Several years into my career in healthcare software, our development teams began using an “Agile” method to plan and create our products.  The change was scary at first, but the results were phenomenal!  Quality improved, people felt more empowered, work got done faster and everyone’s voice contributed to the successful release of great software.   Wikipedia defines the Agile Software Development as

 “an approach to software development under which requirements and solutions evolve through the collaborative effort of self-organizing and cross-functional teams and their customer(s)/end users(s).^[1]It advocates adaptive planning, evolutionary development, early delivery, and continual improvement, and it encourages rapid and flexible response to change.”

That sounds complicated, but it was really quite logical.   We just constantly re-evaluated priorities and methods as new information was learned, problems arose, or the team changed but the end goal remained the same. Instead of creating a long term, fixed plan that included every imaginable issue, we started with a basic description of a “thing” we wanted to build, a general idea of what it would take, and a team.  As we developed the “thing” if something wasn’t working, we could modify the plan.  If someone was on vacation, we might redistribute the work.  If a team member had a better idea, it was welcome and up for discussion. When it worked well every member of the team was equally important and had the same goals – to deliver a quality product.

Agile works with these four principles:

• Individuals and Interactions over processes and tools  (people and their voices matter)
• Working Software over comprehensive documentation (getting the thing done and done right is most important)
• Customer Collaboration over contract negotiation (do something that is meaningful and useful, not just something that “checks the box”)
• Responding to Change over following a plan (not walking off a cliff just because the directions say to do so!)

Agile in Healthcare

The Agile System is similar to emergency department triage which requires constant assessment and reprioritization of all the patients which present themselves for treatment.  First come, first served doesn’t apply.  You do the most important things first but adjust as you go.   Just when you think you have things in order, an ambulance rolls in and you start the process all over again. In a fluid world, having a fluid system really makes sense.

These processes define how I see the world and manage my life.   Even my diabetes.  Initially I struggled to follow the care plans set forth by the providers and educators.  Nothing ever seemed to fit just right.  I was a round hole in a square peg world.  NPH peaked when I wasn’t hungry or in the middle of a trauma patient.  I worked nights, so I was constantly adjusting when to dose.  I moved on to multi-dose injections, then to a pump to give me more flexibility all the while being told I needed a better routine.  Routine is the bane of my existence.  I don’t want to do the same thing, the same way every day.  Phooey.  I wanted my ideas to matter, I wanted flexibility, I wanted success and happiness.

Long before I knew what agile software development was, I had implemented it into my diabetes management and found providers who would support me.   I adjusted daily to make it work and to have successful outcomes.  My experience was similar to that of my software team.  Quality of life improved, I felt more empowered, blood sugars were better, and I had a voice in my care.   Insisting on flexibility and living life on my terms, is the smartest thing I have ever done.  I control diabetes.  It doesn’t control me.  I know that sounds cliche, but its true.

Agile for Diabetes

I’ll leave you with my modified agile principles for diabetes management.

• Patient Needs and Abilities over provider mandates and guidelines (we are not cookie cutter and it is our life)
• Daily Persistence over impossible perfection (doing this every day to the best of our abilities is all you can ask)
• Encouragement and Solutions over shame and fear mongering (we really don’t know why our BGs are off sometimes and we know about all the horrible complications)
• Responding to Change over following a fixed plan (education and encouragement to adjust to whatever life throws at you)

Go live YOUR life and Do Great Things!

Patricia