I recently had a sudden reason to do something I had not done since childhood. I went to the hospital as a patient. Surgery could not wait. I’m doing well now, moving on the road to full recovery. As I reflect back on the experience, I found things to learn about team work, skill boundaries and how a team of highly specialized people can work in, well, an Agile way.
Keeping Context and Vision
In a health care delivery situation the provider (doctor, nurse, etc.) needs to understand from the patient the current status of the problem. As I arrived at the urgent care center the triage nurse asked basic questions like “When did this start?” “How is the pain?” and “Where is the pain?” Literally just minutes later I saw my first doctor who asked the same questions, even though he had the paper that the nurse had just filled out. He entered my answers on a computer, starting my incident record. I then proceed through at least eight additional professionals who asked me these same basic questions at the beginning of each of our individual encounters.
Early in the morning after my first night in the hospital the new day shift nurse again asked these same basic questions. I thought all this repetition was an effect of a bad computer system that didn’t share information well. I joked that the nurse should already have that information. She laughed and said that the information was right there on the screen, she just needed to hear it from me. The basic vision of service came from one source, the patient.
(By the way, the morning of the day I left the hospital, I got a new nurse. And he asked me the same basic questions again, for the 12th time.)
I already mentioned the paper documents and computers that abounded, each collecting and feeding information to my care-givers. As I moved through the rooms, the information was already there, all the way to the operating room and my convalescent room. Also of note was a “team board” in my room. Nurses and others wrote on it to update information, give me tasks (“Four walks today, please.”) and allow me to communicate with them.
Regular checks of my blood pressure and other basic information helped adjust the path of care dynamically. And the questions. Always asking questions to be sure they were accomplishing the goals of the work.
Absolute Skill Divisions
Agile frameworks tend to favor a cross-functional team. I noticed that the medical professionals helping me had skill boundaries that they would not cross. For example, the nurse assistant would not ever administer my medication, only the nurse. Regulations, procedures and knowledge prevents too much cross-functionality as person after person provided my treatment. So how did the hospital maintain a “team” feel when treating me?
- The context and vision focus throughout the process, as I mentioned above. Each person who was my primary care giver at that time learned the goal of treatment directly from me.
- Notes, charts and documentation were made by each and every person who interacted with me.
- Each person who arrived had obviously already read some of the notes. They had paper with my name on it or a computer reference already in mind before they said one word.
- Each professional completed their work with me before leaving me. They got “Done” with that step before making way for the next person. No doubt they had other patients but, when they were with me, they were focused on me. Not once did I feel like they were distracted from my needs.
What did I learn that can help the teams I see and work with?
- Keep asking the basic questions and keep providing the answers. Don’t assume you know the vision or the problem, no matter how much documentation or other information you have. Ask the customer. Don’t assume someone already knows the goal of the work, keep answering them.
- Be prepared to work now and for what comes next.
- Do what you your team expects, until it is “Done.” That way the next thing has a fresh starting point.
- Share goal and product progress information, all of it, all the time.