HOUSTON, TX, USA | 5–8 NOVEMBER 2017

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PMO17BR303

The Big Bang – Cerner’s Approach to Agile Transformation

Matt Anderson, PMO Director

Cerner Corporation

Objectives

• Provide strategies for doing a Big Bang agile rollout

– Provide foundation for a successful plan

– Help avoid potential pitfalls

– Create a sustainable model

• Position the PMO as a leader in the transformation

Cerner Corporation

• Started in 1979, based in Kansas City, MO USA

• Leading global supplier of healthcare solutions, healthcare devices and related services

– Focus on creating a safer and more efficient healthcare system

– Key solutions include:

• Computerized physician order entry (CPOE)

• Electronic medical records (EMR)

• Personal health records (PHR)

• Clients in 35 countries serving more than 27,000 unique facilities

– Hospitals, physician practices, retail pharmacies

• NASDAQ – CERN

– US$4.8 billion in revenue in 2016

Healthcare is too important to stay the same

Migration to Agile (2009)

Cerner’s Challenges to Agile

• FDA-regulated healthcare environment

– Had to prove we could be agile and meet compliance

– FDA, CE Mark, ISO guidelines perceived as very waterfall

centric

• Culture change

– “Just get it done” (command and control)

• Development ecosystems

– Some legacy code still on Visual Studio 6

Why Agile?

• Business focused

– Speed to market

• Concept to first client adoption – 30 months

• Retain market leadership

– Return on investment

– Improve quality

• Develop the right solution

• Develop the solution right

– Support “edge” teams

• Core solutions released together, but “edge” teams

unnecessarily held up by inflexible methodology

– Analogous to core web browser versus plug-in for

browser

Grassroots Movement• September 2008

– Several teams express frustration with rigid process

• Cerner culture is “kill a snake,” so alternatives sought

– Recommendations to “look into agile” as a possibility from a couple of engineers

• General feeling was that due to FDA regulation, it could not happen

• Q4 2008

– Small group of teams begin discussions to start unofficial agile pilots

• January 2009

– Five teams kick off pilots with minimal support

– Group meets together weekly to discuss progress and share ideas

• April 2009

– Development executives hear about pilots and are exposed to the positive results

– Presented short-, medium- and long-range goals on what agile could do

Top-Down Support• July 2009

– CEO Neal Patterson announces intention to “blow up the waterfall”

• Q3–Q4 2009

– Pilot program expanded to eight teams and several key initiatives to

determine if it could scale

– High executive visibility

– Tooling pilots to plan for scale

– Education provider pilots held

– FDA and other regulatory impacts mitigated

• January 2010

– Key business leaders trained in agile principles

• 75+ vice presidents and executives

– Renamed lines of business – Agile Business Units (ABUs)

The Plan• March 2010

– Plan and budget presented for a planned incremental training and

coaching rollout

– After reviewing options, decision from senior vice president of

engineering to go “Big Bang” instead of incremental – “Go fast”

– Back to the planning board…

Pilot6 mo Big Bang

12 mo

Prove Scale6 mo

Big Bang Plan Elements

• Agile center of excellence

• Development process

• Education and coaching

• Tooling

– Ecosystem

– Metrics

• Partnerships

• Manage expectations

– Engineering

– Rest of Cerner

– Clients

Standard Development Process

Agile Center of Excellence

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Manage

Expectations

Partnerships

Agile Center of Excellence

• Created a virtual center for “all things agile”

– Web 2.0 technologies

– One stop shop for agile questions, coaching requests and general information

– Accountable for agile success

• Named “agile champions” from pilot teams

– Respected engineering associates who could speak “agile” and “Cerner”

– Training

– Coaching

– Community participation

• Manage vendor relationships and budget

2010 Agile Training/Coaching Plan

• Train the trainer model, with 50% external/50% internal; KC and India

Cerner 2010 Agile Timeline

• 1,600 development team associates trained in less

than five months

– All global development offices included

Jan-10 Jan-11

Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10

27-Jan-10

Core Leadership Training

26-Apr-10 - 10-Sep-10

Agile Boot Camp

26-Apr-10

Agile Essentials Recorded

Agile Center of Excellence Launched

Development Process Update Plan

• Major overhaul to support agile

– Worked closely with FDA, ISO and other regulatory groups to reinterpret

regulations from an agile mindset

– Determined where “additional process” would be required from agile

applications in other industries

• Audits

– Initial internal audits performed on pilot teams to find potential gaps

– Early rollout of planned changes (March 2010)

– Follow up internal audit of pilot teams prior to official launch

• Official launch 1 July 2010

Tooling

• Ecosystem

– Defined approved tools and guidelines for new tooling

– Created education and “brown bag” discussions to promote

appropriate usage

• Metrics

– Set expectations that they would significantly change

– Eliminated most existing metrics in favor of a few key metrics

Partnerships

• Develop vendor relationships to build and supplement internal

expertise

– Tooling

– Training

– Coaching

• Learning from other’s experience is significantly less expensive in

the long term

• Become self-sufficient

Setting Expectations

• Create training materials for each audience

– Development and business executives

– C-level executives

– Clients

• Tailor agile message to support their goals

– Follow up with results to maintain trust

– Use terms they understand

• “Capability” versus “epic”

Slide for Executives –

Agile Executive

• Establish, maintain and communicate vision

• Enable and trust teams to deliver

– Empower and inspire agile business unit teams

• Provide ongoing solution input and direction ahead of iteration planning

• Prioritize, adapt and embrace

• Servant leader

• Remove obstacles

– Identified by the teams

– Obstacles not seen by the teams

– Protect the high-performing teams

• Measure what is needed

Slide for C-Level Executives –

Cerner Adoption Measurements

• Training records

• Coaching assessments

• Quarterly team assessment

– Baseline at boot camp

• Measurement of success criteria

– Speed to market

– Client adoption

• Team performance

– Delivery against commitments

– Client demos

• Lead time

– Time from investment to adoption

Slide for Clients –

Success Measures

• Value and experience

– Client interest

– Client benefits quantification

– User experience and usability

• Client adoption

– Time to put major release into production

– Time to activate capabilities into production

• Solution quality

– Client-found defects

– Ratio client-found vs. release validation defects

Slide for Clients –

Key Client Responsibilities

• Engage with Cerner ABUs regularly to provide feedback

• As a development partner…

– Work with the ABU and development teams to create prioritized

list of capabilities

– Attend client demos at the end of each development iteration

– Provide regular feedback on progress and ensure proper priority

– Test capabilities and take them live as soon as they are

available

Results – Review the Why

• Business focused

– Speed to market

• Concept to first client adoption – 30 months

• Retain market leadership

– Return on investment

– Improve quality

• Develop the right solution

• Develop the solution right

– Support “edge” teams

• Core solutions released together, but “edge” teams

unnecessarily held up by inflexible methodology

– Analogous to core web browser versus plug-in for

browser

Results After One Year (2011)

• Culture

– “Agile” and “lean” used in everyday vernacular (most of the time correctly)

– Leaders challenge each other to act as servant leaders in executive sessions

• Some “command and control” tendencies surface from time to time, but other leaders are the checks and

balances

– Associate attrition for satisfaction issues reduced by 80%

– 95%+ adoption by development teams (2,000+ associates)

30 mo ↓ 10 moDirect ROI ↑ 429%Indirect ROI ↑ 1,000%

Productivity ↑ 24%Development Cost ↓ 14%Quality ↑ 6%

Passed audits with new (significantly reduced) process

Keys to Cerner’s Success

• Strong grassroots and top-down support

– Engineering momentum

– Vision and funding

• Connected to key associates within organization early in the process

– Mavens* – distinguished engineers, PMO

– Connectors* – key pilot teams, PMO

– Associates with high trust within organization

• Leveraged current culture to change future culture

– Build on the past, don’t “throw it under the bus”

• Excellent training partner

• Business driven implementation

– Agile to “win the game,” not just to be agile

* - “The Tipping Point” by Malcolm Gladwell

Drawbacks From Big Bang

• Coaching post training

– Large scale enabled only three visits per team and some teams fell into less than

optimal practices

• Some teams “adapted” before “adopting,” so they are not consistently getting the

results

• Some key items to agile have lower adoption

– Burndown charts

– Physical tasks board (favor electronic tooling instead)

• Team “depth” in agile principles shallower on teams that had only the minimal

recommended coaching

• Hiding behind the tool

– Early electronic adoption over physical led to some less effective practices

Since 2011• Development course offerings expanded

• Coaching, coaching, coaching

• Lean portfolio management

– Focus on value stream and find and eliminate bottlenecks

• Moving agile/lean into non-development applications

• Culture change continued

– 2012 Corporate Core Values – across all 10,000+ associates

• Flawless – personal commitment

• Empowered – freedom to do the right thing

• Value – satisfying a need, exceptionally

• Grown to 25,000 including major acquisition (Siemens Health Services)

– Successfully merged two agile cultures

• Member of the Steve Denning Learning Consortium – developing and sharing best practices in

business agility

So What?

• What are you going to do to improve your PMO’s role in your agile

journey/transformation?

• Recommendations

– Define your why

– Build your short-, medium- and long-range goals for your

first/next turn of the agile crank

– Identify your connectors, mavens and skeptics

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Questions

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Contact Information

• Matt Anderson

– matt.anderson@cerner.com

– @CernerAgileMatt

• SD Learning Consortium

– SDLearningConsortium.org

– SDLCAgile@gmail.com

– @SDLCAgile

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