You may remember Fred Brooks’ Mythical Man Month – a classic book on software engineering of the early seventies. He introduced the idea software development by a surgical team with a highly skilled code smith – the surgeon – who cut the code surrounded by assistants who facilitated the surgeon. Back then the size and complexity a typical program could be handled by individuals but as systems grew larger many surgical teams were required. Overall efficiency was limited by the inter dependencies and communication between teams and so the surgical team fell out of fashion.
A recent encounter with my finger and our domestic short hair tabby gave me the opportunity to witness how today’s surgical teams work. It struck me how agile their approach to providing clinical care is. Their daily ‘scrums’ begins with walking the wards to assess the previous day’s work and the new cases for theatre that day. Speed is important so nursing staff will have removed impediments like dressing’s ready for the consultants’ assessment. The team including anaesthetists, surgeons and chief consultant move from patient to patient like the development team move from story to story in the daily standup. The patient tells their story and the team listen and assess. Wounds are tested – stressed and checked.
The definition of done for the surgical team is approval for patient discharge. Each of their sprints lasts just one day as each patient’s story is reviewed, planned and committed to a sprint. Backlog prioritisation takes place during the scrum with patients being told the news. Bedside whiteboard recording the NBM – nil by mouth decision for theatre that day. Bedside charts record the tasks and the result of tests performed.
While there are clear parallels between the flow of patients and the development of software, I was struck by the efficiency and agility of the clinical teams. Daily sprints with daily ceremonies are demanding. Theatre staff work shifts so the day is much longer than is usual for software development. Okay, in both cases many long nighters have been the norm to meet a challenging emergency.
With regional anaesthetic it’s now possible to witness the surgical team at work – from the anaesthetist’s preparation to being wheeled back to the ward by another surgeon as the porters have gone home. Still one lead surgeon cutting the code with support from others. And technology plays a crucial supporting role with ultrasound to show the precise location where the nerves need cooking to searching for X-rays stored in the cloud.
Agility is live and well in a hospital near you.
My gratitude and admiration to the staff at the Queen Victoria Hospital in East Grinstead and for demonstrating how super-agilility works with precision. This is not just on the main wards – the efficiency extends to out patients with automated self service check-in kiosks that are simple to use and direct patients to the correct waiting area with ease.
Now I just wonder where my data will end up… See WIRED Nov 2014.