HOUSTON, TX, USA 5 8 NOVEMBER 2017 #PMOSym PMO17BR303 The Big Bang Cerner s Approach to Agile Transformation Matt Anderson, PMO Director Cerner Corporation
Objectives Provide strategies for doing a Big Bang agile rollout Provide foundation for a successful plan Help avoid potential pitfalls Create a sustainable model Position the PMO as a leader in the transformation
Cerner Corporation Started in 1979, based in Kansas City, MO USA Leading global supplier of healthcare solutions, healthcare devices and related services Focus on creating a safer and more efficient healthcare system Key solutions include: Computerized physician order entry (CPOE) Electronic medical records (EMR) Personal health records (PHR) Clients in 35 countries serving more than 27,000 unique facilities Hospitals, physician practices, retail pharmacies NASDAQ CERN US$4.8 billion in revenue in 2016 Healthcare is too important to stay the same
Migration to Agile (2009)
Cerner s Challenges to Agile FDA-regulated healthcare environment Had to prove we could be agile and meet compliance FDA, CE Mark, ISO guidelines perceived as very waterfall centric Culture change Just get it done (command and control) Development ecosystems Some legacy code still on Visual Studio 6
Why Agile? Business focused Speed to market Concept to first client adoption 30 months Retain market leadership Return on investment Improve quality Develop the right solution Develop the solution right Support edge teams Core solutions released together, but edge teams unnecessarily held up by inflexible methodology Analogous to core web browser versus plug-in for browser
Grassroots Movement September 2008 Several teams express frustration with rigid process Cerner culture is kill a snake, so alternatives sought Recommendations to look into agile as a possibility from a couple of engineers General feeling was that due to FDA regulation, it could not happen Q4 2008 Small group of teams begin discussions to start unofficial agile pilots January 2009 Five teams kick off pilots with minimal support Group meets together weekly to discuss progress and share ideas April 2009 Development executives hear about pilots and are exposed to the positive results Presented short-, medium- and long-range goals on what agile could do
Top-Down Support July 2009 CEO Neal Patterson announces intention to blow up the waterfall Q3 Q4 2009 Pilot program expanded to eight teams and several key initiatives to determine if it could scale High executive visibility Tooling pilots to plan for scale Education provider pilots held FDA and other regulatory impacts mitigated January 2010 Key business leaders trained in agile principles 75+ vice presidents and executives Renamed lines of business Agile Business Units (ABUs)
The Plan March 2010 Plan and budget presented for a planned incremental training and coaching rollout After reviewing options, decision from senior vice president of engineering to go Big Bang instead of incremental Go fast Back to the planning board Pilot Prove Scale 6 mo 6 mo Big Bang 12 mo
Education Tooling Big Bang Plan Elements Agile center of excellence Development process Education and coaching Tooling Ecosystem Metrics Partnerships Manage expectations Engineering Rest of Cerner Clients Manage Expectations Partnerships Standard Development Process Agile Center of Excellence
Agile Center of Excellence Created a virtual center for all things agile Web 2.0 technologies One stop shop for agile questions, coaching requests and general information Accountable for agile success Named agile champions from pilot teams Respected engineering associates who could speak agile and Cerner Training Coaching Community participation Manage vendor relationships and budget
2010 Agile Training/Coaching Plan Train the trainer model, with 50% external/50% internal; KC and India
Cerner 2010 Agile Timeline 27-Jan-10 Core Leadership Training 26-Apr-10 Agile Essentials Recorded Agile Center of Excellence Launched 26-Apr-10-10-Sep-10 Agile Boot Camp Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-10 Jan-11 1,600 development team associates trained in less than five months All global development offices included
Development Process Update Plan Major overhaul to support agile Audits Worked closely with FDA, ISO and other regulatory groups to reinterpret regulations from an agile mindset Determined where additional process would be required from agile applications in other industries Initial internal audits performed on pilot teams to find potential gaps Early rollout of planned changes (March 2010) Follow up internal audit of pilot teams prior to official launch Official launch 1 July 2010
Tooling Ecosystem Defined approved tools and guidelines for new tooling Created education and brown bag discussions to promote appropriate usage Metrics Set expectations that they would significantly change Eliminated most existing metrics in favor of a few key metrics
Partnerships Develop vendor relationships to build and supplement internal expertise Tooling Training Coaching Learning from other s experience is significantly less expensive in the long term Become self-sufficient
Setting Expectations Create training materials for each audience Development and business executives C-level executives Clients Tailor agile message to support their goals Follow up with results to maintain trust Use terms they understand Capability versus epic
Slide for Executives Agile Executive Establish, maintain and communicate vision Enable and trust teams to deliver Empower and inspire agile business unit teams Provide ongoing solution input and direction ahead of iteration planning Prioritize, adapt and embrace Servant leader Remove obstacles Identified by the teams Obstacles not seen by the teams Protect the high-performing teams Measure what is needed
Slide for C-Level Executives Cerner Adoption Measurements Training records Coaching assessments Quarterly team assessment Baseline at boot camp Measurement of success criteria Speed to market Client adoption Team performance Delivery against commitments Client demos Lead time Time from investment to adoption
Slide for Clients Success Measures Value and experience Client interest Client benefits quantification User experience and usability Client adoption Time to put major release into production Time to activate capabilities into production Solution quality Client-found defects Ratio client-found vs. release validation defects
Slide for Clients Key Client Responsibilities Engage with Cerner ABUs regularly to provide feedback As a development partner Work with the ABU and development teams to create prioritized list of capabilities Attend client demos at the end of each development iteration Provide regular feedback on progress and ensure proper priority Test capabilities and take them live as soon as they are available
Results Review the Why Business focused Speed to market Concept to first client adoption 30 months Retain market leadership Return on investment Improve quality Develop the right solution Develop the solution right Support edge teams Core solutions released together, but edge teams unnecessarily held up by inflexible methodology Analogous to core web browser versus plug-in for browser
Results After One Year (2011) 30 mo 10 mo Productivity 24% Development Cost 14% Quality 6% Direct ROI 429% Indirect ROI 1,000% Passed audits with new (significantly reduced) process Culture Agile and lean used in everyday vernacular (most of the time correctly) Leaders challenge each other to act as servant leaders in executive sessions Some command and control tendencies surface from time to time, but other leaders are the checks and balances Associate attrition for satisfaction issues reduced by 80% 95%+ adoption by development teams (2,000+ associates)
Keys to Cerner s Success Strong grassroots and top-down support Engineering momentum Vision and funding Connected to key associates within organization early in the process Mavens* distinguished engineers, PMO Connectors* key pilot teams, PMO Associates with high trust within organization Leveraged current culture to change future culture Build on the past, don t throw it under the bus Excellent training partner Business driven implementation Agile to win the game, not just to be agile * - The Tipping Point by Malcolm Gladwell
Drawbacks From Big Bang Coaching post training Large scale enabled only three visits per team and some teams fell into less than optimal practices Some teams adapted before adopting, so they are not consistently getting the results Some key items to agile have lower adoption Burndown charts Physical tasks board (favor electronic tooling instead) Team depth in agile principles shallower on teams that had only the minimal recommended coaching Hiding behind the tool Early electronic adoption over physical led to some less effective practices
Since 2011 Development course offerings expanded Coaching, coaching, coaching Lean portfolio management Focus on value stream and find and eliminate bottlenecks Moving agile/lean into non-development applications Culture change continued 2012 Corporate Core Values across all 10,000+ associates Flawless personal commitment Empowered freedom to do the right thing Value satisfying a need, exceptionally Grown to 25,000 including major acquisition (Siemens Health Services) Successfully merged two agile cultures Member of the Steve Denning Learning Consortium developing and sharing best practices in business agility
So What? What are you going to do to improve your PMO s role in your agile journey/transformation? Recommendations Define your why Build your short-, medium- and long-range goals for your first/next turn of the agile crank Identify your connectors, mavens and skeptics 27
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Contact Information Matt Anderson matt.anderson@cerner.com @CernerAgileMatt SD Learning Consortium SDLearningConsortium.org SDLCAgile@gmail.com @SDLCAgile 29