Leveraging scrum in interoperability

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Leveraging scrum in interoperability

Middleware is tricky. It’s extremely technical, solutions require a lot of moving parts, a lot of collaboration and a substantial amount of dependencies across people and technologies. This in itself can lead businesses to want to take a ‘less risky’ approach to developing the solution by managing the projects in a waterfall method. But is it less risky? We at Healthcare Gateway have been leveraging Scrum to develop our interoperability solutions in an agile way for several years now and this is what we have learned.

Creating alignment is key

In our case, we are between systems that provide data and systems that consume data, and these are plentiful within the landscape of the NHS.

Scrum advocates cross functional teams, everyone in the scrum team should have the skills to do all parts of the work required. You cross train each other in specialities and work on removing single points of failure so the team is sustainable. For this concept to truly take hold you need to embrace the agile principle of ‘Business people and developers must work together daily throughout the project’. Soft skills are your superpower! Not all integration projections are built equal and the difference between developing a solution and delivering a solution is in your ability to collaborate and communicate effectively across multiple internal teams and also in our case, across multiple external parties. Creating alignment here is crucial to the successful delivery of a project that meets the customer’s needs. Utilise daily stand-ups, create alignment in your roadmaps across development, product and commercial. Create tribes or design trios to get ahead of the impediments and requirements but most importantly take time to acknowledge when something isn’t working and use those soft skill superpowers to learn and create better collaborative solutions.

Focus on end to end

One of the most important factors in a Product Owners role is to understand what to deliver each sprint that will provide the most customer value. This can sometimes be tricky when developing middleware solutions. “How do you deliver a demonstrable potentially shippable increment each sprint with no front end?” This question arose time and time again not only in our teams but also in my CSM training from teams across the country not only in middleware but also in those using scrum in IT and hardware.

You may not have a front end, but you do have the ability to develop an end to end connection between the two systems you are trying to connect. Start with a basic connection, basic test data, basic security and then iterate. 

Leveraging mock data

One of the biggest challenges for us and our development teams is the vast number of systems we develop interoperability for. This limits our ability to test how our solution for data providers may function across multiple consuming systems with their own specialist eco systems of security protocols, UIs and requirements. Providing your development teams time to build mock systems, mock providers and create a space in which they can test and demonstrate their work provides enough confidence in their solution to continue on while in the interim removes the impediment of access to supplier / source test systems.

Utilising the sprint review

We’ve worked on our sprint review a lot with our teams over the last year, working from home during the pandemic has in some ways helped us innovate and harness our collaboration power more effectively online. We’ve looked more closely at what the scrum guide requirements for sprint reviews are and put what we can in place but it brings us back to the question of “how do you demonstrate middleware solutions in a non-techy way?”

Internal stakeholders can include a wide variety of people from across the business so while the demonstration in an internal sprint review can be more technical, you still want to encourage the Scrum Team to demonstrate an end to end potentially shippable increment covering the technical benefits of the increment in a more user centric way.  The benefit of this is buy in at every stage.  We want our internal teams to be excited about what we are building, we want them to talk about it, question it and feedback.  For this our teams have been using tools like swagger and postman to provide the front end demonstration of data moving from source to target in a digestible way, incrementally demonstrating and explaining the additional functionality that has been added and why.

External stakeholders for us are our partners and end users.  Demonstrating to these stakeholders can sometimes come a little later. This is due to access to test systems, data and moving away from mock to real world testing.  Setting up later demonstrations out of sprint reviews so far has worked for us here, but we are always pushing ourselves to reach that goal of having our end users feedback directly on sprint reviews to further close that feedback loop and decrease our time to market.

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By Zoe McLean, Agile Coach at Healthcare Gateway

Zoe became the Agile Coach for Healthcare Gateway in February of 2021, after working as Scrum Master supporting the development team with agile practices. As Agile Coach, Zoe has been working with the wider business to implement agile methods and increase our overall agility.

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NHSX Technology Funding

funding

NHSX Technology Funding

During the pandemic, we saw a huge increase in digital transformation and the aim is to build on this progress to ensure all health care services have a strong digital foundation moving forward.

The strategy towards technology in health care is to digitise and join up services and transform health care services to increase effectivity and productivity. The NHS Long Term plan has committed to digitising the whole of the NHS by 2024, but there are still a number of trusts that are far away from reaching this goal.

NHSX have published a number of documents which aim to set out what is expected of Integrated Care Systems (ICSs) in order for them to meet the goal of being fully digitised and have connected services. The ‘What Good Looks Like’ framework defines the digital capabilities that are required for safe and efficient care, and enables measurement of digital progress across health and care. The ‘Who Pays for What’ proposal identifies the barriers faced by organisations when investing in technology and proposes actions to overcome these problems.  

At Healthcare Gateway, we are passionate about helping our customers in their journey through digital transformation, and we hope that this article will provide our customers with information to guide them to improve interoperability.

What Good Looks Like

The ‘What Good Looks Like’ framework set out by NHSX provides guidance for health and care leaders to help digitise, connect and transform health services safely and securely to improve patient outcomes.

It includes 7 measures of success which will be used to accelerate digital transformation, by allowing leaders to assess current levels of digital maturity and identify gaps and opportunities for improvement.

  1. Well led: Leaders in healthcare will drive digital transformation and promote a culture which leads to delivering efficient, safe, high quality care.
  2.  Ensure smart foundations: Putting in place reliable, modern, secure and resilient data and infrastructure to continuously improve IT and digital services.
  3. Safe practice: Ensuring that technology meets the standards set out by Digital Technology Assessment Criteria.
  4. Support people: Ensuring workforce is digitally literate and able to work well with data and technology.
  5. Empower citizens: Ensuring citizens have access to digital services that suit all literacy and digital inclusion needs.
  6. Improve care: Using data and technology to transform care pathways, and ensure patients get the right care, at the right time, at the right place.
  7. Healthy populations: Using insights from data to address health inequalities and improve health and wellbeing of the population.

The goal of this framework is to ensure that NHS leaders have the right information to digitally transform services to provide better, safer care. For further information, please see the NHSX website here.

Who Pays for What

‘Who Pays for What’ will change the way that the NHS tackles digital investment and will take steps to support Integrated Care Systems (ICS’s) in making better investment decisions. Initially it addresses the current barriers to digital investment and goes on to propose actions to overcome these barriers in the years to come.

The main barriers to investment in digital technology were found to include:

  • Complex funding arrangements
  • Lack of visibility of future national funding opportunities
  • Single year budgets and late notification which results in poor investment choices
  • Complicated bidding processes
  • Measurable benefits to digital investments not being fully understood by all
  • Unknown current costs on technology, unknown suggested costs and the impact underinvestment on technology can have.

NHSX Digital then go on to outline their plan to tackle these problems in 2021-2022, which includes simplifying the funding process; moving forward national funds will be combined into one singular pot. The Unified Tech Fund provides guidance on the application process for bidding for funding. You can read more about this later on in this article. NHSX will also improve the metrics that are available to help ICS’s understand where they are digitally and what they need to do to fulfil the successes in ‘What Good Looks Like’. The proposal will also provide tools to help ICS’s track the benefits that they gain from their investments in technology.

You can read more about the plans to tackle barriers to investment in technology in 2022 and onwards, on the NHSX website.

Unified Tech Fund

The Unified Tech Fund has brought together a number of national technology funds, amounting to a total of £680 million being available to NHS organisations in the 2021 – 2022 financial year. The aim of this funding is to ensure a basic shared care record is in place within all ICS’s, to support the digitisation of pharmacy, optometry, dentistry, ambulance and community services sectors and improve interoperability and as a result, improve patient safety and experience through increased digitisation.

The different funding areas included are:

  • Frontline digitisation
  • Shared care records
  • Cyber security infrastructure funds
  • Digital productivity
  • Digital pharmacy, optometry, dental, ambulance and community (PODAC)
  • Diagnostics
  • Digital maternity
  • Digital child health.

All of these have been allocated different amounts of funding and all have different closing dates ranging between October 2021 and March 2022. The prospectus then sets out the application process for each of the individual funds, including the requirements of applications. For more information on the different funds available, see the Unified Tech Fund prospectus.

At Healthcare Gateway, we aim to make sure our customers have access to all the information they need to improve their digital transformation, along with the support required to make the necessary changes to improve interoperability across health and care settings. To find out how we can help your organisation in your journey to digital transformation, please get in touch here.

IKR