What do Agile coaches and surgeons have in common?

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Full disclosure: I am an Agile Coach and an Enterprise Transformation Leader, and my knowledge of the work that surgeons do is based on my personal (very limited) experience. During coronavirus, I watched a few TV shows that I missed in my prior life and one of them, Grey’s Anatomy, resonated with me. I frequently found myself thinking that I’ve been in a similar situation with the organization that I am transforming, and decided to share some of my thoughts in this blog.

There is of course the obvious. As Agile coaches, we come into an organization to heal. Below is my attempt to “dissect” the concept.

1. Focus and relentless prioritization. Doctors start by addressing the direst problem first. This is exactly the same concept as a lean flow. In order to increase throughput, we need to address the bottleneck first. As the constraints theory teaches us, if we address anything rather than the bottleneck first, we will only slow down the process. This is why Derek Shepherd died in Grey’s Anatomy – the doctors worked extremely hard to save him but they failed to start with the most urgent problem - his brain bleed, hence the outcome.

2. Make decisions based on relevant data. When a surgical case is presented, the surgeons consider relevant data only. This is specific to each patient. Rather than measuring and listing everything they know about each patient, they start presenting the case by identifying each patient and then providing 3-5 factors that are relevant to the case. This reminds me of a question: which Agile metrics we should collect followed by a comprehensive analysis of all existing delivery data done every quarter. Instead, for each organization that we coach, we want to define a small relevant dataset and track this data to address the root cause until the next data point becomes a priority.

3. Identify and target the problem. There is no cookie-cutter solution to an Agile transformation, similar to no single cure for all patients. In each case, you make the assessment. It starts with the patient (organization) telling you where the symptoms are, and you as a professional, helping uncover the underlying root cause(s) and addressing them.

4. Set expectations from the start, be open upfront about risks, and don't fear failures. The healing process is not an easy one. It’s painful, it causes resistance, it impairs the patient, but it leads to a healthy long-lasting outcome. Similarly, in Agile transformation, it will get worse before the benefits become obvious. And sometimes both surgeons and Agile Coaches fail. Sometimes it’s their mistake, sometimes there is nothing they can do, but in either case, it’s learning, and they persevere and move forward – to the next patient to save, to the next organization to transform.

5. Identify meaningful OKRs. Objectives and Key Results that define success have to be meaningful, thinking otherwise leads to failures, sometimes irreparable. In Grey’s Anatomy, it was shown that when a company called Pegasus was buying the hospital with the only goal of making a profit, their decisions made a lot of damage – to people's morale and to the outcomes. A group of brilliant surgeons stopped being a team and turned against each other. This competition impaired teamwork and caused a patient’s death. Further, after Pegasus was gone, there was still the aftermath they had to deal with, sometimes not even being aware of the consequences.

A short-term gain of Pegasus cost-cutting caused a plane crash when their airline carrier was downgraded to a cheaper company. Moreover, it led to three patients dying because the surgical gloves were of low quality. This almost destroyed the new ownership who came after Pegasus and were not aware of these decisions. The long-lasting effect of the short-term cost-cutting was devastating, and the subsequent long-term investment by surgeons who were passionate about saving people led to rebuilding the hospital as the tier 1 trauma center.

6. People first. Whatever we do, it’s always about people. And it is not a general statement, it’s a fundamental concept of addressing any organizational transformation or any patient treatment process. I remember years ago when I was a software developer, we had a report distributed monthly: how many bugs did each developer produce during this month? The report would go to all developers in the department, and the ones who wrote clean code were celebrated. It did a lot of damage, and primarily, the damage of code quality. We got rid of this practice fast, but it taught me the fundamental concept that you get what you measure.

Measuring the right data leads to the right outcomes and vice versa. In Gery’s Anatomy, it was exactly the same situation. Once a poorly managed company with the wrong goals (profits vs. people) bought the hospital, they started measuring the death rate of each surgeon individually. Besides comparing apples to oranges (e.g. brain surgery has higher mortality rates than plastic surgery by default), it caused the opposite outcome. Do you think mortality went down? The wrong metric led to all types of wrong behaviors. The surgeons were not willing to take the risk, so there were more patients dying than before. This is the power of system thinking.

7. Focus on teamwork in a psychologically safe environment. As Agile coaches, we do not compare people or teams. We compare trends over time to understand where we can coach and improve the system rather than creating a psychologically unsafe environment of constant competition. Similarly, in Grey’s Anatomy, every surgery is teamwork – no matter how experienced the head surgeon is. There is work that nurses do day-to-day, and having the right team that a surgeon can trust is the fundamental constituent of success.

In Grey’s Anatomy, it was shown how Ben Warren as a nurse was able to solve major medical challenges that the surgeons couldn’t by observing and knowing his patients from an angle that was not known to them. An intern donated his blood and saved the patient when the blood bank was locked in a hacker attack. At the same time, there is always a lead doctor for each patient who has the ultimate responsibility for this patient’s health. This combination of empowerment and ownership in a psychologically safe environment is exactly what we as Agile Coaches are trying to build.
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I am sure there are more things in common. We identify the problem, we work on a solution as a team, we support, and we cure. Are there any fundamental similarities (or differences) that I missed that resonate with you?