Discussing agile methodologies in healthcare with Kenny Cruden

It’s been a challenging few months for companies trying to adapt to new ways of working under the current COVID-19 pandemic. However, those teams who have already implemented Agile Methodologies may be better equipped to cope with such change. Interestingly, one of the main lines from the  Agile Manifesto is “Responding to change over following a plan” which can be a lesson learned in dealing with the current global crisis especially in companies in the healthcare industry. 

To explore the concept of agile and how companies adopt agile practices, we caught up with QA Consultant and Agile Coach with over 20 years’ experience, Kenny Cruden. To further explore QA and Agile Methodologies, we asked Kenny some questions around his current role at a tech healthcare company as well as lessons learned and his thoughts on how companies can better adapt to change.

 

Can you tell us about your consulting background and what you are currently working on? 

I started my career in 1997 and was exposed to agile methodologies in 2004. I then quickly became aware that not many companies had any understanding of what agile was. I generally became the consultant who ended up in the agile space with a focus on Quality Assurance (QA) and how that actually works with an iterative development lifecycle. 

I have worked in various companies in e-commerce, media, telecommunications and internet service providers to help them deliver their software more frequently and with a better standard. 

I’ve had a decade of doing that up until about 2016. From then on, I have been doing contracting work as a consultant and agile coach. 

 

How do you see agile methodologies supporting healthcare companies in meeting rapidly changing customer needs?

In a way, it’s similar to what happened in the FinTech industry. Traditionally, the big banks ruled the roost. If they were to build something, it would take a minimum of six months or a year. Then the small companies come in and were able to build and test quicker, which meant they could also get things out to customers quicker. That has been revolutionary and has completely changed the FinTech industry. 

This is what we are also seeing in health care technology. 

“Small health care tech companies are able to iterate so much faster. They can find people to help them with ground research which can be done fairly quickly which means they have a quicker turnaround. Then they can iterate again and that’s very valuable.” 

This gives us the ability to build and test products very quickly and the ability to be able to continue to learn and try things out on an actual person rather than spending months designing and thinking within the internal teams. 

“Let’s get tech products or services in front of actual customers, who have vastly different expectations than we thought when we built them. It’s about getting that feedback that a small company using agile can actually benefit from.”

Many people aren’t very tech-savvy, and we need to build products that people will actually understand. There’s a certain age bracket of people who will understand how to use them, but my mom, for example, doesn’t really know how to get around tech and so I have to help her. That’s what we need to think about from a health tech perspective. Everyone wants to have good health, and everyone has health concerns, and we need to create something which everyone can actually use.

It’s also interesting to look at how a company that wants to build a global service to provide affordable and effective healthcare for everyone on the planet deals with the limitation that not everyone has access to smart devices such as a smartphone. Some people may not have the ability to access a text on a phone. We need to overcome this challenge or else the healthcare solution will not be accessible to some at all. From an e-commerce perspective, you can generally get around these things in a different manner. You can go and ask someone else to do it. But if you’re talking about someone’s health, you have your own individual health record, which is personal specifically to you that you can’t share with anyone else. This brings some interesting challenges.

 

What solutions do you think consultants can offer to better react to the challenges of the Covid-19 pandemic? 

Companies are trying to adapt to the COVID-19 pandemic and everyone’s trying to move and change quickly. 

“There’s one thing I always see when I do consulting work which is that everyone seems to think they are doing agile, and when a huge shift needs to happen, companies generally forget all the practices that they need to work in an agile manner. They resort back into a waterfall model.”

For me, being a consultant in situations like we have with COVID-19 is really important because we can see when a company is going down the wrong tracks and has lost the discipline to be able to continue to work agile. This is because they may only be thinking about the rush to push out products quickly. Here, a consultant should be able to come in and steer the ship to prevent that from happening. 

I think that’s what a consultant should do anyway. Agile methodology, as a concept, is really basic. But it’s the actions and how you structure architecture in multiple teams that a consultant can come in and assist with.

What are the main challenges for healthcare companies looking to innovate in product development, services, and customer experience?

One of the main challenges are that the standards and compliance required are stricter than you have, for example, in the financial industry. There’s a part of the company, called ‘clinical safety’. Within our company, we have people who are clinicians who understand the regulations, and they have the job to make sure that our product is safe. 

From a QA perspective, my mantra has always been,“Are we building the correct product?, and if so, are we building it correctly?” I ask businesses and end-users, “Is this what you think you need?”. But when a clinician is looking at it, they are asking, “If a user picks up this product and starts to use it, is it safe?”

If a product can be misinterpreted, by form, the colouring, the screen, the format the text, etc., then that’s dangerous, and could harm someone. 

Most of the time, these clinicians working for healthcare companies generally have not been exposed to agile practices. When we’re trying to execute development, we want to bring in all the business people and have them involved in all the different decisions that need to be made. We need to have a cadence that everyone can work with, including the clinical safety people who don’t really work in that manner. 

Until now, in general, the healthcare industry has been working based on medical standards which are more or less written from the perspective of a waterfall approach to building a product. This means months to design, months to build, months to test, months to make sure it is clinically safe.

“Now that we are implementing agile methodologies in the healthcare industry, we need to think about how we help the clinical safety, regulatory  and compliance teams to fit into a faster cadence.”

For example, in the past, healthcare standards and regulatory documentation and auditing would be done once a year. Now we’re doing it once a week. There is still room for innovation, and to bring people such as clinicians into the fold and to get them to understand how we work from within an agile team, and how they can contribute within the process.

 

Can you share any advice or tips on how teams can begin switching from traditional to agile methodologies? 

The concepts around agile methodologies are simple. Normally you would have a big process of months of implementing each phase in development, now we’re doing it in shorter phases. But very often companies will start agile and still have many waterfall practices. In this instance, it’s important to bring in people who understand how to implement agile properly and can guide companies along the way. It is not an easy process and adopting agile takes more discipline than a waterfall process. 

This is what generally happens within transformations where leaders kick off agile and people are pushing some software out every two weeks, but when you delve into what’s happening within the teams, it’s absolute chaos. And the problems just get bigger and bigger. 

“Switching to agile is more about changing people’s mindset. An organisation needs to change its mindset in order to embrace agile methodologies. And it should be implemented and understood by more than just a small part of the business.”

Shifting to agile is about getting everyone who is involved in the business to realise that they are going to have to change the way that they normally approach their work. And that’s difficult because no one likes change. Working in an agile way requires a mindset shift rather than having anything to do with technology. You have to be a kind of ‘chief manipulator’ to get people to really buy into changing their behaviour.

I’ve seen in many companies where leaders want to adopt agile and they tell their people to go and do it. They don’t think they’re going to have change at all. This can have a negative impact on actually enforcing change where it comes down to what the leaders haven’t done, haven’t been involved in, or haven’t changed – which is actually killing the whole program. 

 

What skills do you think consultants need to develop in order to meet the challenges that companies are currently facing? 

I’ve found that the top consultants have the ability to empathise. Change is quite an emotive thing and people get flustered by it and they don’t like it. When someone is trying to change the way people work, we need to empathise with what that person is going through. 

You need the type of person who can come in and recognise those who are not comfortable in changing what they’re doing and find out why that is. Then you can take someone through a process to get them to buy into the changes the company wants.

 Some consultants who come in and they don’t really consult, they come in and say, ‘You’re doing this wrong, you need to do this”, and it creates such a division. 

“Being a good consultant is about being someone who realises that they can’t walk in and say, “Right you need to change that”. You need to help people in the company see the problem themselves and then help them along the whole journey.”

Another quality of a good consultant is someone who has experience in many situations and has gone out of his/her comfort zone a few times. For example, I was comfortable at ThoughtWorks but then left to do consultancy on my own at an international bank. Whilst at the bank, I didn’t have a support network and this taught me how to develop my ability to consult on my own. And it’s this type of person who has experience in different situations, for example, working in start-ups or companies that are completely remote, and learn all the different things that can happen within a company. No two companies are the same, they all have different constraints, and a consultant needs to learn how to adapt with whichever constraints they’re faced with. They need to learn how to adapt to them, whenever they arrive at a client to then be able to help that client. It’s being comfortable with being uncomfortable.

And another characteristic I’ve seen from the best consultants is that they are curious about all aspects of the business and understand they are there to help everyone. This links with communication skills and soft skills and how people express themselves. Having an open mind to understand that, if someone within the team is uncomfortable, then try to understand them and help them.

It’s not about getting the two main leaders in the room to understand the work. It is absolutely everyone who needs to understand and then you have a cohesive team that will actually work together. And it’s definitely not only about the rockstar technologists, but it’s also about the whole group of people. Let’s all move together so that everyone understands what they are meant to do at each point in the process. 

 

What are some of the biggest trends you have seen in your area of expertise in Quality Assurance?

In the 90s and early 2000s, when test automation was emerging, it was generally thrown onto the QA’s and the testers. But people didn’t have the skills to do it. They managed to write some sort of code for tests. That went on into the early 2000s until developers started to get involved in testing. However, this was not done very well. Then the QA’s came back in and needed to be trained to build the top part of the testing stack (UI driven tests) where the developers focused on the lower end of the unit test and lower component tests. 

What I see now is everyone who has been working in QA wants to become a testing developer and they’re taking on that title but they don’t have the same standard of skills in programming that a developer has. This has led to a similar situation we had in the early 2000s.

Everyone is talking about automation and no one seems to talk about technical QA, which for me, is understanding the full architecture and how to strip that into pieces and be able to analyse them individually. We should be able to do that in such a way that you can then advise developers on how to programmatically check that and optimise. That seems to be completely lost in the career, the career aspirations of QA’s.

To make sure that we don’t fall into that trap in my company, I want us to have technical QA’s. People who understand the technology and who also have that exploratory mindset, prepared to go in and ask any question of anyone to figure out what’s going on and make sure that we have the lowest risk possible when it comes to building and releasing a bit of software. That for me is what the QA discipline is all about. 

 

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