Agile working in the NHS

Our Business Analyst Cat Jones joined the NHS for their Big Room Planning Event recently – read on to discover large-scale agile working, and the real-world challenges posed by digital transformation.

What is the Big Room Planning Event?

The NHS Blood & Transplant (NHSBT) Organ Donation & Transplantation (ODT) team follow a lean agile working methodology called The Scaled Agile Framework (SAFe). As part of this, all agile teams within ODT are brought together under an Agile Release Train – a way of managing concurrent work streams. The separate teams within an organisation plan, commit and execute together.

Define, build, test, deploy, repeat.

The Big Room Planning Event (BRPE) is a two-day planning session where the release train deliverables for the current PI (a “program increment”, a label for the period of time we work to, which for this project is 3 months) are reviewed, and planning takes place for the next PI.

The idea behind the BRPE is to get all stakeholders in the same place at the same time, and discuss requirements or dependencies for the work coming up. It’s a great way of planning – you reach an agreement there and then, together, often negating the need for multiple calls and meetings.

All teams (around 8) come prepared with their own strategies – we always have a clear plan and agenda of topics in mind for the BRPE, so we know exactly who we need to speak to on the day to ensure our deliverables are successful.

What’s Apadmi’s role?

Apadmi are part of Team Cuckoo – ODT give all their teams bird names, hopefully it’s no indication of how they see us!

As we built DonorPath and we’re working on the next stage of its evolution, we need to work within their release train and integrate into their agile working framework. We have many dependencies on the NHS for delivery, so we attend the BRPE to plan our sprints for the next PI, agree new releases, and review progress or outstanding issues.

Who we take depends on the agenda we’ve set for the two days, and their skills are called upon in very different ways – generally, we’ll have:

  • Myself as BA – I work with the product owner and NHSBT BA to map out any missing requirements, clarify ambiguity within the JIRA tickets for up-coming work, and assign these tickets to sprints within that PI
  • Software and mobile experts – they discuss architectural improvements, advise on the potential impact that any changes could have on the live DonorPath app, and agree the best approach for implementation
  • A project manager – they’re a vital part of this team, understanding what timescales certain agreements have, and factoring it into our wider portfolio of work, allocating resource and so on
  • Sometimes we’ll take a UX expert if we intend to discuss the look, feel and structure of something

We’ll work closely with a variety of people while we’re there – from solutions architects and business leads to the test team, developers and delivery leads. Our product owners John and Laura lead the discussions to ensure we always walk away with a tangible objective.

What happens at the BRPE?

The structure can be quite fluid, but it looks something like this…

Day one

  • We arrive at the conference venue in the morning, find where our team is stationed and get together. There’s always an introduction from the programme manager, detailing the agenda for the two days
  • There’s usually a second speaker who highlights any recent exciting developments. At the last event, we were told about the work the kidney team are doing to increase matches, and the story of a young gentlemen who lives life on the waiting list – it’s very humbling, and a reminder of the real-world problems we’re working to solve
  • Once the talks have finished, we move into planning in our groups. This can be breakout conversations about specific elements, or planning a large body of work to sprints. We work in our teams from 11, reviewing our drafted plans after lunch

NHS and agile working

Day two

  • A similar structure to day one, but with more focus on planning and reaching a conclusion
  • The product owners conduct a scrum of scrums, going around each group, assessing and prioritising their planned work. They iron out any issues and challenge any points there and then
  • At the end of the day, all teams present back and highlight any dependencies they may have on other teams or individuals.

NHS and agile working

How can large scale organisations include agile working?

Agile means adaptation. SAFe works well for large organisations, as its framework allows for flexibility as business priorities change.

For example, the potential new opt-out legislation for organ donation was something ODT couldn’t have planned for, but it’s guaranteed to have an impact on their workload and their release train. Agile means the team can re-prioritise quickly and easily, while the BRPE offers the perfect opportunity to communicate to the rest of the team.

Conversation and collaboration with “shop-floor” stakeholders are also key to large-scale digital transformation becoming a reality. With the NHS, clinicians are the end users, the people who deal with the day-to-day issues we’re trying to solve; no one understands those frustrations and challenges better, so they naturally stay focussed on overcoming them.

Those of us who are removed from that daily activity can switch emphasis, forgetting about the real-world scenarios where any additional technical complexity could prove to be a hindrance, not a help.

If a business is committed to digital transformation, end users must be involved from the beginning – if it doesn’t meet their needs, it won’t be a success. That’s one of the great things about DonorPath; I haven’t met a single NHS professional who’s interacted with the solution and not found it invaluable – people wouldn’t be without it.

While agile working can help you to adapt to a changing business approach, it’s that end user engagement that should define why the approach must change in the first place.

Check out our video on DonorPath if you’d like to know more about the solution we built with them to save time, money but ultimately lives.