Agile Care

I love agile development. We use agile with development efforts and I’ve recently tried to implement aspects of it into parenting. I’m sure most developers reading this know agile. If you want to learn a bit about agile development, Wikipedia is probably the best intro to it.

There are lots of reasons I really like agile. It’s a wonderful way to turn big projects into very tangible and manageable tasks. It’s also a great way to flatten the structure of a group, keep lines of communication open, and increase personal and group accountability. If you look at those benefits, you quickly realize that agile as a methodology does lots of things that we should be striving to do in healthcare, especially as it relates to engaging patients.

I looked around for stuff on agile healthcare and didn’t really find much. A couple of population health tools, predictive analysis stuff, and then some organizational tools (lean mostly.) I didn’t see anything related to using agile as a methodology or framework for working with patients. That surprises me. If there is more that I’m not seeing, please send along any info as I’d love to see anything related to this.

Below I’ve take some liberties and broken out areas of agile thinking and tried to map them specifically patient care.

Flattened structure. I think I read the phrase "shared decision making" every day. It’s in almost every story or post about the future of healthcare and is seen as an essential part of effective patient engagement. Agile does a great job of flattening an operational structure and improving decision making. Patient care is the domain of PCPs, specialists, nurses, care navigators/managers, caregivers, and of course patients. That’s a broad group. Historically it was hierarchical, with doctors at the top and patients at the bottom. Our goal should be to flatten this structure to give everyone a voice and increase understanding at all levels of interaction with the patient. PCPs can remain coordinators, especially if a part of a patient centered medical home model, but integrate more data points from those directly providing regular care, as well as the patients themselves.

Discrete goals (closing the feedback loop). Long-term targets, while necessary, aren’t very tangible. Losing 25 pounds over 12 months is a great goal, but it’s not really tangible on a daily or weekly basis. Breaking goals down into weekly objectives, which ideally translate into daily targets, helps patients more easily see and work towards the finish line. It also closes the feedback loop with patients to be able to have them accomplish goals on a daily or weekly basis. One added benefit, if applied to the care team, is to create a better understanding of the roles and action items for each member.

Daily scrum (regular communication). We should strive to give patients and all of the care team a voice. With agile development, daily meetings are held to discuss progress and roadblocks. In agile parenting, the standard seems to be weekly meetings. The point is to have regular check-ins that are short and structured. Agile meetings typically ask three questions. In healthcare, those could be: (a) What healthy thing did you do this week? (b) What problems did you encounter with your health this week? and (c) What are your health goals for this upcoming week? I’m sure there are some other questions that might be relevant, but keep it simple and let patients elaborate so you can discover what is important to them.

Accountability. Discrete goals and regular communication ideally create accountability, not just for the patient, but for all of those in the care team. Everybody makes mistakes, and acknowledging those mistakes helps everybody learn. Agile is a great way to facilitate this learning and continually improve.

Beyond what is laid out above, each of the areas needs to be integrated into a formalized process or workflow if it is going to be effective. There is a very big technical component to this because lots of agile is about contact and communication, something that would have to be done virtually if agile is applied to healthcare. There are tools that we use for agile development because we are not all co-located. These include things like IM and Google Hangouts. In healthcare, there need to be more solutions to facilitate what I described above.

But the first step is not the cool tools or the great UI. It’s defining a process that works for everybody. This is hard with providers because it’s a major shift in the approach to care. I’d love to hear some ideas on how to accomplish this or learn about examples of pilots testing processes similar to agile. Maybe with a targeted approach to something very specific like discharge and readmission prevention.

Travis Good is an MD/MBA involved with health IT startups. More about me.

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