company lacked a SAFe DevOps Practitioner. Still, they made progress on a delivery pipeline and staging environment, supported a grayscale release of a product, and shortened the time to release future versions.

LIC - Adopting SAFe in Agriculture

Beyond that release, LIC notes improvements across multiple areas:

  • Time-to-market – A 75% reduction in the time to get features to market (from 12 to 24 months down to three to six months). Features are now released twice a week for COBOL and legacy solutions.
  • Customer value – With more frequent releases, customers now see value much faster. “Customers have absolutely noticed,” Littlefair says. “Whenever something goes out, we post it on social media and we’re seeing a lot more engagement and real-time feedback there.”
  • Quality – A 25% reduction in defects in production
  • Predictability – 98% accuracy on delivery predictability
  • Morale – A 60% improvement in employee engagement survey results

Culture Shift

LIC’s SAFe journey has led to numerous changes across the organization. For one, meetings look quite different than they did before SAFe was adopted. Initially, some leaders preferred not to include all teams in planning meetings. Now, everyone joins, and Littlefair notes, teams hold each other more accountable and ask more insightful questions.

Before, analysts would write involved business cases and ‘push’ them on teams. These days, product owners make sure work is properly sized and teams ‘pull’ the work.

On the Path of Value-Stream Funding

Currently, LIC runs three ARTs and has extended SAFe across the entire technical landscape. Having moved beyond Essential SAFe, the co-op is now on a course to fund projects at the value stream level. Business leaders now clearly see the value of their investments, and discussions center on priorities in terms of features and benefits.

“SAFe has succeeded in a culture and mindset change,” Littlefair says. “We have a set of processes, rules, and practices that work extremely well, and that have led a cultural shift.”

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Suggested Case Study: Amdocs

Valpak – Using SAFe for Digital Savings Marketplace

Valpak - Using SAFe for Digital Savings Marketplace

Industry:

Advertising & Marketing

Overview

Valpak’s IT group builds and supports technology for a wide variety of stakeholders and audiences including Consumers that are focused on saving money with coupons, Valpak Franchises that need systems to run their business and sales operations, Merchants interested in tracking and maximizing their
returns on investment, and traditional internal corporate stakeholders that need to run the core business operations.

Read the full Valpak case study to learn how they leveraged SAFe to compete in the quickly changing Digital savings marketplace.

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Suggested Case Study: Fannie Mae

Seamless Payments – A Story of Successful SAFe Transformation

To sum up, the case study of Seamless is evidence that small or medium-sized companies can benefit from a scaled agile framework with custom modifications.”

Challenge:

  • Multiple environments
  • Feature requests coming from different markets
  • Synchronizing work between teams (Software Engineering department spans 4 countries)
  • A way to deal with inevitable change of culture due to fast growth

Industry:

Technology, Financial

Introduction

Founded in 2011, and active in more than 30 countries, Seamless handles more than 3.0 billion transactions annually, making it one of the world largest suppliers of payment systems for mobile phones. Perhaps best known for its flagship mobile wallet product, SEQR (se•cure), the fast-moving Stockholm-based company has grown from 50 to 200 employees in 2 years, and is pursuing an expansive growth strategy that has presented challenges both technical and organizational.

Challenges

Seamless Payments - A Story of Successful SAFe Transformation
  • Multiple environments
  • Feature requests coming from different markets
  • Synchronizing work between teams (Software Engineering department spans 4 countries)
  • A way to deal with inevitable change of culture due to fast growth

Wanting to avoid the unnecessary bureaucracy that often comes with expansion, they turned to a scaled-down version of SAFe—along with major technical investments in the deployment pipeline—to provide a structure that would provide a solution for current challenges, and accommodate growing complexity.

More Stories in Less Time—Despite Setbacks

Seamless Payments - A Story of Successful SAFe Transformation

The story of this SAFe transformation is published in InfoQ, and comes from Agile and Lean Product Development Expert, Mikael Lundgren, and Seamless Payments’ Software Engineering Manager, Tomek Pająk. They provide an account of the experience that is rich with detail, and goes beyond tactical execution to include the strategical thinking behind this scaled-down transformation. They recount:

  • How they down-scaled SAFe while maintaining its core ideas
  • Tools utilized for managing backlogs of features, epics, and stories
  • Recruiting Scrum Masters to act as Agile coaches for entire organization
  • Establishing new roles to better support working environment
  • Introducing WIP-limited program execution where work is planned in Agile Release Trains

Many thanks to the study authors, Mikael Lundgren and Tomek Pająk, for sharing your story and providing inspiration for small to medium-sized companies seeking scalable solutions as they face similar growth challenges.

Read the full story in the InfoQ article, Downscaling SAFe.

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Suggested Case Study:

Standard Bank

NAPA Group – Benefits of Using SAFe and Scrum

NAPA Group is a leading software house providing solutions for ship design and operation with the mission to improve safety and eco-efficiency of the global maritime industry. Headquartered in Finland, NAPA and NAPA for Operations (Onboard-NAPA) have established themselves as the de facto standard for ship design. They are used by shipyards, owners, designers, classification societies, research institutes, authorities, consultancies and universities around the world.

Industry:

Software, Maritime

The partner that made it happen:

Overview

NAPA Group - Benefits of Using SAFe and Scrum

In 2012, with nearly 400 user organizations for design application and 2,000 installations onboard, they found themselves suffering from growth pains stemming from major annual releases, a large volume of projects, variable scope and schedules, and lack of a framework of best practices needed to support their fast-paced expansion and development. In other words, release schedules were slipping, and it was becoming difficult to get software out.

“95% of ships built annually are designed by our customers using NAPA.”

With guidance provided by Scaled Agile Gold Partner, Nitor Delta, NAPA embarked upon a 2-year journey of dramatic organizational change that included a combination of Scrum integrated with a full SAFe implementation that ultimately led to their first Release Planning event in 2014.

The results from their 2-year journey are impressive:

• Transparency increased on all levels
• Delivery cycle time down from >12 months to 3 months
• Increased predictability (2014 92% successful releases)
• Need for patches decreased
• Less defects in main branch
• Good basis for further growth

The NAPA experience is a classic example of how the principles of SAFe and Scrum can work in harmony for successful business agility to produce measurable business results. They have demonstrated that the strategic planning enabled by the Portfolio level in SAFe in no way diminishes the value of Scrum, but in fact, illustrates the complementary aspects of both practices.

Many thanks to Toivo Vaje, SA, of NAPA Group for sharing your Lean-Agile experience, and to Maarit Laanti of Nitor Delta for your role in this successful SAFe implementation.

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Suggested Case Study: HPE Software