Applying Agile principles in the Healthcare industry to improve the quality of care

This research paper explores the application of Agile principles in the healthcare industry to improve the quality of care. It discusses the benefits and challenges of implementing Agile in healthcare organizations and highlights the need for agile project management in healthcare. The paper also includes a literature review of relevant studies on Agile in healthcare.

Running head: HEALTHCARE
Healthcare
Name of the Student
Name of the University
Author Note

1HEALTHCARE
Topic Title: Applying Agile principles in the Healthcare industry to improve the quality of care.
Introduction
One of the chief priorities of the heath care industry is to focus on the quality of care
provided to the healthcare service users. The chief aim of the healthcare industry is to ensure
positive health outcomes of the patients. Using the agile methodology in the healthcare industry
has the potential to optimize the process as well as needs for treatments that can be delivered
both quickly as well as efficient software based heritage of agile, differentiate itself from the lean
software based heritage, which has its origin in the manufacturing industry. The term agile can
be defined as team based iterative software development methodology. The agile framework can
be defined as a model that contains process groups that run in a logical order within a defined
period of time. Pharmaceuticals are suffering from large price hikes when it comes to vital drugs.
According to a recent survey, the average spending of drugs has got increase by 456.5 billion
dollar in the year 2018 (Banos et al., 2015). When it comes to the patients over 60, they are
found to require increased healthcare under tight budget restrictions.
Due to increasing cost of products, healthcare organizations are finding it highly difficult
to provide high quality services to the healthcare service users. Along with this, . Currently, not
all patients can afford medical treatment due to low income or insurance policies and, therefore,
affect the overall state of the economy of the nation. However, one cannot ignore the fact that it
is the right of all the citizens to get easy access to the healthcare departments on time. From
several researchers, it has been found that the agile principles if implemented in the healthcare
management system have the potentiality to deal with the above mentioned issues. The chief aim
behind the development of the agile framework includes minimizing the enormous time lag

2HEALTHCARE
between the business requirements and the delivery of the technology to answer the requirements
of the consumers. Considering the fact that majority of the developed countries like U.S. are
suffering from gaining population. The need of healthcare facility has got increased to a great
extent. According to a survey, by the year 2020, the heath care needs in developed countries like
Australia UK an US will get increased by 17.2 percent. Health care organizations are facing
issues to cope up with the rapidly increasing heath care needs. The increasing demand of heath
care service within a affordable price range is making it difficult for organizations to provide
high quality heath care service to patients irrespective of their financial status The 4 chief values
of the agile framework that can be implemented in the contemporary healthcare system include,
Individuals and Interactions Over Processes and Tools, Working Software Over Comprehensive
Documentation, Customer Collaboration Over Contract Negotiation and Responding to Change
Over Following a Plan. The Agile methodology can optimize the healthcare process for
treatment to be provided to the patients on time. The managers of health care organization are
working on creating, updating as well as constantly improving the processes associated with
healthcare facilities.
Problem statement and justification
The chief issues faced by the contemporary healthcare organization include lack of financial
capacity to cope up with the enhanced healthcare needs, it management issues, lack of
appropriate number of skilled staffs and other human resource related issues. Providers are
facing enhanced regulatory changes, coding updates, increased costs, secuirity issues as well as
disruptive technology. One of the major frameworks that have the potential to solve the above
mentioned issues is the Agile management system.

3HEALTHCARE
In order to create, update as well as continuously improve the healthcare processes, the top
priorities of the healthcare service providers inclide providing appropriate levels of patient care
and patient care quality, as well as learning about patient and health plan member populations
and optimizing costs for health care delivery. Considering the act that the mentioned proprieties
are highly focused on the process efficiencies as well as patient health management outcomes,
the health care managers are learning and implementing agile methodologies that is focused on
understanding as well as improving the value of the consumers. In case of the healthcare service,
this indicates focusing on both the aspects of the health care service users as well as heath care
service providers.
When it comes to the contemporary system, a good number of issues can be detected.
One of the chief issues in the contemporary healthcare system includes IT management issues.
While the information technology has proven to be highly beneficial to the healthcare industry, it
has also raised issues of security as well as regulatory compliance to the healthcare service users
protection laws like the accountability act and the health insurance portability act. According to
Sinthamrongruk, Dahal & Yanchinda, (2018), in the year 2017, the largest number of data
breaches had taken place within health services that is comprised of 39 percent of all breaches.
One of the chief healthcare issues faced by the healthcare mangers includes offering affordable
healthcare rates despite the rising costs of the pharmaceuticals, healthcare spending as well as
insurance premium. Enhancement in healthcare also allows for larger gaining population.
Considering the fact that the number of heath care service users above the age 60 years is
increasing with time, it is becoming highly difficult for the healthcare service providers to
provide affordable healthcare services to the huge number of service users within a highly
limited number of cost.

4HEALTHCARE
Another major issues faced by health care service provider includes regulatory issues in
healthcare. The changing coding has introduced a complex issue that needs extensive as well as
possible costly training to upgrade the heath care service providers.
In order to deal with the above mentioned issues, it is highly crucial for healthcare
mangers to implement agile principles effectively. In this research paper, the researcher aims to
identify, analyse as well as implement how the agile principles of management can enhance the
service provided by healthcare homes. The agile model is basically a model that contains
process groups to run in a logical order within a definite period of time also known as “iteration”
along with a feedback loop to the consumer for validation of the solution. Thus it can be said that
the agile project management is an approach that leverages this iterative model for defining as
well a controlling the project work. When it comes to the principles of agile, it has moved
beyond their origin in efficient software development amongst the teams along with deeper into
business workflow management consumer responsiveness as well as productivity and this true
especially in the case of healthcare organizations.
The agile project management offers practices as well as tools that can be implemented by the
hospital leaders for increasing the quality of the care along with optimizing processes in the
healthcare home. In the mentioned framework, the organization does not require to know every
operation from the core. It just needs to have a general idea of where it wants to go and how it
wants to get there. Agile Project Management enables a healthcare organization to hypothesize
solutions, develop as well as test them, make adjustments, and continue forward in an iterative
manner until it achieves the desired outcome of improvement.

5HEALTHCARE
While one of the major strengths of the research paper is that a good number of authentic
academic literatures will be reviewed in order to collect data, a major limitation of the research
paper includes lack of primary data. In future researchers, both primary s well as secondary data
will be collected in order to enhance the authenticity of research paper.
Literature review (1750)
A good number of researchers have been conducted when it comes to the implantation of
agile principles in the healthcare industry. In the following section, a review of literature of
selected academic literatures that are relevant to the research topic has been conducted. The chief
purpose of this literature review is to gain an efficient knowledge of factors related to the
research topic that has already being invented and talked upon. Along with this, the literature
review has also helped the researcher to gain an in-depth insight of the research issue and
evaluate the benefits of the implementation of agile principles in the Healthcare industry to
improve the quality of care.
Tolf et al. 2015 aimed to understand the concept of ‘agile’ and the potential of the medical
(hospital) managers who optimize the design of organizational structures, the processes that fuse
internal efficiency with an external effectiveness. The study uses a methodological approach and
performs an integrative review was through the research database. The study found out that
organizational agility depends on an assumption that environment must be uncertain and highly
unpredictable. The five of the organizational capacities derived were - 1) transient and
transparent inter-organizational links 2.the market sensitivity, the customer focus 3) managerial
support of self-organizing employees 4) The organic responsive and elastic structures 5)
formation of a flexible resource planning for hassle free delivery. The research study portray

6HEALTHCARE
Agile as a “new paradigm” that is following a lean, required lean base development and
complementary approaches to hybrid strategies. The study implies that an agile practice can
incorporated into hospitals in order to devise a good and apt patient management. The study,
although digresses at some point but maintains an overall coherence throughout the paper.
Duffau, Grabiec and Mireille Blay-Fornarino 2017 aimed to move towards an Embedded System
Agile Development, Validation, Challenging Verification and Accreditation. According to the
study, whenever the agile development encounters critical embedded systems - the verification,
the validation, critical embedded systems and the accreditation activities is likely to be impacted.
This study highlight the cardinal challenges to integration ecosystem and the study aims to
handle the critical issues. The study researches in how the approaches are used in research,
development of the healthcare company called AXONIC. The study highlighted an increase in
the testing and the specification of the activities, resulting in associated justifications. The
Approach’s originality lies in fact, in its end-to-end testing of drugs and an automatic production
of documents using the argumentation diagrams. In AXONIC company’ context, which develops
neuro-stimulation systems, different test types are studied by the researcher. This include
acceptance tests, execution bandwidth, by retaining reliable human resources. The Study implies
to enrich ecosystem with automatic test activities. The study implies on an improved
responsiveness to the changes that is necessary to agile development. The conclusion of the
study succeeds at reaching its research aim.
Flood et al., 2015, aimed to study the insights in Global Health Practice with perspective
of an Agile Software Development Movement. Adapting to the design principles along with an
agile software movement, the study proposes a very analogous approach in order to design the
global health programs, which emphasizes on the interface between the concerned research and

7HEALTHCARE
its implementation. According to the research study, the implementation in most of the global
health interventions use a process that is analogous to the waterfall model in traditional software
development (Kramer, 2018). A special emphasis is put on selection of the interventions, which
are guided by a high-level of evidence and then applied to a specific setting. The study concludes
by supporting an analogous framework of global healthcare delivery with the perspective of agile
software. This can resolve some of the persistent tension. An agile global health is critical to
development of health programs that can work on particular populations and communities. The
paper overall, looks out in the new perspectives which are the main strengths of this study.
A study by Lennerz et al., (2016) proposed the incorporation of next generation sequencing
(NGS) in clinical genomics approach for diagnosis of wide range of cancer and hereditary
diseases. Several studies have mentioned the advantage of whole genome sequencing or exome
sequencing in health sector to project enhancement of medication and therapies among people
with low socioeconomic status. The researchers introduced the term ‘human pipeline’, to
facilitate next generation sequencing in agile heathcare management, which states enrolment of
the patient followed by current procedural terminology (CPT) initiated by the hospice assistants
and medical practitioners. A cumulative approach, consisting diagnosis by the general physician
and pre-approval from the health insurance policies can anticipate the authorization of next
generation sequencing to be implemented for the patient and can be performed to attain cost-
effectiveness. This will help the patient to overcome higher cost of NGS, and could provide
effective treatment due to subsequent achievement of individual-specific diagnosis. Genuine
reasoning should be provided by health professionals to the insurance company that could merge
the gap between sequencing agencies and patient care. Thereby, sample of the patient’s genome
can be obtained, so that, the data generated by NGS could be incorporated into clinical

8HEALTHCARE
description of the patient, and report can be prepared justifiably. Contribution from all these
abovementioned fields can correlate to bring greater specificity in diagnosis and treatment of the
patient.
Another study by Kannan, Fish & Willet, (2016) suggested ‘Agile Modelling’ as an
essential modulator of electronic health record (EHR) system implemented for enhancement of
resource management. Although, EHR abolishes barrier of manual data entry, crowding of
arbitrary requirements and frequently attributed medication or therapy hampers initial workflow
experience of the interface utility. Such confusions in requirements distort the progress of
clinical care among patients. Removal of such ambiguous entries can be improved by agile
modelling based applications in designing requirements with a greater accuracy. These
modalities include gathering data about patient history, familial background, decision trees,
diagrams representing the health issues, software interface based storyboard, brief description of
similar cases and possible diagrammatic solutions for the case. Inclusion of these parameters can
increase efficiency in management of healthcare among wide range of populations.
Concern for healthcare facilities by determining cost-effectiveness (lean) and addition of
flexibility from the healthcare operatives (agile) can provide solution to the challenges faced by
healthcare administrators (Tolf, 2017). Study suggests that agile can be combined with lean to
achieve long-term benefits in healthcare management. Embracing coping mechanisms, active
participation, open and neutral understanding of the circumstances to better manage the external
factors of healthcare have intrinsic advantage regarding patient care and explore dynamic
possibilities of medical treatments. Effective plans to better manipulate time stringency can lead
to lesser patient waiting period, which creates faster deployment of medical care and decrease
chances of mortality and risk factors among patients. Regulations regarding public healthcare

9HEALTHCARE
policies and peer pressure of the market, promoted healthcare institutions to adapt lean
techniques with agile strategies. Professionals with greater flexibility of working skills,
accommodation of alterations requested by patients, sincere management towards differential
obstacles faced by a patient are addressed as the best suitable alternatives in healthcare territory.
According to Maijala et al., (2018), lean leadership as well as managerial factors can be
considered as an effective way of enhancing the skills and capabilities such as problem solving,
making changes occur, empowering, communicating, coaching, supporting, facilitating, being
democratic, organizational learning, and organizational success, all of which represented middle-
stage or advanced managerial skills and capabilities. In order to conduct the research, a
systematic literature review has been conducted. With the help of electronic data bases namely,
PubMed, PubMed Systematic Review, ABI/INFORM, Business Source Complete, Emerald, JBI,
and Cinahl. Inclusion criteria included (i) a description of Lean management or leadership in
health care, (ii) a reference to Lean thinking, (iii) a peer-reviewed original research article or a
literature review, and (iv) a full text article available in English. Among the 1,754 peer-reviewed
articles identified, nine original articles and three systematic reviews met the inclusion criteria.
McCaffery, Trektere & Ozcan-Top, (2016) stated that, a good number of issues can be detected
when it comes to implementation of agile software for enhancement in the quality of healthcare.
The Agile development methods report to offer solutions within other industries that has the
potential to solve challenges that has been encountered within the medical device industry.
However, there are some concerns with using agile for medical device software development
associated with satisfying the regulatory bodies. In order to conduct the research, the researcher
has implemented literature review as a method of secondary data collection. Along with this,
survey has been conducted in order to conduct the research.

10HEALTHCARE
Jamot & Pettersson, (2016) argued the chief challenges faced by the same. Agile methodologies
has had an enhancing popularity within healthcare software development due to a good umber of
advantages over more traditional waterfall-like methodologies. However, there are still a good
number challenges and uncertainties facing practitioners working with, or wanting to adopt an
agile methodology within the regulated domain. In this researcher has conducted the research
through interviews with a total of 9 practitioners from 5 Sweden-located companies. The
interviews produced a set of 37 challenges, summarized into 10 challenge categories based on
similarity.
Summary analysis and Conclusion
From the above discussion, it can be clearly understood that the Agile framework has the
potentiality to solve the issues associated with the healthcare industry. Agile practice can
incorporated into hospitals in order to devise a good and apt patient management. It has also
been highlighted an increase in the testing and the specification of the activities, resulting in
associated justifications. The Approach’s originality lies in fact, in its end-to-end testing of drugs
and an automatic production of documents using the argumentation diagrams. In AXONIC
company’ context, which develops neuro-stimulation systems, different test types are studied by
the researcher. This includes acceptance tests, execution bandwidth, by retaining reliable human
resources. The Study implies to enrich ecosystem with automatic test activities. However a good
number of challenges associated with agile system has been associated with the saem. However,
with effective strategies the challenges can be eliminated.
Gap in research

11HEALTHCARE
One of the major gaps of the research paper includes lack of primary data collection. Another
major loophole includes lack of data about the strategies that can eradicate the issues associated
with implementation of the Agile framework.

12HEALTHCARE
1. Maijala, R., Eloranta, S., Reunanen, T., & Ikonen, T. S. (2018). Successful
implementation of lean as a managerial principle in health care: a conceptual analysis
from systematic literature review. International journal of technology assessment in
health care, 34(2), 134-146.
2. McCaffery, F., Trektere, K., & Ozcan-Top, O. (2016, June). Agile–Is it Suitable for
Medical Device Software Development?. In International Conference on Software
Process Improvement and Capability Determination (pp. 417-422). Springer, Cham.
3. Jamot, M., & Pettersson, M. (2016). Agile challenges within regulated healthcare
environments.
4. Duffau, C., Grabiec, B., & Blay-Fornarino, M. (2017, October). Towards embedded
system agile development challenging verification, validation and accreditation:
Application in a healthcare company. In 2017 IEEE International Symposium on
Software Reliability Engineering Workshops (ISSREW) (pp. 82-85). IEEE.
5. Flood, D., Chary, A., Austad, K., Diaz, A. K., García, P., Martinez, B., ... & Rohloff, P.
(2016). Insights into global health practice from the agile software development
movement. Global health action, 9(1), 29836.
6. Kramer, M. (2018). Best Practices in Systems Development Lifecycle: An Analyses
Based on the Waterfall Model. Review of Business & Finance Studies, 9(1), 77-84.
7. Tolf, S., Nyström, M. E., Tishelman, C., Brommels, M., & Hansson, J. (2015). Agile, a
guiding principle for health care improvement? International journal of health care
quality assurance, 28(5), 468-493.

13HEALTHCARE
8. Lennerz, J. K., McLaughlin, H. M., Baron, J. M., Rasmussen, D., Shin, M. S., Berners-
Lee, N., ... & Schmahmann, J. D. (2016). Health care infrastructure for financially
sustainable clinical genomics. The Journal of Molecular Diagnostics, 18(5), 697-706.
9. Kannan, V., Fish, J. C., & Willett, D. L. (2016, February). Agile model driven
development of electronic health record-based specialty population registries. In 2016
IEEE-EMBS International Conference on Biomedical and Health Informatics (BHI) (pp.
465-468). IEEE.
10. Tolf, S. (2017). Lean, agile, and lean and agile hospital management: responses to
introducing choice and competition in public health care.
11. Banos, O., Villalonga, C., Garcia, R., Saez, A., Damas, M., Holgado-Terriza, J. A., ... &
Rojas, I. (2015). Design, implementation and validation of a novel open framework for
agile development of mobile health applications. Biomedical engineering online, 14(2),
S6.
12. Sinthamrongruk, T., Dahal, K., & Yanchinda, J. (2018). Heuristic and fuzzy scheduling
synergy with knowledge acquisition of resource selection system development for home
healthcare service. International Journal of Agile Systems and Management, 11(3), 247-
269.