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NextGen Case Study

Case Study: NextGen Healthcare

Accelerating Value Delivery Through a SAFe-based Operating Model Refresh

Executive Summary:

NextGen Healthcare, a leader in healthcare technology solutions, embarked on a significant initiative to refresh its operating model and streamline product delivery. Recognizing the need for improved data-driven decision-making, enhanced sustainability, and continuous improvement, NextGen partnered with an Enterprise Transformation Coach to leverage the Scaled Agile Framework (SAFe). This collaboration resulted in the successful establishment of a lean-agile, flow-based operating model, leading to significant improvements in delivery speed, quality, and alignment with strategic objectives.

The Challenge:

Prior transformation attempts within NextGen Healthcare faced challenges in gaining widespread leadership buy-in and achieving sustainable change. The existing delivery structures operated in silos, hindering data aggregation and consistent application of best practices. This resulted in long release cycles (1.5+ years), low planned/completed ratios (~35%), and significant work-in-progress (WIP). The need for a unified approach to product delivery, improved forecasting, and better alignment between technical work and strategic goals became critical.

The Solution:

A SAFe-Based Transformation

An experienced Enterprise Transformation Coach collaborated closely with NextGen’s leadership, including the CTO and SVPs/VPs, to architect and implement a refreshed operating model based on the Scaled Agile Framework (SAFe). The approach was characterized by:

  • Empathy and Gradual Change: Recognizing past challenges, the transformation was approached with empathy, assuring stakeholders that the journey would be collaborative and adaptive. A series of minimum viable changes were introduced to meet the organization where it was and build momentum.
  • Leadership Buy-in: Securing strong leadership support was paramount. The coach effectively communicated the “What’s In It For Me” (WIIFM) by leveraging a technology background and building trust.
  • Data-Driven Roadmap: Lean-Agile maturity models, assessments, and interviews were employed to create an 18-month transformation roadmap. Needs were translated into a prioritized backlog of stories, managed with leadership feedback to ensure measurable outcomes.
  • Establishment of Agile Release Trains (ARTs): Seven Agile Release Trains were stood up, forming the backbone of the new delivery structure. This facilitated alignment, collaboration, and consistent delivery across product lines.
  • Coaching and Mentoring: Extensive coaching was provided to leadership (CIO, SVP, VP), product management, ART Release Train Engineers (RTEs), Product Owners, Scrum Masters, and development teams. This included guidance on Agile principles and practices, facilitating initial PI Planning events, and clarifying roles and responsibilities.
  • Jira/eazyBI Optimization: A significant effort was undertaken to standardize and optimize the use of Jira and eazyBI across 500+ users. This involved designing consistent issue types, screen layouts, workflows, transitions, automation, and validators (JavaScript). This initiative alone saved an estimated $2,500 per day by eliminating redundant configurations and enabling enterprise-wide data aggregation.
  • Performance and Operational Metrics: The coach guided the definition of Objectives and Key Results (OKRs) and Key Performance Indicators (KPIs). Performance and operational metrics (Cycle time/Delivery speed, Quality/Defect rate, ROI) and reporting mechanisms were developed to track progress and demonstrate the benefits of the new operating model.
  • Internal Playbook and Training: An internal playbook and training curriculum were collaboratively developed to support the transition and ensure the long-term sustainability of the new operating model.
  • Re-architecting Tooling: The tooling landscape, particularly Jira and SharePoint, was re-architected to align with the new operating model and facilitate seamless collaboration and information flow.
  • Scaling Agile: A team of seven internal and external coaches was led to transform the 1700+ employee Product Delivery Organization into a single portfolio with six product lines and eleven quarterly cadenced delivery team-of-teams, encompassing over 80 agile delivery teams.

Results:

The implementation of the SAFe-based operating model yielded significant positive results for NextGen Healthcare:

  • Improved Delivery Speed: Release cycles were dramatically reduced from 1.5+ years to quarterly releases.
  • Increased Predictability: The planned/completed ratio improved significantly from ~35% to ~85%.
  • Reduced Waste: Work-in-progress (WIP) was reduced by approximately 80%.
  • Enhanced Quality: The percentage of User Stories with Acceptance Criteria increased significantly, ranging from ~5% to 67%, indicating a greater focus on clear requirements and quality.
  • Data-Driven Decision Making: Standardized Jira configurations enabled data aggregation, providing valuable insights for roadmaps, quarterly planning, and portfolio management.
  • Cost Savings: The Jira/eazyBI optimization resulted in estimated savings of $2,500 per day.
  • Improved Alignment: The new operating model fostered better alignment between technical work and strategic objectives, leading to economically prioritized work and improved capacity planning.
  • Cultural Transformation: Coaching and the focus on shared learning and adaptation contributed to a more agile and collaborative organizational culture.

Conclusion:

Through a strategic and empathetic approach leveraging the Scaled Agile Framework, NextGen Healthcare successfully refreshed its operating model. The transformation led to tangible improvements in delivery speed, quality, predictability, and cost-efficiency. By fostering leadership buy-in, providing comprehensive coaching, and optimizing key tools, NextGen Healthcare established a foundation for continuous improvement and sustained success in delivering innovative healthcare solutions. The case study highlights the power of a well-executed SAFe implementation in driving significant organizational agility and business value.

How the need for the CDR Model was identified

Starting with WSJF, which is the suggested prioritization for enterprises adopting SAFe, people find that the variables used to estimate the cost of delay are not well aligned with the typical language used when prioritizing defects. We tend not to talk about the value of fixing a defect, the reduction of risk, or the business opportunity created when fixing defects.

When discussing defects the conversation often considers how many people are affected, the impact on these people, and the severity of that impact. For this conversation, the RICE prioritization model is a better fit for the language used. Looking at the first 2 parameters we see that this model provides a better alignment with the conversation:

  • Reach represents the number of people affected, and
  • Impact represents the consequence of the defect’s effect.

The shortcoming with RICE, when used with defects, is that it, like most prioritization models, is intended to be used on a single backlog of similar items. But, not all of the work in a backlog is the same type of work. A backlog typically has a number of work types, such as New Features, Work on Technical Debt, or Maintenance items. SAFe handles this using Capacity Allocations. Defects are another type of work and should have a capacity allocation, but then there are sub-categories for defects that we need to consider.

Introducing the CDR Model

Classification-aware Defect Ranking (CDR) Model

For enterprises that have a significant backlog of defects,
Who are dissatisfied with their current prioritization approaches,
The Classification-aware Defect Ranking (CDR) Model,
Provides clarity on those parameters to be considered for an objective approach to determining a ranking score that is the basis for prioritization,
Unlike other ranking approaches that tend to be subjective and inadequate in capturing the various considerations.

For the CDR Model defect classification is based on a mandate to repair and breadth of exposure (who knows about the defect).

The CDR Model uses this classification along with inputs for Reach, Impact, Confidence, Pressure, and Understanding to calculate a Defect Ranking Score.

So many defects, what do I do?

I’m really excited about a new model that I have developed for defect prioritization. I’ll be introducing the model soon. Return here for more information and watch LinkedIn where I will post an artiicle about the model, schedule a webinar on the topic, and offer a course.

Follow my company on LinkedIn at: Michael Richardson Enterprises, LLC

Or, follow me on LinkedIn at: Michael Richardson