Agile Project Management and its Application in Medical Practice

19 min read

A contemporary insight into managing today’s Medical Practice

With the fast-paced technological evolution all through the last couple of eras, one thing we have learned from the tech industry is that the healthcare business is lagging behind all others. Medical practices, in particular, are typically behind by all means in adopting a practical, yet efficient tool to stay ahead of the 21st-century millennial expectation while concomitantly sustaining a competitive edge.

Therefore, in my opinion, physicians’ practices, and not just large organizations, must adopt a form of project management methodology and tools that will pave the road on the way to what they do best; that being said the patient care.

Midst the spectrum of project management apparatuses, we can name nine most common methodologies, including Agile, Scrum, Kanban, Scrumban, Lean, eXtreme Programming (XP), Waterfall, PRINCE2, and PMI’s PMBOK. One can also note hybrids of one or more of the latest methodologies applied by various organizations.

I, for my part, don’t see myself as a proficient in project management; still, my intention is to present another perspective towards solving common medical practice challenges of our time.

This article solely focuses on the Agile practice, and its potential value in healthcare and by no means favors one method over another.

Definition and Critical Characteristics of a Project in Medicine

The project provides an opportunity for organizations and individuals to achieve their business as well as non-business ambitions more efficiently through implementing transformation. Projects support our desired changes in an organized fashion and with a reduced likelihood of fiasco.

The typical project is usually impermanent. It invariably has a point of start and a finish utilizing a set of unique deliverables or a single product.

Every project requires progressive elaboration, including continuous investigation and improvement, as it becomes available, and all this allows constructing more accurate and comprehensive plans.

Any deliverable should address a problem or need analysis before the project start. Likewise, a standard project must be purposeful as it has a rational and measurable purchase, logical as it has a specific life-cycle, structured as it has interdependencies between its tasks and actions. A project may entertain conflict as it attempts to resolve a problem, restricted by available resources, and may go together with risk as an element.

A Project is distinguishable from others based on types of work they aim to do, such as task, process, procedure. In the meantime, through wide-ranging sense, a project is defined as a precise, predetermined activity that produces a visible and measurable outcome under exact predetermined specifications.

If we consider the patient clinic visit as one out-of-the-way project, based on that assumption and by taking into account the complexity of the present healthcare system, we will be confident that some form of project management methodology is supportive to any medical practice.

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Project Management Triangle

The project management triangle also called the triple constraintiron triangle, or only the project triangle, is a model of the limitations of project management.

According to the triangle, the quality of work is restrained by the project’s funds, deadlines, and scope. (Figure 1.)

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Fig 1.

In a typical scenario, any given project manager has to make decisions between the three constraints while striving to keep the triangle as equilateral in shape as possible. Shifts in one restraint compel modifications in others to compensate. Otherwise, the quality will suffer. For instance, a patient visit can be completed faster by increasing the budget or cutting the scope of work.

As we know, insurance companies are not going to adjust compensation based on the financial requirements of a project; therefore, under such circumstances scope; hence the quality of care will suffer. Similarly, the increasing amount of work or deliverables may require corresponding increases in budget and schedule, something, as well as highly unlikely to achieve without utilizing essential technology, strategy, and human resources.

In short, cutting a budget without adjusting schedule or scope will prime lower quality.

Fundamentals of Project Management and its Medical Application

The primary challenge of development management is to reach all of the outlined goals within the given constraints, as described by the project triangle. This information is usually specified in project documentation, created at the start of any development process. As, from the time a patient contacts the doctor’s office until discharged with a plan and follow up on the program, a medical practice must have a well-defined goal provided the prevailing constraints. Therefore, It is fair to state that the objective of project or practice management is to yield complete patient care, in compliance with the physician’s and patients’ goals and expectations. In many cases, the aim of such patient encounter management is also to shape or reform the physician’s claim to feasibly address objectives; and endure optimal patient satisfaction.

Once the objectives of the medical practice are precisely introduced, then they should be able to influence all fortitudes made by others who are involved in their plans, such as managers, consultants, contractors. Poorly defined project management objectives are damaging to decision construction.

Project management is often tailor-made to a specific type of project based on size, the scope of the scheme, nature, and the type of the industry.

The Four P’s of Project Management

How to Approach a Project

Regardless of the methodology engaged overall project objectives, timeline, and cost, as well as the roles and responsibilities of all members and stakeholders, needs careful consideration.

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What is a Project, and how it Applies to Patient Care?

Other parts to mention concerning a project are work packages related to a division of a project task. Consequently, the Work unit is a division of that work package.

Imagine; patient care as a project; where within its spectrum and sequences of the said process of patient care arises tasks, work packages such as schedulingevaluating, and follow up after discharge.

The principal benefits of using project administration exercise within a medical practice environment can accelerate the perfection and strengthening of the physician’s practice management by achieving the concepts of hands-on supervision. The latter approach also helps deal with risks resourcefully by accomplishing distinct variations that are linked to the clinic’s strategies.

Project Management Tools and their Significance

Within the assumed domain, we can also find a variety of focus points and approaches to the project, including Benefits realization managementCritical chain project managementEarned value managementIterative and incremental project managementLean project managementPhased approachProject production management.

Choosing the Right Methodology for a Medical Practice

Today, one can find abundant project management methodologies used in one way or another, nine of which I outlined earlier in this article. Nevertheless, to understand better, all popular methods are the scheme of exercises, techniques, procedures, and rules used by those who work in a domain. Nonetheless, the methodology must be selected based on performing things in a certain way, like applying various principles, themes, frameworks, processes, and standards. So, for the sake of conversation, let us pick the “Agile methodology.”

Agile Management is the Application of Healthcare Values

Because Agile methodology values are based on the combination of experience throughout the delivery process, it can be a useful model for small medical practices.

Evolution of Agile Methodology

The Manifesto for Agile Development

● Individuals and interactions; over processes and tools

● Working service operation; over comprehensive documentation

● Clientele Collaboration; over contract negotiation

● Responding to change; over following a plan

In agile methodology, tools and processes are vital, but it is even extra critical to have qualified staff effectively working together. Adequate documentation is valuable in helping people to understand how the operation and patient care distribution is constructed and how to utilize a system, including technology and service delivery. Still, the central theme of the project is to take care of the patient, not to document or follow a set of unyielding protocols.

A pact is relevant but is no substitute for working closely with physicians and patients to discover what they desire.

A project strategy is essential, but it must not be excessively stringent to acclimatize alterations in technology or the setting, stakeholders’ priorities, and people’s understanding of the problem and its solution.

The Agile Movement is not Anti-Methodology

The Philosophy of Agile Methodology

Physician and patient satisfaction by timely and consecutive delivery of valuable service is the core target of any medical practice. Therefore, acknowledgment of altering requirements, even later in the process, is essential to its project management. The methodology must be able to deliver services frequently, tightly within daily teamwork amid staff. Agile offers that kind of management system.

Projects built around Agile structure encourages individuals who should be reliable; it affords a face-to-face discussion as the best form of communication.

Patient and physician satisfaction is the primary measure of growth in the Agile system. It offers unstainable growth, can bear a steady pace, presents uninterrupted awareness of excellence and ethical practice model. Simplicity, as the craft of maximizing the amount of work not done, is essential.

Best architectures, rations, and designs emerge from self-organizing teams. Within the latter, regularly, the crew weighs on how to come to be more productive and adjusts accordingly.

Most agile development methods break project work into small increments that minimize the amount of up-front planning and design. Iterations, or sprints, are short duration frames that commonly last from one to four weeks.

Each redundancy comprises a cross-functional team working in all duties, including planning, analysis, operation design, surveying, and approval testing.

At the end of the project, a working system is demonstrated to participants. This minimizes the overall risk and allows the outcome to adapt to changes swiftly.

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Adopting Agile Principles in Health Care

A core principle of agile methodology in healthcare is that for every innovation, from inception, it establishes an Agile team comprised of clinicians, engineers, managers, data scientists, and user representatives. Each group organizes a project cycle to improve results, raise the value to patients, health professionals, and to the overall system.

While the core team covers not many employees, several hundreds of people from member health care systems have participated in Agile projects. By implementing Agile principles in the integration process, medical practices can integrate changes and iterate quickly, thus online mechanisms for clinical deliverables from behavioral health, diabetes management, patient engagement, campus wayfinding, practice compliance, and remote monitoring.

Healthcare organizations and medical practices are innately complex adaptive systems, with many clinical and non-clinical disciplines working in tandem using technology to serve the needs of patients, within an invariably shifting administrative and reimbursement policy, besides with rapidly expediting medical information.

Cultural appropriation of Agile and similar theories is predominant to both expediting the delivery of reform and obtaining reception of methods that are not traditional within healthcare. To that end, medical practices must focus on spreading a culture of innovation throughout their organizations.

Efficient and face-to-face Communication

The Agile System requires very Concise Feedback Loop and Adaptation Cycle

The Quality focus in Agile Methodology

Adaptive vs. Predictive Method

Adaptive systems concentrate on readjusting swiftly to shifting realities. Thus, when the needs of a project change, the adaptive team changes too. But, at the same time, an adaptive organization is restrained in predicting precisely what will happen in the future.

An adaptive team cannot outline precisely what responsibilities they will have in the coming week, nonetheless only which features they plan for the following month. The further away from a date, the vaguer will be an adaptive method is about what will happen on that date.

Predictive methods, on the other hand, tend to focus on analyzing and planning the future in detail and cater to established risks. In the climaxes, a predictive team can communicate precisely what features and tasks are scheduled for the entire length of the management process. Predictive methods rely on active early-stage analysis, but on the downside, if the aforementioned fails, the project may have a shifting course towards complication.

Predictive teams repeatedly institute a change control board to ensure what they consider only the most valuable variances. Therefore, to help managers choose between adaptive and predictive models, they implement a risk analysis.

Project Life-Cycle in Agile Methodology

Situation relevance should be acknowledged as a differentiating attribute between Agile methods. Nonetheless, in practice, provisions can be tailored using various gears.

Agile development has been broadly recognized as highly suited to certain types of environments, including small teams of experts working on undeveloped projects.

In response, an assortment of strategies and outlines has grown for overcoming challenges with large-scale development efforts amongst other problems; and there are now several recognized frameworks that seek to mitigate or avoid these difficulties.

Agile Methodology; in the highly Regulated Domains

Experience and Adoption of the Agile Tool

Measuring Agility

Internal Assessments

Public Surveys on Agile Methods

Surveys also increasingly account that the Agile system helps them to deliver faster, improves their ability to manage changing client priorities, and increases their yield. Studies have also consistently conferred better results with agile development approaches compared to classical project management. In opposition, there are also reports that agile management methods are still too young to qualify extensive academic research on their success.

Common Agile Development Pitfalls

Lack of Sponsor support Agile System

Insufficient Training with the Agile

Poor Engagement of the Project Owner with Agile

Lack of Focus by the Team Members

Excessive Preparation/Planning for Agile Methodology

Problem-Solving in the Daily Stand-up

Assigning Tasks in an Agile System

Scrum Master as a Contributor

The scrum master brings about the process of how information is swapped.

Another standard Agile method deadfall is for a scrum leader to act as a contributor. But, the scrum master needs to ensure they can move in the role of scrum master first and not working on development tasks. A scrum master’s part is to facilitate the process rather than create the product.

Absence Automation of Testing

Test automation provisions constant restructuring. It allows a manager to quickly run trials to confirm that the refactoring has not altered the functionality of the system. It may reduce the workload and increase confidence that cleanup efforts have not introduced new defects.

Allowing Technical Debt to Build-up

Attempting to Accept excess Responsibility in an Iteration

Having excessive work-in-progress (WIP) ends in wastefulness, such as context-switching and queueing. The team needs to evade feeling compelled to take on additional work.

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Fixed Time, Resources, Scope, and Quality

Burnout of the Originator

Agile Management is Iterative and Incremental

Agile X techniques may also be called extreme project management. It is a variant of the iterative life cycle where deliverables are submitted in stages.

The main difference between agile and iterative development is that agile methods complete small portions of the deliverables in each delivery cycle (iteration). In contrast, iterative methods evolve the entire set of deliverables over time, completing them near the end of the project.

Both iterative and agile methods were developed as a response to multiple obstacles that developed in more consistent forms of the project structure. For instance, as projects grow in complexity, end-users conduce having trouble determining the long-term requirements without being able to view progressive ideals. But Projects that happen in iterations can continuously gather feedback to help filter those requirements.

Agile Business Management Model

  1. Integrated client engagement, which involves embedding patients and physicians within any delivery process to share accountability for product or service delivery.
  2. Facilitation-based management or adopting agile management models, like the role of Scrum Master, to aid the day-to-day operation of teams.
  3. Agile work practices: ratifying specific iterative and incremental work habits such as Scrum, Kanban, test-driven development, or feature-driven development across all business functions.
  4. An enabling organizational structure with a focus on staff engagement, personal autonomy, and outcomes-based governance.
  5. DataOps or, Applications of the agile process to data analytics, business intelligence, big data, and data science.

Agile paradigms are flexible; hence they can be applied in other areas of life, such as raising children. Its success in child development might be founded on some basic management principles; communication, adaptation, and awareness.

Criticism of the Agile Project Management

The agile journey is particularly self-conscious. It continually checks its self-appearance in a mirror but is tolerant to few criticisms, lone attentive in being with its peers, rejecting en bloc all wisdom from the past, merely because it is from the past. It literally adopts fads and new dialects, yet, at times, cocky and arrogant.

Is the Agile Methodology the Right Option for Medical Practices?

Agile is a more reliable method for small medical practices because it is a grassroots movement and flexible. It can furthermore be hybridized for optimal adaptability.

Today, apart from large and most medium-sized healthcare organizations, the majority of physician practices are alien to any kind of project management. But with the increasing volume of regulations and mandates, along with emerging value-based reimbursements, utilizing some form of project management, methodologies are becoming unavoidable and exceedingly necessary.

The sway of individuality for the benefit of mainstream and sake of rebellious minority


Adam Tabriz, MD Dr. Adam Tabriz is an Executive level physician, writer, personalized healthcare system advocate, and entrepreneur with 15+ years of success performing surgery, treating patients, and creating innovative solutions for independent healthcare providers. He provides critically needed remote care access to underserved populations in the Healthcare Beyond Borders initiative. His mission is to create a highly effective business model that alleviates the economic and legislative burden of independent practitioners, empowers patients, and creates ease of access to medical services for everyone. He believes in Achieving performance excellence by leveraging medical expertise and modern-day technology.

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