Saving Lives Using Scrum: How to maximize social impact and minimize fundraising stress.

A leading expert has said that historians may look back on human progress and draw a sharp line designating “before Scrum” and “after Scrum.” 

This is the first article in a two-part series from my perspective as the former CEO and Founder of Hope Xchange Nonprofit, before I was aware of Agile/Scrum, and shares with you a sadly missed opportunity to save lives and improve mental health outcomes for one of our most vulnerable populations, LGBTQIA youth diagnosed with bipolar disorder who are at the highest risk for suicide.

The second article is from my perspective of a now Certified Scrum Master (CSM), and shares my vision of how nonprofit organizations (NPOs) can implement Agile/Scrum using a bottoms-up, programatic approach to demonstrate its business value (i.e., to more easily sell it in-house and to your Board) and how it can truly make a dramatic difference.

A Retrospective Lesson for Nonprofit Teams

I share this lesson as I would love nothing more than for this urgently-needed HOPE for LGBTQIA program to see the light of day. For me, there is simply nothing more important than saving lives. Nothing.

I also do so because I firmly believe that this program would already exist if we had used an Agile/Scrum rather than traditional waterfall project management approach. Not only could we have gotten the program launched (deployed in iterative increments), but also delivered a more client-centered implementation in half the time and with half the fundraising effort. 

Before I dive into the why and how, for those who may be new to Agile and Scrum, let me first provide a brief primer with a nonprofit spin for context, as well as some additional reading recommendations for those who would like to dig deeper.

Why Adopt an Agile Mindset and Scrum Framework?

Easily the most insightful and practical business book I have read this year is SCRUM: The Art of Doing Twice the Work in Half the Time by Jeff Sutherland, co-creator of Scrum, and J.J. Sutherland. (Disclaimer: If you’re like me and like to get shit done but also have a balanced life, this is not a book you skim, but one you study. You grab a highlighter or two and, if you’re like me, you not only highlight the golden nuggets littered throughout but put exclamation points and smiley faces in the margins!) 

I was intrigued by Sutherland's proclamation that Scrum doesn’t have to be confined to for-profit businesses. It is universally applicable as it both accelerates human effort and innovates social good. This is not a heady theoretical discussion as he has seen first-hand how this lightweight framework has been used to improve some of the thorniest problems with which society is grappling: improving our failing education system, lifting people out of poverty, revolutionizing the way government is run, delivering vaccines to endangered children and eliminating hunger.

What if there was a faster way to solve humanity’s problems that nonprofits are courageously combatting with teams often fueled primarily by compassion? Can nonprofits be more agile and more quickly adapt to today’s environment of constant change? Can we utilize Scrum to solve society’s increasingly complex problems faster, innovating social good with less fundraising effort?

The Answer is Yes.

Agile dates back to 2001 and has its roots in software development. A team of 17 leaders came together to write what has become known as the Agile Manifesto. Why are so many organizations across a vast array of industries now adopting Agile? Look no further than the 13th Annual State of Agile Report for the benefits companies are reaping, including a 63% increase in delivery speed / time to market, 64% increase in team morale and 52% reduction in product risk.

Ben Battaglia puts a nonprofit spin on the Manifesto in his post, Why Nonprofit Teams Need Agile, (as well as sharing a convincing case for why NPOs should adopt Scrum). While there is value in the four items on the right, the bolded items on the left are valued more.

Forward-thinking NPOs are now starting to depend on Agile practices to maximize the impact of limited resources and to stay flexible and innovative with both program and fundraising initiatives.

Scrum is the most widely-used framework to put these Agile values into practice, with 72% of respondents to the 13th State of the Agile survey practicing Scrum (or a hybrid). It derives its name from the game of rugby and refers to the way a team comes together to move a ball down the field. As Sutherland states, in Scrum, "careful alignment, unity of purpose, and clarity of goal come together."

Would your nonprofit leadership seize the opportunity to achieve its mission faster and create an even greater impact faster? If the answer is yes, I highly recommend this free webinar, Why Use Scrum: How to Double the Outcomes of Your Nonprofit in Half the Time, hosted by Avi Schneier, Scrum, Inc. and Diane H. Leonard, Agile in Nonprofits.

And, rather than get into a lengthy explanation of how Scrum works, I will show you by how, we would have leveraged this approach to launch our HOPE for LGBTQIA program.

The Hope Time Machine

I invite you to go back in time with me in the “Hope Time Machine.” On this journey, you will meet Hope Xchange, understand why this program was (and still is) urgently needed, and how this program could have seen the light of day and pulled gay youth with bipolar disorder out of the darkness had we used Agile/Scrum. (Note: our website has been temporarily republished on a different free domain name for the purposes of this retrospective article and will be taken off-line shortly. Please excuse any broken links, particularly those related to donations).

Hope Xchange was the only nonprofit dedicated to preventing suicide and improving mental health outcomes in the bipolar community. Next year, more than 50,000 Americans will die of suicide. Half of them will have bipolar disorder. As a “front-line” organization, our mission was focused primarily on directly helping those affected through 1:1 interactions and mentorship.

In Demi Lovato’s latest release, Anyone, she asks why no one listened. At Hope Xchange, we listened. Our early intervention, compassion-driven programs reached those who were struggling with mental illness wherever and whenever they needed us most.

We knew how to save lives and heal with hope through our HOPE for Bipolars peer mentoring program. We knew how to help parents better understand and cope with youth diagnosed with bipolar disorder with our HOPE for Bipolar Loved Ones program.

We knew how to advocate in our increasingly uncaring world littered with road blocks and red tape to ensure access to the treatment and care needed for mental wellness and recovery with our mental health advocacy program.

We knew dipping into our HOPE Emergency Fund made the difference in someone being able to afford an Uber to get to a doctor’s appointment or pay a cell phone bill so peer mentoring could continue. And, we did all this with a team of dedicated volunteers who cared a hell of a lot. 

But then we heard a loud call to action from a most vulnerable, totally under-served population at the highest-risk for suicide: LGBTQIA youth diagnosed with bipolar disorder. And, after doing our homework, we knew that our current programs were not the complete solution. We sorted out what would work and it was a big program with a big price tag which would require a big team effort and a big fundraising push.

Suicide is now the leading cause of death in the LGBTQIA community, with this group making up 30% of all youth suicide. According to The Trevor project, the rate of suicide attempts is four times greater for LGB youth and two times greater for questioning youth than that of straight youth; and, nearly 50% of young transgender people have seriously thought about taking their own lives, with 25% attempting suicide.

Of those who die by suicide in this country, 90% have an untreated mental illness. NAMI reports that LGBT individuals are almost three times more likely than others to experience a mental health condition. And, due to prejudice and other biases, many experience more negative mental health outcomes.

While there are resources available to help gay teens and young adults, including the It Gets Better campaign and The Trevor Project, there is no solution specifically tailored to those who are also struggling with a mental illness.

To stop LGBTQIA suicide, we must provide both crisis intervention and sustained mental health support on the "front line." And, we must do so where youth are reaching out for help, online, and do so in a caring, nonjudgemental manner.

Building a virtual safe space where gay youth who are struggling can log into a password-protected site via a Mobile app/tablet/laptop and interact with their own community who are experiencing the same struggle can not only empower them but also lift their peers up. In such an environment, they may also be more willing to reach out for help when in crisis and to request a (1:1) peer mentor, as well as mental health advocacy assistance, for both caring and life-sustaining support.

For more on mental health issues in the gay community, why our youth are not reaching out for help and how to address disparities in care, see Hope Xchange's blog post.

Perhaps nowhere is the need for this program more urgent than in the transgender youth community where suicide rates and attempts are staggering as this population is so grossly underserved, discriminated against and victimized. To read more, please see my LinkedIn article.

Back to the big program with the big price tag? A first-of-its-kind virtual password-protected safe space, HOPE for LGBTQIA, that we believed, based on our research and our mentoring experience, must include the following functionality:

• live chat with immediate access to a therapist (if deemed necessary by a trained Hope Xchange mentor diagnosed with bipolar disorder),
• option to email questions to our LGBTQIA mentoring team, to request a LGBTQIA peer mentor or one of our mental health advocates, 
• mobile app with geo-locate functionality (latter, so if police need to be called because of imminent danger, the exact location could be immediately provided, i.e., if about to jump of a bridge, we would know exactly what bridge),
• social networking and messaging, and
• support center with links to educational and advocacy resources.

So, where did we go wrong? We brought in a dedicated volunteer project manager as we knew we needed to focus, one of the five Scrum values. (Our team already lived the other four Scrum values: courage, commitment, openness and respect). Then we made what would prove to be a crucial misstep. Despite an inordinate amount of heart-driven effort that I am so incredibly proud our team put forth, we used the traditional waterfall project management method. Sometimes such detailed project plans set unrealistic expectations, goals and deadlines and, in Sutherland's prophetic words, are "always always wrong."

Instead of moving the ball down the field, play-by-play, we went for the touchdown. Not only did we lose the game, we lost our way. Our team's morale took the nose dive of all nose dives, our fundraising goal was far too unrealistic, and the worst part, our potentially life-saving program did not see the light of day. It drove Hope Xchange right into the ground.

But, more importantly, how could we have gotten it right? Rather than fundraise to build the entire solution — and risk everything on that effort succeeding — we could have leveraged the Agile/Scrum approach, building one iterative program increment at a time in five back-to-back, two-week sprints with five consecutive and more realistic fundraising drives to support each Sprint goal.

Time-boxed Sprints, never more than one-calendar month (but, in our case, two weeks would have been sufficient), force delivering incremental "done" products early and often so those you are trying to help do not suffer needlessly by waiting. Unlike traditional waterfall project management, this approach also has built-in realism: defined events and transparent artifacts to focus enthusiasm, ground expectations, minimize risk, and enable critical inspect and adapt cycles.

Built into these iterative cycles are ample opportunities for client feedback so the program can be tailored to give end users exactly what they most want and need, as well as opportunities to collect user testimonials along the way that can then be leveraged in smaller, incremental fundraising drives that are more realistic and attainable.

The product backlog lists the higher-priority (value) items as User Stories, with a realistic number tackled in each Sprint contingent on the capacity of the development team. User Stories can be written from the perspective of the internal stakeholder (in this case, Hope Xchange) or the external stakeholder (gay youth diagnosed with bipolar disorder). An example user story for each follows.

[Internal Stakeholder] User Story: Access to Live Chat

In order to keep a LGBTQIA youth with a bipolar diagnosis in crisis from self-harm, as a suicide-prevention nonprofit we want to provide 24/7 live chat functionality on our website staffed by trained peer mentors.

[External Stakeholder] User Story: Password-Protected Social Network

As a transitioning 16-year old being bullied at school and recently diagnosed with bipolar disorder, I want an online space where I can feel safe and accepted.

Before each Sprint, a Sprint Planning session (time-boxed to maximum of four hours for a two-week Sprint) is held where the team shifts the highest-value User Stories from the Product Backlog into a Sprint Backlog and collaboratively agrees on a Sprint Goal. The what and how is discussed amongst the team: what can be done this Sprint and how will the chosen work get done? Often this work is broken down into manageable tasks that can be tackled in a day, with these tasks written on sticky notes.

Per the Scrum Guide by creators Ken Schwaber and Jeff Sutherland, teams are made up of a Product Owner, Scrum Master and the development team, who are self-organizing and cross-functional, choosing how best to accomplish their work rather than being directed by others outside the team. This model is designed to optimize flexibility, creativity and productivity and has proven itself increasingly effective for complex work.

During the Sprint, 15-minute Daily Scrums are held to share struggles, inspect progress, identify any impediments to development and enable adaption as needed to ensure the Sprint Goal is met. If using sticky notes, for example, tasks are moved from To Do, In Progress, or Done on the Scrum Board. For example, see the image below for an illustrative, albeit oversimplified, Scrum Board shifting the Internal Stakeholder User Story, Access to Live Chat, into the Sprint Backlog.

Because this User Story would have been one of our highest priorities, it would have been pulled into the first Sprint, after a small fundraising push to raise funds for the down payment to the third-party vendor developing the mobile app. That eight-week effort needed to run in parallel with the first four two-week Sprints so we had time to do the integration and testing in the fifth and final Sprint. All the in-house volunteers were equipped to do the required tasks to launch the Live Chat on our website. And, we already had Network for Good fundraising pages and other donation options in place to drive the needed funds for this campaign.

After each Sprint, a Sprint Review meeting (time-boxed to maximum of two hours for a two-week Sprint) is held, with stakeholders also invited, to inspect the program increment, and refine the Product Backlog if needed based on stakeholder and client feedback. Attendees also collaborate on the User Stories, refining as needed, and decide what should be tackled in the next Sprint to optimize program value.

Finally, a Sprint Retrospective meeting (time-boxed to a maximum of two hours for a two-week Sprint) is held with the Scrum Master and development team inspecting itself and creating a plan for productivity improvements that are then carried through to the next Sprint which starts immediately thereafter. Yes, folks we are truly sprinting here but, in our case, lives and mental well-being are at stake!

Hope Xchange Paid Dearly. Looking Into Agile/Scrum Will Cost You Nothing.

We thought we had set ourselves up for success: we had a volunteer development team in place, our website platform already had built-in chat and password-protected member functionality, we used with tremendous success Volunteer Match to recruit the most kind-hearted, compassionate and well-qualified peer mentors as well as an extremely talented marketing and communications team for online fundraising. We also had secured a rock-solid plan from a third-party vendor to build the mobile app with our desired geo-locate functionality.

We were a small yet nimble volunteer-driven nonprofit that had managed to build a national reputation, even garnering the attention of the FDA with a Patient and Caregiver Listening Session. Our team was chock full of passionate sprinters. We could have been sprinting away while the third-party vendor was designing the mobile app piece in parallel, and then done the integration and testing in the final Sprint.

All we needed was a change in approach (Agile/Scrum), white board and sticky notes.

In other words, we had all the bits and pieces to pull this off. We had the requisite foundation but we opted to go for a traditional waterfall project management approach to put all the walls up at once and one huge fundraising push to pay for this large build. We could have built incrementally and paid for one room at a time. And, we paid dearly. Our doors are now closed.

Please look into Agile and Scrum. This, my friends, will cost you nothing.

In the second part of this series, I'll discuss how you can implement Agile/Scrum in your nonprofit using a bottoms-up, incremental approach to demonstrate its business value (i.e., to sell it in-house and to your Board) and how it can make a dramatic difference to those you serve.

Further Reading and Resources

• 4 Agile Startup Practices Empowering Nonprofits, Virtuous Nonprofit Blog Post by Gabe Cooper
• Improving Care through Scrum and Servant Leadership, Blog post by Rich Rinaldi, MBA, CSM
• 4 Advantages of a Nonprofit Having a Scrum Master, Agile In Nonprofits Blog post by Diane H. Leonard, GPC
• Agile Development: Can Combining New Approaches, New Data and New Coalitions Make Development More Effective?, by Katell Le Goulven, United Nation Children’s Fund (UNICEF) https://www.weforum.org/agenda/2015/01/how-to-make-development-organisations-agile-and-effective/
• A wealth of basic knowledge can also be found on Scrum co-creator sites at scrum.org and scrumalliance.org.

Author's personal note of gratitude to Jesse Fewell, leading training and consultant in all things Agile and Scrum and, who I was also fortunate enough to soak up so much wisdom from at the Scrum Alliance in-person training. Jesse, you are inspirational (oh, and a know-it-all :)