CVS Health Tackles COVID Response – SAFe for Healthcare

When empowerment and urgency come together, anything is possible.

Share:

Join four Agile leaders from CVS Health to learn how they banded together to form teams out of existing trains in order to tackle their monumental, and ever-evolving COVID response.

What does it look like when all roles across an operational value stream truly come together without the usual complexity and roadblocks that come with being in a large organization? How did they show up, lead with heart, and truly live their values? And what lessons were learned that other organizations can take away from this extraordinary experience.

Having scaled Agile in place already prior to this happening helps create a lot of clarity and transparency on where we should identify people who already had all the skill sets that we needed to really achieve this. And then it set up like a common language to talk about things like priority and how to sequence work. And honestly just really live the values of SAFe even more so than the process of SAFe which I think is just a beautiful place to be.”

Presented at the 2021 Global SAFe Summit, October 2021 by:

  • Caitlin Clifford, Senior Director of Digital Health Services /CVS Health
  • Rebecca Davis, CVS Health Digital Lean Agile Practice Leader /CVS Health
  • Matthew Huang, Senior Product Manager of Immunizations /CVS Health
  • Randy Kendel, Release Train Engineer of Immunizations /CVS Health
  • Interviewer: Michael Clarkin, CMO, Scaled Agile Inc.

Back to: Customer Stories

Next: TV Globo Customer Story

Kaiser Permanente builds the future of healthcare with SAFe

Reimagined technology and clinical workflows transform home care for members

Share:

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

Back to: Customer Stories

Next: FedEx Customer Story

Stories from the Field: Remote PI Planning at CVS Health

Safe Business Agility

In this podcast series, we talk to customers about their field experiences with remote SAFe ceremonies and implementations. In this episode, we talk with Rebecca Davis, SPCT at CVS Health and member of the company’s Agile Transformation leadership team, about fully remote, distributed PI Planning at CVS Health.

Click the “Subscribe” button to subscribe to the SAFe Business Agility podcast on Apple Podcasts

Share:

Detail Page

This In this podcast series, we talk to customers about their field experiences with remote SAFe ceremonies and implementations. In this episode, we talk with Rebecca Davis, SPCT at CVS Health and member of the company’s Agile Transformation leadership team, about fully remote, distributed PI Planning at CVS Health.

Visit this link to watch the video referenced in the podcast:

Hosted by: Melissa Reeve

Melissa Reeve is the Vice President of Marketing at Scaled Agile

Melissa Reeve is the Vice President of Marketing at Scaled Agile, Inc. In this role, Melissa guides the marketing team, helping people better understand Scaled Agile, the Scaled Agile Framework (SAFe) and its mission.

Guest: Rebecca Davis

Rebecca Davis is an iSPCT and leader within the Agile Transformation

Rebecca Davis is an iSPCT and leader within the Agile Transformation Office of CVS Health Digital. She helps the people who do the work become empowered, authentic decision makers, while guiding internal SPCs to mature and excel at leading their individual areas.

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

Back to: All Case Studies

Suggested Case Study:

Center for Medicare and Medicaid Services

Centers for Medicare and Medicaid Services

SAFe case study CMS

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 to 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 adoption of SAFe for one of her systems.

SAFe case study

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.

SAFe case study

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.

SAFe Case Study

“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.

Back to: All Case Studies

Suggested Case Study:

NHS Blood and Transplant

Easterseals

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

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. 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.

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.

Back to: Customer Stories

Next: Standard Bank Customer Story

NHS Blood and Transplant – Adopting SAFe in Healthcare

NHS Blood and Transplant – Adopting SAFe in Healthcare

“Adopting SAFe has set in motion the skill development and mindset for successful organizational change even as we scale to new programs, release trains, and people.”

Gary Dawson, Assistant Director, Solutions Delivery

Challenge:

NHSBT sought to improve the business processes and the supporting IT environment in two major programs, and do so without adversely impacting its core business or service delivery to patients.

Industry:

Government, Healthcare

Solution:

SAFe®, Consulting and Coaching Service

Results:

In the first PI, NHSBT was able to deliver a committed, finite number of product features, as well as prioritize IT operations alongside the business part of the organization.

Best Practices:

  • Include all in the journey — The mutual understanding between IJI, managers and employee teams was critical. “It made the difference that we were bringing them on the journey—rather than telling them how we were going to impose something on them. It has been a key element in NHSBT’s success,” Dawson says.
  • Show and tell — “Show and tell” sessions (every two weeks) and then a mid-PI retrospective helped the business see the benefits of the change process and really feel part of it.

The partner that made it happen:

Introduction

NHS Blood and Transplant (NHSBT) is a joint England and Wales Special Health Authority that provides a blood and transplant service to the National Health Service—supplying blood to hospitals in England, and tissues and solid organs to hospitals across the United Kingdom. Each year, donors give approximately two million donations of blood and 3,500 organs—saving and transforming countless lives.

Safeguarding the blood supply and increasing the number of donated organs involves collecting, testing, processing, storing, and delivering blood, plasma, and tissue to every NHS Trust in England. NHSBT also matches, allocates, audits, and analyzes organ donations across the whole of the UK.

With an increased need for its services, the organization recognized that effective technology is crucial to the delivery of safe products and services for patients. While looking ahead to its corporate 2020 vision, NHSBT identified several goals: replace an aging IT infrastructure, migrate to SaaS cloud-based services, and replace the critical operational applications underpinning its activities while ensuring they remain compliant with external regulatory monitoring.

NHSBT sought to revolutionize the way it interacts with blood donors by taking full advantage of the opportunities afforded by digital technologies. That means careful consideration of the realities of existing interdependencies between the national databases and NHSBT services, systems, data, processes, and people.

Adopting SAFe in Healthcare

NHSBT identified the need to improve the business processes and the supporting IT environment in two major programs: ODT Hub and Core Systems Modernization.

“NHSBT was embarking on its most complex transformation program ever, initially focusing on the Organ Donation and Transplantation (ODT) area of its business,” notes Gary Dawson, Assistant Director, Solutions Delivery. “It needed to modernize a significant percentage of its core systems, platforms, and architecture along with re-aligning the infrastructure to more modern cloud-based technologies. The impact on the current business and practices couldn’t be underestimated across the organization—we were anticipating changes in how we work and how the system worked.”

It’s All About the People

NHSBT employees truly care about the organization and its work. Dawson, working with the wider NHSBT ICT organization, felt that it was important to correctly evaluate IT needs in line with organizational changes and be able to guide the system changes with the people using them.

“We recognized that both the overarching change and the adoption of a new technical platform and architecture—the effects on the culture of the organization—could, if not managed strategically, create a complex management problem and have an impact not only on the core business, but also the working relationships of the people within NHSBT,” Dawson says. “We needed a system and guidance to adapt and benefit from the changes and we were clear that the waterfall methodology that we had previously relied on wouldn’t support this change. We have dedicated and passionate people who work here, who really care about the cause and want to achieve the goals of the organization, but this change would only work if everyone was on the same page and we could go through the journey together.”

A New Approach to Adopt Change

The Chief Digital Officer had set the strategy for implementing Agile into NHSBT and brought on Dawson specifically with this in mind. From day one he worked extensively and closely with the Business, IT, and Program Delivery stakeholders to ensure cross-organizational support. After an initial meeting, they knew that an experienced consultancy like Ivar Jacobson International (IJI) would aim to understand NHSBT and work collaboratively to deliver solutions and training so that internal changes were manageable.

IJI suggested NHSBT use Scaled Agile Framework® (SAFe®) to help support the governance and manage both the organizational and technical changes. The ICT Leadership Team immediately took the view that this was the right methodology to achieve NHSBT’s goals and looked for an appropriate vehicle in which to introduce it. They decided the Organ Donation and Transplant (ODT) Hub Program as the most appropriate place to start implementation. ODT was initializing a hands-on software delivery and its timeline aligned well with the cadence of delivery that the framework provided. In addition, funding was in place and all the teams involved were based in one location. It would act as an ideal start and pilot for other elements of the organization to observe.

Adopting SAFe in Healthcare

Because ODT was the first in a series of transformational changes, it would also be the model that other parts of the organization would take as an example, so it was crucial to get it right from the start. “IJI’s expertise with Agile transformation programs was a perfect fit with what we were aiming to do. Because we’d be working with new team groupings, we wanted to assist employees with transitioning to new working relationships and processes and also address the naturally risk-averse elements,” Dawson says. “We had to stay within regulatory standards. Rapid and vast change, if not done properly, has the potential to be disruptive, and actually hinder advancement. We chose Ivar Jacobsen International to provide company guidance, including coaching and training services, for the implementation of SAFe at NHSBT.”

A Proven Framework in SAFe®

SAFe offers a broad range of content and phased implementation for organizations looking to increase productivity, change system structures, increase employee training, add solutions-based management and develop greater efficiencies across company platforms and people.

Because proper preparation is critical to set the stage for smooth adoption, IJI delivered a two-day workshop, ‘Leading SAFe,’ that engaged managers interactively while explaining what SAFe was and how to implement it properly.

Meanwhile, Dawson and IJI also began to structure team units. They identified product managers and product owners working collaboratively to define their roles within SAFe and guided them on SAFe practices. Training roll-outs started with 10 or 12 courses, ranging from large-room sessions of 30-40 people for SAFe overviews and discussions of how it could work within NHSBT. These were followed over a two-month period by smaller and more interactively focused sessions for product managers and owners intended to further guide them and increase engagement. Sessions included six to 10 people with the appropriate attendees to maximize the interaction and cross-functional engagement—even at the point of training.

Meanwhile, program managers, with Dawson, started to work on organizational components, such as planning sessions across the organization (75 – 80 people). Planning included who would be involved, as well as logistical challenges. Dawson spent considerable time explaining the rollout and SAFe implementation to all levels of employees to facilitate understanding and new team groupings. IJI was on hand at all stages of implementation to guide, coach, teach, and assist teams to transition to SAFe, following a strategic Program Increment (PI) cycle that ensured SAFe was adopted by employees with secure checkpoints and feedback along the way.

Building Success

Adopting SAFe in Healthcare

Over the first Program Increment (PI), NHSBT’s ODT program came through on most of its deliverables. “It was amazing how much we were able to do in such a short time,” Dawson notes. “Now that we’ve done that, we can see what we need to do for future PIs and are continually able to refine and understand the teams’ velocity; it’s all falling into place and people really are committed.”

In that first PI, they were able to develop and learn to work effectively as a team and were able to deliver a committed, finite number of product features, as well as prioritize IT operations alongside the business element of the organization.

During the short introduction phase of three to four months, they were able to not only onboard and train all the teams aligned to the Release Train, they were also able to get the business component of NHSBT aligned with IT. There were challenges—such as integrating business managers into the teams and defining product owners—but “show and tell” sessions (every two weeks) and then a mid-PI retrospective helped the business see the benefits of the change process and really feel part of it.

“We would never have had that level of interaction in a waterfall delivery,” Dawson says. “To achieve the levels of understanding of both the technology and deliverables—along with all the interdependencies—would have taken months of calls, meetings, and discussions. We planned the next three months in just two days and now we retain that level of engagement on a daily basis.”

SAFe has become part of everyday procedures at NHSBT, with a series of checkpoints and loops that ensure communication is clear and efficient between teams and individuals. IJI understood that it was important to Dawson and NHSBT that change occurs but not at the cost of quality or control, and that value to the business should be equal to the ability of the organization to cope with the rate of change. NHSBT was able to build Agile confidence across the ODT program—senior stakeholders could support the cultural change because SAFe provides the governance required to build in the needs of Quality Assurance and regulators.

Successfully Scaling to New Programs

Having delivered the first MVP (Minimum Viable Product) of the ODT Program, it is clear that the introduction and embedding of SAFe within NHSBT has begun to provide early delivery of significant business benefits.

NHSBT has now run two SAFe big-room planning events for its Core Systems Modernization (CSM) Program, which is potentially a much larger program to replace its core blood offering system relating to blood, blood-derived products and tissues.

“We’re definitely not standing still,” Dawson says. “We are building momentum and will continue to run with the same rhythm that SAFe has provided us with our ODT program. Adopting SAFe has set in motion the skill development and mindset for successful organizational change even as we scale to new programs, release trains, and people.”

Back to: All Case Studies

Suggested Case Study: Royal Philips

Royal Philips

“Philips is continuously driving to develop high-quality software in a predictable, fast and Agile way. SAFe addresses this primary goal, as well as offering these further benefits: reduced time to market and improved quality, stronger alignment across geographically distributed multi-disciplinary teams, and collaboration across teams to deliver meaningful value to customers with reduced cycle time.”

Sundaresan Jagadeesan, Program Manager – I2M Excellence SW Development Program

Challenge:

Philips sought to transition from traditional development to Agile, as well as bring an Agile mindset to business units beyond software to address the needs of a dynamic customer environment.

Industry:

Information Technology, Healthcare

Solution:

SAFe®

Results:

  • Average release cycle time down from 18 months to 6 months
  • Feature cycle time reduced from >240 to <100 days
  • Sprint and PI deliveries on time, leading to “release on demand”
  • Quality improvements—zero regressions in some business units
  • 5 major releases per train per year on demand

Best Practices:

Philips recommends a straightforward, 4-step approach for any organization aiming to transition to Agile

  • Develop products in the Agile way with focus on basic Agile practices (Scrum)
  • Establish product ownership with a focus on enabling scaling aspects (SAFe practices)
  • Establish a release pipeline with continuous integration (supported by automation)
  • Adopt a DevOps culture with focus on continuous delivery (to production environment)

Introduction

Netherlands-based Royal Philips is a $26 billion medical technology company committed to making the world healthier and more sustainable through innovation. Their goal is to improve the lives of 3 billion people a year by 2025, so being able to achieve faster time to market has a direct impact not just on bottom line, but on millions of lives as well.

Agile Transformation Journey

In 2014, the company began exploring the use of Agile methods to improve processes and increase efficiency across the organization. With a traditional, project-based approach to software development, release cycle time averaged 18 months. Philips had to accelerate delivery to meet market demands.

“Changing customer expectations and the tremendous pace of market disruptions require a framework and processes that are quick, scalable and responsive,” says Sundaresan Jagadeesan, Program Manager at Philips Electronic India Limited. “The Scaled Agile Framework® (SAFe®) with its non-linear approach and adaptability, is the way of the future.”

Vigorously Deploying SAFe

At Philips, the SAFe initiative fell within a program called I2M Excellence Idea to Market. The program is part of Accelerate!, a multi-year, worldwide business-transformation program designed to change the way the company does business and unlock its full potential. To that end, the company formed a foundational core of Scrum, upon which it could build SAFe practices.

“We chose SAFe to meet our goals of reducing time to market, improving quality, strengthening alignment across geographically distributed multi-disciplinary teams, and collaborating across teams to deliver meaningful value to customers with reduced cycle time,” says Jagadeesan.

Philips is now vigorously deploying SAFe in its software businesses and is piloting its use in complex systems environments (hardware, software, mechanical engineering, customer support and electrical teams). What’s more, the company has brought SAFe beyond software development to the R&D activities of a number of businesses, particularly in the Business Group, Healthcare Informatics, Solutions & Services (BG HISS).

Agile Transformation Journey

Driving Feature Cycle Time Down 58%

To date, Philips has 42 ARTs running across various business units, making this one of the larger-scale SAFe implementations. With a focus on the systems business, the company has launched multiple ARTs there as well, including the first ART in Philips China.

Agile Transformation Journey

The results:

  • Average release cycle time down from 18 months to 6 months
  • A greater focus on the customer mindset
  • Feature cycle time reduced from >240 to <100 days
  • Sprint and PI deliveries on time, leading to “release on demand”
  • Quality improvements—zero regressions in some business units
  • 5 major releases per train per year on demand, each catering to multiple products
  • 3700+ people engaged in a SAFe way of working
  • Around 1300+ trained and formally certified in Agile and SAFe
  • Process and tooling alignment

The results from the original pilots caught the attention of and acted as catalyst for many other business units in Philips.

Offering Key Learnings

Through this process, transition leaders at Royal Philips learned what worked most effectively. They found it important to embed the Agile mindset and approach in other crucial areas of work—not just R&D, but in areas such as HR, Finance and Q&R—to ensure streamlined, efficient processes and quicker turnaround times.

Philips also found it critical to involve the senior management and leadership team of the organization in this transitional journey.

“Finally, to ensure an effective move to Agile, it is critical to change mindsets within the organization,” Jagadeesan says. “Agile implies continuous learning as enterprise behavior, decentralized decision-making, quick adaptiveness and more.”

“Any transformation program will be successful if you actively seek and solve business problems,” he adds.

Philips Royal recommends a number of organizational and cultural changes for any company making this transformation:

  • Create an environment that encourages proactive, feedback-seeking behavior
  • Motivate teams and give them the autonomy they need to function well
  • Engage in courageous conversations
  • Enable cultural change in the organization
  • Focus on building teams for the long run with emphasis on stability
  • Trust the team to solve problems by “teaching them to fish” instead of fishing for them
  • Enable teams and support them by removing impediments
  • Differentiate between outcome (value generated) and output (velocity-productivity improvements)
  • Identify value streams and optimize around value to help the alignment and effective collaboration across the team
  • Gain stakeholder alignment, and leadership commitment and support
  • Train and coach based on roles
  • Have a deployment strategy and change leaders’ coalition to help accelerate scaled Agile transformation

“Our Agile transformation journey is successfully underway,” says Jagadeesan. “It has been a tremendous learning experience, and we continue to deliver value to all our stakeholders and customers. Agile learning is an enriching and fun-filled journey!”

Back to: All Case Studies

Suggested Case Study:

Easterseals Northern California