Agile Method and Organizational Change









Agile Method and Organizational Change





Agile Method and Organizational Change


            In order for innovative ideas to be successful, there are critical factors which must be put in to consideration. The examination is done using the agile software development in order to develop health care innovation together with its proposed users. In the article, change management is initially discussed and then the use of agile software development is further discussed


            There exist different fields of innovation and most of them do not achieve the capability of reaching a stage of large scale adoption. (Heeks 2006, Kaplan, Harris-Salamone 2009). As much as innovative ideas are often developedas proof of concepts, in many occasions, they do not lead to long lasting changes in the organizations that are involved.In the health care system for example, there is an increasingdemand for care and the shortage of available staff members. For this matter, there is an increasing need to improve the ratio of success for these innovation projects.

In order for innovative ideas to be successful, there are criticalfactors which must be put in to consideration. For instance, there is a general model which organizes success factors in groups of four (Bouwman et al. 2008). The STOF approach organizes these success factors into Service, Technological, Organizational and Financially oriented factors. The key element is that successfully introducing and adopting innovations in the society calls for a development of a business model that shelters all available aspects of the STOF model.Adhering to these factors creates values which are sufficient to the intended stakeholders and users.In any case any of these factors are omitted, there may develop several complications that may prevent the extensiveimplementation of an innovation.In this paper, the success factor that deals with the management of the people is examined. The examination is done using the agile software development in order to develop health care innovation together with its proposed users. In the article, change management is initially discussed and then the use of agile software development as discussed below.


Change Management

            There exist theories which are involved in chain management which will be used to gauge the applicability of agile software development as an approach to chain management. For this purpose, Kotter’s, model on change management will be used to compare the agile methods with the characteristics of a typical eHealth innovation ventures.

Change Management in Health Care Information Technology

            Organizations dealing with provision of health care face a number of challenges which eventually force them to change. Example of these pressures include budget cuts, increasing demands for care thus leading to tighter market for the job. According to Stacy and Dunphy (1991), changes range from an array of incremental file tuning to radical transformation. A higher number of radical changes have an increased impact to the organization and its associated members.The diversity and extent of the challenges that are faced in the health care system are such that they can only be faced with radical innovation options and not comparatively small tunings.

In most cases, innovations usually call for changes for individuals in the associated organization. Employing newer ways of innovation calls for individuals to revert to previously un identified ways of working and apply them in their daily working routine. For these changes to become effective, they must be fully supported by the management because they do not come as easy. Such a case becomes much relevant especially when dealing with the health sector because of the involvement of a huge number complicated of roles, duties and responsibilities (LeTourneau 2004). Since this paper concentrates on health care, change management and informatics, it is advisable to use the definition by Lorenzi about change management which states “The process of assisting individuals and organizations in passing from an old way of doing things to a new way of doing things”.

According to Barnes and Palmer, change management on an organizational level is approached using two theories, the planned change and emergent change. Planned change describe clear and defined goals, are thorough, top-down and strict mechanisms such as management of projects are used. Emergent change uses bottom-up interaction process which eventually leads to change. As much as these two theories are considered to be directly opposite, some people consider combining these two methods to bring out productive change in an organization. Both of these plans are characterized by a sequence of steps and when adhered to, the result of the desired change is rational. The Kotter’s generic eight step plan is the one most commonly used.

Regarding individual levels, organizational change requires change in an individual level. On a research on organizational change, the main cause as to why change does not stick is because of resistance to change (Kotter 1995, Kanter, Stein &Jick 1992, Beer, Nohria 2000). The extent of resistance to change can be reduced by enhancing preparedness for change. Acceding to Holt (2007), there are four factors which influence the reediness of an individual on change and they include:

  1. Self-efficacy. Is the individual ready to bring out the desired change?
  2. Management support. Are the leaders committed to help the individual change?
  3. Is the desired change the best option for the organization?
  4. Personal Valence. How beneficial is the change to the organization?

For effective transformational changes, self-efficacy and management support are considered to be the key elements. Systems which are co-created are better advantaged by the factor of self-efficacy because they fulfil the user’s need. The system of self-efficacy also provides an opportunity to try out different ways to work out and at the same time creating the system. This system contributes to the beliefs of the individual’s own capacity (Rafferty, Simons 2006). In the past, there have been a number of papers which have focused the research on the end user involvement while developing healthcare innovations (Nies, Pelayo 2010, Scandurra, Hagglund& Koch 2008, Teixeira, Ferreira & Santos 2012).

Innovational projects in eHealth possess a number of characteristics such as, firstly, the transformational nature with which it has been described previously.Secondly, the results of the project are not really known during the time the project is initiated and thirdly, there is development of a software system. Approaches for the eHealth innovation projects should ensure that they adhere to management support, a way to allow emergence and self-efficacy. In the perspective of software development,Agile approaches have been specifically designed for projects whose outcomes are not certain and ultimately require user involvement. Agile methods, apart from their known value of realizing a system, can be used as valid change management approaches for such kind of changes.

Kotter’s Theory of Change Management

            Kotter mainly focused on the aspects based on various people to achieve long-term changes in organizations by proposing an 8-step rule which need to be addressed in order to effectively realize change in an organization. According to Kotter, if any of these rules are not well followed, it will prove to be difficult for an organization to realize change. The eight step rule is divided into three phases

The first phase “developing a climate for change”

  1. Developing a sense of urgency
  2. Build a guiding team
  3. Creating a vision

The second phase “Engaging and enabling the whole organization”

  1. Communicating for buy-in
  2. Empowering others to act on vision
  3. Creating short term wins

The third phase “implementing and sustaining the change”

  1. Consolidating and producing more change
  2. Institutionalize new approaches

Agile as a Change Management Tool

            In the last ten years, the field of software development has so much been associated with the increasing number of agile methods. The development of these software projects have been met with; iterative fashions, such that new functionality is achieved through small iterations with each delivering small increments in the process. Explorative fashions, in that all the ventures are as a result of full specification resulting from consequences of later planned iterations. interactive fashions, in that the customer representatives are actively indulged in the evaluation of the last iteration thus leading to planning of the contents of the next iterations.

With regard to agile methods in health care, there are several papers written suggesting the applicability of agile methods. For instance, Offenbeek(1996) suggested to apply iterative and interactive methods to situations which pose to be of high resistance. Health care can be categorized in this category.Krause and Lusignan (2010) stated that from the point where usability of clinical operations is viewed, agile methods prove to be more appropriate than processes which separate users from developers. The agile approach can be viewed as an improvement over the traditional plan driven approaches (Kitzmiller, 2006). Since agile methods have proven to be in the high increase over the past years, the need for more continuous and rigorous studies is also on the increase. From an industry survey, currently, scrum is the most used agile method

The Scrum Approach

            According to Scwaber (2002), scrum is an approach of project management whichemphasizesthe aspects of projects where the full description of the anticipated product at the start of the project is still not known. For this matter, is impossible to plan for everything at the beginning of the process. As much as scrum originates from software development, it is generic enough to be applied to other domains. The central process of scrum ensures that the team is self-sustaining and able to continuously assess, inspect and adapts to its own processes. The software is developed in an increment of two week periods called sprints. The features which are to be implemented in to the system are recordedin a product backlog.At the start of every sprint planning, the representative of customers intended users and management, decide through assigning priorities of which backlog items record a high business worth and should be developed in the subsequent sprint.

At the end of each sprint, there is a demo during which the progress of the system is confirmed to the stakeholders using a live system. During this time, stakeholders are allowed to test and experiment with it and give their respective feedback. The best practice is to avail a fully functional product in every increment because immediate usage increases the value of feedback in the remainder of the development program.After the demo, the team performs a review where it examines and adapts its own processes.

Essential things in this process are two with respect to the co-creation notion. The first thing is that the demos impose that both the owner of the product and the building team frequently discuss the observable results which have meaning to both groups.In this way, common understandings and even a shared language is wrought. The second essential thing is that owner of the problem has the opportunity to decide each iteration and what should be developed next. Through this processes, the customers or intended users are effectively turned into co-creators.

Change Management Support Through Agile

            There are several ways in which agile development methods can benefit change management. To effectively examine these methods,an analysis on which parts of Kotter’s Model is supported by an effective agile approach is done. For the first phase of Kotter’s method, scrum does not support the development of the sense of urgency which must be applied. Once the project has been initiated, scrum provides several supporting constructs, whether the it is afull scale project or a small scale pilot project. The reason behind this is that scrum is a prioritized back log product. At the start, the project starts with a collaborative session which contains all stakeholders. In such a session, the original vision is interpreted into finer backlog items which are further prioritized by the appointed product owner. The result of such a session is that a sense of urgency is created, creating a vision and building a guiding team. The best practice is to have team of management who act as guides, software developers and healthcare staff who are present at the planning of the sprint and the demo.

The preceding phase according to potter is concerned with communication which forms a principle focus on agile methods. The development that is shown through a working product towards the end of every sprint shows powerful communication effects on the involved organization. It makes a good practice to make the demo of the sprint o be open for all the parties that are interested due to the concerns of the feedback. When it is possible for an organization to view intermediate versions of the product and provide responses ultimately adds up to the add-in. the stakeholderscan be effectively participated in the processes rather than be provided for with facts later. Another supporting aspect of scrum is that the priorities of the growth of the supporters can be adopted as the needs rise during the project. The fith step, the empowerment to act on the visions, has been supported in several ways, for instance, part of the procedure is to regularly inspect the weaknesses that are holding the business back. It falls under the duties of the scrum master to effectively get rid of these weaknesses. As for the other project participants, the constant periodic nature of the sprint keeps them working on their designated duties quickly. The following sprint demos and reviews will swiftly point out problems in the organization and allow for correction actions to be taken. The other factor which improves empowerment acts is the fact that earlier versions of the system exist and not imaginary.

The extent to which scrum best supports Kotter’s final phases of implementation and sustainability of change is dependent on whether scrum can be applied at that particular time or not.If scrum is still operable at the 7th and 8th stages, be it with lesser team or at a slower rate, then the discussed benefits are still in effect. However, the last two steps, 7th and 8th, are completely disconnected from the stage of development, this can occur due to the time of evaluating a pilot system, change policy or take decisions. In such cases, there exists a probable risk that the energy gathered during the agile development phase might be lost.


            In this article, the applicability of the agile software development methods as change management approach has been examined. The comparison between change management models of Kotter has proven that practices of agile methods can enable organizations to go through necessary steps of producing climates associated with change, therefore, agile practices can be seen as an effective change management approach. On the other hand, the major risk of agile methods is that they are only confined in the development phase and as a result, there is a loss of momentum when the issue of implementing and sustaining the change. This risk can however be mitigated by continuing agile practices for example iterations and demonstrations in the final phase.




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Field Code

Kaplan, B. & Harris-Salamone, K.D. 2009, “Health IT success and failure: recommendations from literature and an AMIA workshop”, Journal of the American Medical Informatics Association : JAMIA, vol. 16, no. 3, pp. 291-299.

Kitzmiller, R., Hunt, E. &Sproat, S.B. 2006, “Adopting best practices: “Agility” moves from software development to healthcare project management”, Computers, informatics, nursing : CIN, vol. 24, no. 2, pp. 75-82; quiz 83-4.

Kotter, J.P. 1995, “Leading Change: Why Transformation Efforts Fail.”, Harvard business review, vol. 73, no. 2, pp. 59-67.

Krause, P. & de Lusignan, S. 2010, “Procuring interoperability at the expense of usability: a case study of UK National Programme for IT assurance process”, Studies in health technology and informatics, vol. 155, pp. 143-149.


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