Implementation of Agile in health care: Methodology for a multi-site home hospital accelerator

Abstract

Abstract Background The diffusion of innovation in health care is sluggish. Evidence-based care models and interventions take years to reach patients. We believe the health care community could deliver innovation to the bedside faster if it followed other sectors by employing an organizational framework for efficiently accomplishing work. Home hospital is an example of sluggish diffusion. This model provides hospital-level care in a patient’s home instead of in a traditional hospital with equal or better outcomes. Home hospital uptake has steadily grown during the COVID-19 pandemic, yet barriers to launch remain for health care organizations, including access to expertise and implementation tools. The Home Hospital Early Adopters Accelerator was created to bring together a network of health care organizations to develop tools necessary for program implementation. Methods The Accelerator used the Agile framework known as Scrum to rapidly coordinate work across many different specialized skill sets and blend individuals who had no experience with one another into efficient teams. Its goal was to take 40 weeks to develop 20 “knowledge products,” or tools critical to the development of a home hospital program such as workflows, inclusion criteria, and protocols. We conducted a mixed methods evaluation of the Accelerator’s implementation, measuring teams’ productivity and experience. Results Eighteen health care organizations participated in the Accelerator to produce the expected 20 knowledge products in only 32 working weeks, a 20% reduction in time. Nearly all (97.4%) participants agreed or strongly agreed the Scrum teams worked well together, and 96.8% felt the teams produced a high-quality product. Participants consistently remarked that the Scrum team developed products much faster than their respective organizational teams. The Accelerator was not a panacea: it was challenging for some participants to become familiar with the Scrum framework and some participants struggled with balancing participation in the Accelerator with their job duties. Conclusions Implementation of an agile-based accelerator that joined disparate health care organizations into teams equipped to create knowledge products for home hospital proved both efficient and effective. We demonstrate that implementing an organizational framework to accomplish work is a valuable approach that may be transformative for the sector.

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