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Agile vs. Waterfall development: When hybrid is the smartest approach

Health IT shops don't have to choose between the two. A senior IT project manager explains how hospitals can make them both work together.

Bill Siwicki, Managing Editor, Healthcare IT News

The development process known as agile has been around IT for more than a decade. While most standard agile frameworks seem to omit the project manager role and the structure provided by traditional waterfall project management processes, the University of Utah health information technology services has embedded successful agile processes within its existing traditional waterfall framework.

Using elements of the agile framework called scrum, HIT services has expanded its portfolio and project management capabilities in its clinical and infrastructure IT delivery through the use of traditional, agile and hybrid project management.

Highly matrixed healthcare organizations do not necessarily need an either/or project methodology to deliver value to clinicians and other key stakeholders – agile project management and waterfall can coexist, and project managers have a valuable place in both, said Spencer Reeser-Stout, senior IT project manager at University of Utah Health.

"Applying agile principles in our organization has made me realize that to be agile you don't need a complete organizational agile transformation as some agile purists may tell you," Reeser-Stout said. "Many of our teams use parts and pieces of the agile/scrum process such as daily standups, visual task boards, backlogs, story-point estimation, etc., and have realized greater efficiencies by adding these to their current operational work processes."

This has allowed for greater visibility of a team's work within the process, greater efficiencies in demand management by planning in short sprints, manageable release cycles, and better communication and collaboration between internal teams and clinical customers, he added.

Not all IT delivery is best handled through a single, rigid process. Waterfall/traditional project management processes are a proven IT delivery process, particularly with larger projects. But with a heavy focus on planning upfront, some work gets done more effectively and faster if health IT staff take out the formality, allowing for flexibility, Reeser-Stout contended.

"With more than 1,200 physicians in 200-plus specialties, we have a constant demand to deliver solutions that improve clinic workflow processes, improve our patient's experience, and provide a high quality of care all at a reasonable cost," he explained.

He also stressed the criticality of having the ability to adapt quickly and respond to changing requirements and competing demands while delivering systems quickly to customers.

"Key agile functions don't always work for some teams and some are more effective using phased/waterfall approaches," he explained. "A hybrid approach covers everyone's needs and can be changed, depending on the team or type of project you are managing."

Healthcare is an incredibly competitive and costly industry. Healthcare IT supports patients via the business, where there is a constant demand to deliver better, faster, cheaper solutions.

"Many people in the IT industry are talking about agile these days, but bringing it into healthcare has been difficult over the years," Reeser-Stout said. "PMI recently released a new version of the PMBOK – Project Management Body of Knowledge – which includes sections about agile best practices and a hybrid approach. PMI's recognition that organizations are looking for a better way to bring both processes together as a hybrid is timely and necessary."

The agile framework provides processes and tools that allow for quick responses to change, reducing cost of quality delivery, he added, helping to bridge a sometimes large divide between IT and the customer.

Reeser-Stout will speak on the subject at HIMSS18 in Las Vegas during a March 7 educational session, "A hybrid approach to the use of agile in health IT," from 1-2 p.m. in the Sands Showroom.

Twitter: @SiwickiHealthIT
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