A Is for Agile—Or Is It? The “Birth” of Agile Project Management

First There Was Common Sense (C)

I’ll admit—when I was first required to learn a “new” project management methodology, I was less than pleased. In my mind project management = common sense, something every organizational fiend pretty much has in hand. But seeing that the tide was not going my way, I determined to hop the band wagon. (I could always offer sarcastic comments a la mode.)

Come to find out, much to the chagrin of others, Agile methodology training was the most validating thing EVER. I MEAN EVAH EVAH.

First of all, these people embrace a principle that every project manager is wedded to: The art of saying no. Here are a few other things we definitely believe in common:

  • Good project management starts with budget and timeline at top of mind rather than designing the perfect project to build.
  • Specialists, and the team, should determine the best way to achieve a desired outcome rather than the person “in charge”.
  • The product owner (or account manager or marketing manager) is the main spokesperson for the product/project/client.
  • Team members can participate in multiple sprints related to multiple projects.
  • Scrum is not the only Agile way to manage projects.
  • More people can be involved than the product/project owner, scrum master, and scrum team—in Scrum they are called the technical analyst, the business analyst, and the functional analyst.

Agile training was like nirvana for geeks experienced in real-life management. (Shout out to the Agile Dad company whose foundations training in Agile is outstanding.)

Agile Helps With Hang-Ups Project Managers Face

Project management can get hung up on all sorts of stuff and Agile methodologies do offer some common-sense ways to cut through the noise. Here are some examples:

Processes & Checklists

As a certified PMP, I can attest to the number of processes attributed to “traditional” project management.* They frequently involve lists and lists of lists. Agile posits that if something has been in a backlog forever without getting done, maybe it should just be removed from that backlog, ‘cause how important is it really?

Agile also suggests making processes work for you. If your team likes a process that is less Agile-based and more team-based, as in makes more sense to the team as a way to do things, then your team’s ideas should be prioritized over codified processes. We value people over processes. (Find this in the 12 principles of the original Agile Manifesto.)

Deadlines

Deadlines can create all sorts of stressors, particularly if you are working with a difficult sponsor who refuses to stay in scope. I have worked with numerous stakeholders that are impulse driven. They personally function much better at the last minute. Unfortunately, I have never seen anything come about through this method that couldn’t be done during reasonable work hours with proper planning. (The theater is rife with this sort of mismanagement.)

Unreasonable hours and expectations also lead to burnout and dissatisfaction. Simply put, the stakeholder’s need for a high rarely results in a better functioning or higher quality product. Production under these methods also frequently leads to a lot of time and resource waste, because impulsive decisions beget fractured vision and lower quality work.

Agile suggests literally completing the simplest foundation for the product or service first that can reasonably be presented and then adding to it over upcoming periods. While this may take the wind out of some ego-sails (who shouldn’t be managing the project anyway), it will result in a higher quality product built through sustainable practices.

Pop Art Exhibit at SFMOMA

Aside: In a recent visit to the San Francisco Museum of Modern Art, I was reminded that the pop-culture artists subscribed to a similar theory—rather than wear their valued selves out as a commodity, these big names started studios where they delegated the production of their work (this might be likened to automation in Agile).

The SFMOMA’s curator summarized it thus:

Such arrangements shifted the emphasis from the creators to the means of production and provoked a dialogue about the nature of art and its position within American culture.^

So did the Agile management philosophies question the traditional project management school of thought.

Scoping & Complexity

Any and all estimates are guestimates. You can scope a project down to the very tiniest details, but there are so many variables that scoping can be truly a time suck. In the particular corners of Agile I explored, the practitioners recommended what they called story points (features or tasks scored by points). The tasks or features could be measured through likening T-shirt sizes to tasks or estimating complexity through planning poker.

I say, just straight up, rate tasks by complexity, which could be defined by:

  • number of entities you engage with,
  • difficulty of task,
  • skill-level, and
  • the like.**

It may be a hard concept for some team members to grasp as it’s a method of taking abstract or unknown quantities and quantifying them, but I believe everyone can learn it to some extent. (And grappling with playing poker cards based on the Fibonacci sequence, which on the cards go up to 400 pts, can give you a brain fart on an equivalent scale.)

Complexity scoring is also a guestimate, just like every other measure of scoping. There is no perfect equation; HOWEVER, if you have a project manager who has worked with a team for awhile, her gut guesses will most likely ring true. (Or maybe just mine have over the last year or two.) This is because the person engaging with the team’s actual work on a regular basis will have a good understanding of team capabilities and work that can be accomplished.

Stakeholder Engagement

Stakeholder engagement is really so very individuated per product and project, it’s almost impossible to quantify. Agile tries to simplify it by having one product owner who is the speaker for the stakeholders or at most a product owner assisted by analysts. Agile also makes some recommendations for project delivery: Must-haves and then should-haves followed by could-haves and would-likes (MoSCoW acronym as delivered by those Agile Dad peeps).

Personally, I find that getting the foundations of a project done and then delivering something desired (but probably unnecessary) is the key to most stakeholders’ hearts. Appease the revenue makers, but then deliver some frosting on top—find a political goldmine that’s relatively simple and make good on that.

While we (project managers) can’t be the heroes, magically rescuing our stakeholders from bad situations they find themselves in, we can still make ourselves look good if we manage it right. Substance delivered with a little style…

Power to the Vocab

The most fabulous thing about Agile is being able to explain the methodologies to other people. Somehow the vocabulary impresses people. You could have run multiple amazing projects and accomplished feats not truly understood, but until you can also spout industry vocab, you will always be second place.

Agile: I don not think that word means what you think it means...

True Agile aficionados may claim that Agile was born at Snowbird in Utah with the release of the Agile Manifesto in 2001,^^ but the rest of us know that before the alphabet (as we know it)  was introduced, other systems and processes have been continuously evolving. (Let me tell you sometime about management processes in the theater. I swear I learned everything I know from working in the theater.)

I do believe that everyone can find significant value in formal training in Agile methodologies, but I also know that practical common sense is an undervalued commodity in business today. And don’t forget the layer that experience adds to the mix. All the training in the world can’t compete with real life experience and/or familiarity with the type of work being done.

So, A may be for Agile and B for its Birth, but C is most definitely for Common Sense.

 

*Quotes courtesy of the fact that while there is a codified project management philosophy, many of us use combinations of common sense processes that might be classified as the old school way to manage projects, but which are really processes streamlined through experience that use techniques from the whatever-works-best school of thought.
^Taken from curatorial notes at SFMOMA about the pop art exhibit. Feel free to contact me if you want a photo of the text as I took a picture of the exhibit description on the wall!
**Complexity scores were something I learned about via a project management team in the healthcare organization I work in. They are also a measure of common sense. For example, if you are at the grocery store looking for the shortest line, making a judgement based on which line appears to be moving fastest ain’t going to cut it. The interaction between cashier and customer generally takes longer than actually scanning merchandise. Although, really, even self-check out can take just as long…
What’s Up With That: Why You Always Seem to Choose the Slowest Line https://www.wired.com/2014/07/whats-up-with-the-other-line-is-always-faster/ via @WIRED
^^https://en.wikipedia.org/wiki/Agile_software_development

The Art of the Content Audit

Originally published on Pulse, University of Utah Health’s intranet, June 12, 2017, this is a case study about a content audit for the Women’s Health Services website at University of Utah Health.

Content, if you haven’t noticed, is a complex beast. For example, we spend a lot of time focusing on good content, what it is, where we get it from, and how we deploy it. But we spend less time than we ought on considering the outcome we want from the content we curate and post.

A content audit is a tool that allows us to review the content we have and take its pulse. It’s a great benchmarking tool with which to craft and test which content pieces are performing the best and where there might be gaps in the content. If there is important content missing that would benefit our users, a content audit is likely to reveal this.

Goals​

For our content audits [at University of Utah Health], we have identified these specific goals:

  • Reduce number of website pages with thin or low-performing content
  • Combine pages with thin content OR flesh these pages out, depending on website goals
  • Archive pages that are out of date, no longer applicable, or very low performing
  • Identify areas where we might want to add content

Where to Start

An audit can be as in depth or concise as the site necessitates. You can also tailor the information you collect in the audit to fit your overall site goals. The typical content audit might include these items:

  • Analytics
    • Page views
    • Time on page
    • Bounce Rate
  • SEO factors
    • Meta title & length
    • Meta description & length
    • H1 heading
    • H2 heading
    • Subtitles: additional use?
    • Word count
  • Content type (video, form, text, etc.)
  • Contact information
  • Images
    • Type of image
    • Image alt text
  • Affiliated documents
  • Duplicate content
  • Last modified

We determined to add in these additional audit points as particularly applicable to our patient-facing sites:

  • Call to action
  • Referring physician link included?
  • Specialist list included?
  • Related MBM specialty?
  • Affiliated service line
  • Affiliated marketing campaign
  • Affiliated research or other programs
  • Any additional content
    • Patient experience story included?
    • Health Feed/Scope inclusion? [U of U Health blog and podcast respectively]
    • Related tags to Health Feed/Scope
    • Clinical trials inclusion?
    • Patient education?
    • Vendor library content included?

Once you have outlined what you would like to inventory, you can begin to collect the data.* Take a look at the content inventory for our women’s health services website:

Redacted content audit women's health
What the full content audit looks like for women’s health services; please forgive the omission of analytics data!

Now that we’ve inventoried the content (rather exhaustively), we can examine how each piece is performing and make some assumptions as to whether the page should be kept, revised, or removed.

Example: Content About Midwives

Previously, we had two website pages about midwives on our women’s health services site.​ The page /what-is-a-certified-nurse-midwife.php receives far fewer page views than the /midwives.php page. However, this is not necessarily a bad thing, particularly as the time on page is over 1 minute. That’s a lot of time in our virtual ‘verse. So the content is important to those who are looking at it, even though the page doesn’t receive a lot of traffic.

In this case rather than get rid of the content, we are going to optimize it by moving it onto a page with more visibility, in this case /midwives.php. This should increase the main midwife page’s value while indicating to Google that we have both updated our site and checked our content for accuracy. (When search engines crawl websites they look for a number of factors that might tell the importance of the webpage. One of these factors is the date the page was last modified.)​

Webpage featuring content about midwifery (or midwives) on University of Utah Health’s women’s services website

The sticky navigation (a navigation bar stays with you as you scroll down the page) allows readers to access all the content about midwives and our services without leaving this page for another. Thus we’ve consolidated a low-performing, but important, page into the content with which it fits, letting the search engine know that we’ve updated the content by modifying the page, while keeping content that is clearly valuable for our readers.

End Objective: Increase Quality of Page Visits

This is just one page treatment out of many options that we might use when it comes to structuring content. All of the content audit goals lead to the most important objective of our content strategy: increase not just traffic to the website, but the quality of the traffic; namely, we want this content to show up for the right people at the right time in the right place.

Where Do We Go Next?

What happens after an audit? We look at the recommendations we’ve made after reviewing each page and determine who is responsible for whatever action needs to be taken. We also track the progress of the content updates.​

Ideally, we apply this process to all our websites on a regular basis, ensuring that our content remains up to date and within best practices.

And that, my friends, is the short of it (the long is all wrapped up in all that data and detail gathering). In the next few months, we’ll keep checking in on this content to see how the website data analytics change (usually we must allow about six months to get a relatively accurate picture of how the content is performing—performance has leveled out by then after the significant changes have been made to the site by then).

*I’m afraid I’ve had to redact the data here; I’m sure you understand!.

The Business Proposition: Keeping the Bird’s Eye View

Healthcare’s Miserable Business Model

Any of you familiar with The Innovator’s Prescription by Clayton Christensen? It’s a book that nails healthcare’s major problems right where it hurts (I leave the anatomical reference to your imagination)—and it starts at the top. Healthcare is an industry forged of multiple business models with more power players attached to it than mafia family heads in New York, Chicago, and Vegas collectively.

Ever sat in a meeting with a client and realized their goals are completely different than yours? Not only that, but it’s like they expect you to read their mind and magically intuit what it is they need and why they hate your solutions! It’s a communications nightmare!

There might have been a situation not too long ago where I sat in a meeting trying to understand why we were coddling a new provider so much. Why were we privileging them over our all the others who must abide by standard best practices that are modeled on protecting the institution’s best interests? Turns out that particular service has had trouble recruiting and keeping this particular type of specialist, forcing us to have to cede, enacting practices that aren’t necessarily optimal for our site users. (I am keeping this deliberately vague to protect the agitator.)

Why does it have to be that way? Lemme’ tell you why: We’re not all playing on the same field.

Nobody’s on the Same Page!

Nobody’s on the same page. Yeah, I just wrote that again ’cause I know you all relate. And I’m not just talking about seeing eye to eye and having things in common and striving for a company culture of unity. I’m talking about top-down bottom’s-up confusion built on multiple premises that we stupidly expect to play nice together.

If there’s anything that I’ve learned over and over and over again in 2017, it’s this: a siloed* department will not stand, or more importantly, will not bring about accolades, accomplishment, or awards-except on an insular individual-centric basis.

So we need to start keeping the bird’s eye view in mind, ’cause if we don’t rise above our siloes, we will continue to kick against the pricks, as it were.^ We need to listen and determine what our colleagues’ endgames are. Only this will help us craft more effective marketing plans and content strategies.

Models of Three, Leave Them Be

That classic mnemonic^^ could really be “models of three, leave them be,” as in don’t try and smush together things that don’t go together. But let me clarify that for you. As defined by Christensen in his prescription, healthcare is made up of three businesses:

1. Solution shops
2. Value-adding business processes
3. Facilitated business networks

We are perhaps most familiar with the solution shop: an entity diagnosing and providing solutions hoping to effect an improved outcome. That pretty much defines the most familiar healthcare business model we know. Providers see patients, compile data, and make a recommendation that we then pay for: fee for service.

The value adding model combines resources and people in a process to output a better product. A restaurant sources food, brings in a chef, and puts out extraordinary (we hope) food selections for us to choose from. In some cases this can be repetitive work, enabling optimization processes that can reduce overhead costs.

Hospitals and clinics bring people and resources together to provide care at lower prices than individual practices can often do. This can evolve into a fixed price system, embedded in equipment and processes.

And business networks. We are familiar with these via social networks, where we get recommendations from friends, keep in touch with peeps, and occasionally buy and sell things. This model offers a network that makes this possible. In healthcare this can be seen in professional business ties to treat chronic illnesses in a more effective manner or pass on knowledge to general practitioners (telehealth models).

The Bird’s Eye View

With three different business models, no wonder no one is on the same page!! No wonder doctors and subject matter experts can’t understand why we make the recommendations we do! They have almost completely different needs! Are they even operating under the same financial model that we are? In many healthcare organizations (or maybe I just mean mine), no!

For example, are healthcare providers individually reimbursed by health insurance separately per patient they bring in making it more effective to emphasize their personal practices? Or is there a blanket payment for sum total patients for the entire service area?

Almost every single group of providers I meet with has different needs. Some need to make money from out of pocket procedures, some need to recruit and retain providers/faculty, some are driven to separate out their own “practice” from the institution due to payment/reimbursement models that will benefit them. And yet others need to reduce hospital readmissions to maintain reimbursements or be penalized.

Lemme’ tell you, it may take awhile to get the lay of the land, but when you catch that bird’s eye view, it really starts to come into focus, albeit a little at a time.

The Proposition

(Remember There Is Always More to the Situation Than Meets the Eye)

So where does that leave us professionals? Hopefully not on the couch at 2 am watching Are You Being Served and trying to think of how to make everybody happy. Because the reality is, nobody’s happy, and nobody’s going to be happy, as long as we continue to operate in siloes. Let me adjust that sentence. The people who are happiest tend to be at the top of the heap in their silo OR the people who actively choose to take the best from their situation and squeeze lemon juice onto their salads.**

What I’m trying to say, in this delightfully amusing (I hope) yet informative post, is that if the confusion starts at the top, we need to realize that and include that in our work satisfaction calculations. What I’m proposing here colleagues, is that we recognize and validate others in their own business models.

We need to figure out what their end goals are before we can effectively diagnose and make recommendations for effective marketing, management, or content strategies. We need to keep the bird’s-eye view in mind.

*Btw, siloed is actually a verb-I just double checked. Silo can be either a noun, a verb, or an adjective referencing isolation, to isolate, or isolated.
^This is a Biblical reference, and a disgusting one. I will leave it up to you to suss out the hairy details however.
^^You know, after that mnemonic about poison ivy “leaves of three, leave them be…”; a mnemonic, might I add, that was no help when I ventured in to some stinging nettle across the pond. Did our wilderness trainers never consider that we might venture farther abroad than our own back woods? Don’t answer that.
**We are sooooooo tired of lemonade. Unless it’s pink. Then I could be persuaded. What about shocking pink? (Elsa Schiaparelli’s signature color and one I came to appreciate when working for a costume designer whose love for it was almost as great as mine has now become. There were sequined dresses.)