Hospital El Pilar: Improving Patient Care With Disciplined Agile®
For more than 50 years, Hospital El Pilar has been providing the highest level of comprehensive care to patients in Guatemala City, Guatemala. The private hospital — which offers a range of medical services including pediatrics, intensive care, oncology, cardiology and outpatient care — is now one of the best hospitals in the country, thanks to its commitment to quality care and continuous improvement.
As part of this commitment, Hospital El Pilar is focused on driving innovation by investing in the latest technology to better serve both patients and staff.
The hospital’s application development team, which works within the technology department to build solutions and strategies that aid hospital operations and outcomes, was experiencing stalled progress on projects due to several obstacles, including:
- Unclear priorities. Every project was defined as urgent, which ultimately left the team unsure of how to focus its efforts and prioritize needs.
- A lack of visibility. “We had little visibility into the progress of projects and requirements, which led us to try to cover a lot and, in the end, there was no progress at all,” said Adolfo Enrique Galán Paz, manager of IT.
- Little interaction with users. “We only had interaction with users at the beginning and end of projects,” Galán said. “That caused us not to deliver what the client really required and drove errors in production when publishing developments.”
- Competing demands. The application development team also served as user support, which hindered the progress of coding and development since the process was constantly interrupted to help users troubleshoot.
To improve how projects were being managed and how key stakeholders and users were involved in the process, the team — made up of a development manager and five developers — selected Disciplined Agile® (DA™) as the best path forward.
To improve project outcomes, the development team ultimately needed to improve how their projects were being managed without recreating the wheel. Project efforts had to continue even as the team worked to improve its processes.
This journey began by separating the support functionality from the application development team in order to allow the team to better focus on their core purpose.
From there, the team — which was using what Galán describes as “some form of Scrum” — began learning and applying DA.
“The advantage of Disciplined Agile is that you can start at the moment exactly where you are,” said Miguel Angel Garcia Trujillo, PMI Disciplined Agile® Coach (DAC) and instructor, and CEO of Ditrats, Aguascalientes, Mexico, who provided DA training and certification to Galán and his team. “This way they can start where they are with the technologies and systems that are already part of the hospital and still create an immediate impact. In general, Disciplined Agile can optimize anything that can be managed.”
As part of their DA adoption, the application development team made some key changes, including:
Prioritizing user stories. Before using DA, the team did not have documentation of user stories, which meant they did not have properly defined user criteria or a definition of done (DoD) for the project. In addition, they decided to include stakeholders in the team. According to Galán, this promotes transparency, makes the work more focused, and ultimately makes the user feel like part of the team that is building the solution.
Implementing a monitoring dashboard. This dashboard provides the team greater visibility into:
- Working speed.
- Average days to complete stories.
- Average days to complete tasks.
- Number of tasks and stories pending in an iteration.
- Burndown iterations.
Redefining the way of working (WoW). The application development team ultimately selected the DA Agile life cycle as its WoW, which they broke down further to include:
Holding daily coordination meetings
- Improves task tracking
- Enables the team to solve problems in real time
- Enables the team to be flexible with priorities as needed
- Helps the team remain aware of any delays that may occur
- Serves as a renewal of the team's commitment on a daily basis
Scheduling retrospective meetings
- Captures minutes with solutions to reported problems
- Includes the development team in the improvements
- Takes self-assessments and prioritizes a positive attitude
- Improves how the team works together for future iterations
- Ensures the team understands stakeholder objectives
- Allows project teams to more deeply understand the whole process to design a better product
- Establishes a relationship of trust with the hospital staff
- Prioritizes communication with the hospital staff
Organizing planning meetings
- Helps gain agreement on the effort required for each user story
- Assists the team in improving iteration planning
- Ensures the whole team understands the work that has to be done for any given project
- Ensures the user understands how a system or technology works before it is put into production
- Offers stakeholders the opportunity to request modifications before the project is finalized and any version is released
Since implementing DA to help manage projects, the application development team has completed several complicated and high-profile development projects for the hospital, including a system that tracks patient care times, an electronic billing system for doctors, an automated nutrition request system for infants, and application programming interface (API) development for the mobile app.
“We have managed to deliver better solutions in a more professional manner with fewer errors,” said Galán. “In addition, more projects are finished on time. Ultimately, we have also increased the level of trust our users and customers have in our team.”