Leveraging Scaled Agile Framework (SAFe) for Rapid Improvements in Healthcare Facilities

Introduction

The healthcare industry is facing unprecedented pressure to quickly adapt and improve. With rapidly advancing technology, constant regulatory changes, staff shortages, patient safety concerns, and more, healthcare systems must find ways to rapidly respond to changing environments and deliver better quality care. Many healthcare organizations are turning to agile frameworks like the Scaled Agile Framework (SAFe) to enable faster innovation and improvements across multiple teams and departments.

SAFe provides a proven model for implementing agile practices across large, complex organizations. It empowers healthcare facilities to deliver solutions and improvements iteratively and incrementally, while aligning various interdependent groups. With its structured approach, SAFe can help healthcare organizations address critical challenges through the rapid delivery of new technologies, processes, and solutions.

Challenges Facing Healthcare Organizations

Healthcare facilities today face a multitude of pressing challenges, many of which seem to change daily. Outdated technology systems and cumbersome processes lead to inefficiencies and errors, compromising patient care. Constant regulatory changes, like new laws around data privacy and reporting, require rapid responses to achieve compliance. Staff shortages, exacerbated by the pandemic, leave teams understaffed and overwhelmed. Patient safety issues, from hospital acquired infections to medication errors, need immediate attention and improvement.

The costs of these challenges are high. Poor quality of care leads to readmissions and poor patient outcomes. Non-compliance with regulations can result in crippling fines. Frustrated staff experiencing burnout are at higher risk for turnover. For healthcare facilities to thrive, they must find ways to rapidly rise to meet these modern challenges.

Overview of SAFe Principles

SAFe is built on nine core principles derived from lean and agile best practices. These include:

• Take an economic view, focusing on the entire value stream rather than individual projects
• Apply systems thinking, optimizing the whole, not local optimizations
• Assume variability and preserve options to build in flexibility for change
• Build incrementally with fast, integrated learning cycles, delivering value quickly and often
• Base milestones on objective evaluation of working systems and test progress with demos
• Visualize and limit work in process, reducing batch sizes and queue lengths
• Apply cadence, synchronize with cross-domain planning, and meet on a regular schedule
• Unlock the intrinsic motivation of knowledge workers by engaging teams for greater initiative
• Decentralize decision-making and push authority to teams executing the work

By instilling these principles across an organization, SAFe helps create an environment that can rapidly respond to changing needs and priorities.

Overview of SAFe Structure

SAFe structures an organization into three levels: team, program, and portfolio. Agile teams focus on building solutions. Programs align teams to a common mission through the continuous delivery of incremental value. The portfolio level manages budgets, governance, and strategic objectives.

Agile Release Trains (ARTs) are at the program level and contain 5–12 agile teams working toward a shared business goal. ARTs deliver value through set intervals called program increments (PIs), which align teams to a regular cadence of planning, building, and releasing.

The portfolio level establishes vision, budgets, and governance for value streams. Value streams are a series of steps an organization uses to build solutions and services that provide value to customers. Enabling end-to-end value delivery is a key aim of SAFe.

Implementing SAFe in Healthcare Organizations

To implement SAFe, healthcare organizations should first identify their value streams and map their flow from idea to delivery. Many healthcare facilities organize around clinical areas like cardiology, radiology, or pediatrics. These can form the programs aligned under value streams.

After identifying value streams, organizations form ARTs consisting of agile teams pulled from business, operations, technology, and other areas. These diverse teams align to deliver regular PIs under a single product manager. For example, an "Infection Prevention" ART may contain doctors, nurses, IT specialists, analysts, and facilities staff. Together, they build solutions to address health-acquired infections.

With ARTs in place, organizations restructure roles and processes to align with SAFe ceremonies like planning, reflections, and system demos. Training helps staff learn agile practices. As ARTs establish a cadence for delivering PIs, solutions and improvements start flowing through the value stream.

SAFe in Action in Healthcare

Major healthcare systems like Kaiser Permanente, Cerner, and Mayo Clinic have adopted SAFe to accelerate innovation and improvements. Cerner has over 3,000 employees trained in SAFe across 20 ARTs. They have reduced product development timelines by 25–50% while improving quality. Kaiser Permanente uses SAFe to upgrade healthcare applications, improve patient estimations, and enhance physician mobility. Their ARTs deliver solutions faster while also boosting staff engagement scores.

These examples showcase how SAFe enables healthcare systems to respond rapidly to needs and challenges. ARTs deliver patient solutions and process improvements at a steady cadence. By organizing interdisciplinary teams around value streams, SAFe also fosters alignment, collaboration, and accountability.

Key Benefits of SAFe for Healthcare

Applying SAFe can have numerous benefits for healthcare organizations:

• Faster innovation and improvements - By structuring programs into ARTs that plan and deliver on a regular PI cadence, new solutions can be built and implemented far faster than traditional models.
• Enhanced quality of care - ARTs often focus on improving patient outcomes and care quality. Issues can be identified and addressed iteratively in a data-driven way.
• Increased productivity and efficiency - SAFe helps eliminate bottlenecks, silos, and waste to streamline value delivery. Programs deliver more value with reduced costs.
• Improved staff engagement - SAFe fosters autonomy, mastery, and purpose in teams, boosting engagement. Staff also develop valuable new skills.
• Greater alignment and visibility - ARTs align diverse teams to a shared mission. Planning together also provides visibility into initiatives across the organization.
• Accelerated response to change - Smaller batches and cadence allow faster adaptation to changing needs, regulations, technologies, etc.
• Consistent innovation culture - SAFe instills a culture focused on continuous improvement, innovation, and delivering maximum value.

Potential Challenges and Mitigation Strategies

While SAFe can bring enormous benefits, healthcare organizations may encounter some challenges:

• Resistance to change - Some staff may struggle with this radically different way of working. Ongoing training, coaching, and leadership alignment can help.
• Lack of skills or experience - Agile practices may be new. Training and bringing in agile experts can help teams skill up quickly.
• Coordination issues across ARTs - Facilitating Program Increment planning together and using value stream mapping can foster alignment.
• Competing priorities - Leadership must be engaged to balance strategic objectives and make trade-offs clear.
• Lost productivity initially - Teams may seem less productive during transition. Look longer-term and provide support.

Conclusion

The challenges facing modern healthcare facilities are immense. Antiquated technologies, constant regulatory changes, staff shortages, and patient safety concerns threaten the quality of care and competitive viability. By adopting the Scaled Agile Framework, healthcare organizations can build the capacity to rapidly innovate, improve, and adapt. SAFe's principles, structure, and practices enable healthcare systems to continuously improve and address pressing needs far faster than traditional models. With SAFe, healthcare facilities can deliver higher-quality care more efficiently while also keeping staff engaged and retaining talent. To thrive in today's environment, healthcare needs the urgency and agility SAFe provides.