Agile manifesto for physicians

I am a physician. For most of my career, “agile” meant the ability to move quickly and easily: the treatment goal for my patients with rheumatoid arthritis. Recently, however, while collaborating with programmers to develop an educational app, I noticed they used the word “agile” in a new way. For them, Agile is a methodology for software development.

As we began working on the app, I was initially overwhelmed by the Agile vocabulary: “backlog,” “sprint,” “scrum,” and “user story.” These phrases were as foreign to me as “pathognemonic,” “synovium,” and “intussusception,” were to them. However, after learning about Agile, I realized that Agile methodology has the potential to revolutionize patient care, as it has software development.

The Old Way

Prior to Agile, programming teams like Microsoft and IBM spent years conceptualizing and planning every detail of the software before creating the product. This process of software development was slow and regimented, programmers were micromanaged, and elaborate documentation was required. The method had many inefficiencies: the process took a long time, and by the time the software was released, the needs of the users may have changed, and the software was no longer useful. This approach suffered from difficulties in predicting at the beginning of the project all of the obstacles that would be encountered throughout the project’s lifetime.

The Agile Way

To improve software development, a group of programmers came together in 2001 to write the Agile Manifesto, which valued:

Individuals and interactions over processes and tools
Working software over comprehensive documentation
Customer collaboration over contract negotiation
Responding to change over following a plan.

Their revolutionary idea was to deliver small pieces of working software in short, rapid “sprints,” instead of one massive software release at the end of the project. The short sprints allowed the software to be tested, with feedback loops constantly informing the next iteration of the software. Instead of providing one “end product,” programmers deliver multiple “works in progress,” updating the software according to user demand. Collaboration, simplicity, and reflection were essential components of Agile software development.

Agile in Clinic

I soon began to see similarities between Agile methodology and how I practice medicine. When I see a new patient in clinic with rheumatoid arthritis, for example, I create a quick outline of how I envision her treatment. However, at every clinic visit (aka “sprint”), I obtain feedback from my patient about how she is doing, and adjust the treatment plan accordingly. Because of the uncertainty inherent to the practice of medicine, these short feedback loops help me better care for and respond to my patient’s needs.

However, many other aspects of Agile methodology, if structured into regular medical practice, could provide further benefits to our patients. For example, a large part of Agile is reflection after every sprint. According to the Principles behind the Agile Manifesto:

At regular intervals, the team reflects on how to become more effective, then tunes and adjusts its behavior accordingly.

After a sprint, team members are asked to analyze what they accomplished, what they missed, and whether the goals of the sprint were met. In addition, the team is asked to analyze how they did what they did, reflecting on theprocess rather than the outcome.

Reflection has been shown to be extremely important in medicine, not only for improving a patient’s care, but as a tool for learning and becoming a better physician. Unfortunately, morbidity and mortality conferences are the only structured meetings in which healthcare teams reflect on the outcomes and process of healthcare delivery. Incorporating regular reflection meetings with a patient’s healthcare team (doctors, nurses, nutritionists, etc) with an evaluation of how the patient is doing, as well as how her care is being delivered, would quickly allow us to identify and overcome many of the current obstacles in medicine.

In a very short time, Agile methodology has produced an amazing array of new hardware and software, and its products have changed the way we interact with the world. It is possible that the adoption of Agile into healthcare could provide similar benefits.

Agile Manifesto for Physicians

I am continuously working to improve the care that I provide to my patients. I have come to value:

The history and physical exam over laboratory results and imaging
Reflection and feedback over comprehensive documentation
Collaborative decision-making over paternalism
Responding to change over following a plan

Ready to become an Agile physician?

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