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Agile System in Health Care: Literature Review

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DOI: 10.1007/978-981-13-6412-9_61

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Agile System in Health Care: Literature
Review

Rahul Sindhwani, Punj Lata Singh, Devendra Kumar Prajapati,

Aamir Iqbal, Rakesh Kumar Phanden and Vasdev Malhotra

Abstract The goal of this exploratory paper is to focus on the present status of
implementation of the agile system in health care. In this article, analysis emphasizes
the definition of agile in health care, enablers cum characteristic, implementation
procedure, and barriers. An inclusive research of the literature pertaining to the
implementation of this system in health care was used to produce a technique to
implement it. A system that is flexible in nature and enables to respond quickly to
customer demand and market fluctuations while still optimizing costs and quality
by adopting upgraded tools, processes, and trainings is termed as an agile system.
The agile system in health care basically offers an efficient framework to organize
and govern process improvement. It can be only accomplished if a systems approach
is enforced together with a proper orientation. The common implementation steps
suggest conduct agile training, start pilot projects, and executing improvements using
interdisciplinary teams. Lack of instructors and advisors is one of the barriers and
they can furnish support by sharing their knowledge and experience and illustrating
with help of an example from real-life applications of agile in health care.

Keywords Health care · Agile · Enablers · Barriers · Factors · System ·

Implementation

R. Sindhwani (B) · D. K. Prajapati · A. Iqbal · R. K. Phanden

Department of Mechanical Engineering, Amity School of Engineering
and Technology, Amity University Uttar Pradesh, Noida 201301, Uttar Pradesh, India
e-mail: rsindhwani@amity.edu
P. L. Singh
Civil Engineering Department, Amity School of Engineering and Technology,
Amity University Uttar Pradesh, Noida 201313, Uttar Pradesh, India
V. Malhotra
Department of Mechanical Engineering, YMCA University of Science & Technology,
Faridabad, Haryana, India

© Springer Nature Singapore Pte Ltd. 2019 643

K. Shanker et al. (eds.), Advances in Industrial and Production Engineering, Lecture
Notes in Mechanical Engineering, https://doi.org/10.1007/978-981-13-6412-9_61
644 R. Sindhwani et al.

1 Introduction

In this globalization era, healthcare organization is facing difficulty to respond

dynamic, uncertain demand of customer and to continuously varying environment.
And this difficulty should be minimized because the necessity of healthcare services
is arising day by day due to the changing environment and culture of society. But on
another site, financial condition is not ameliorating of these organizations to offer this
service which is easily accessible, affordable, and accurate. For this purpose, there is
a requirement of the new and efficient way of facilitating healthcare service. Hence,
it is a very challenging issue for both industry and academia that how to improve it?
However, there is various resolutions that have been suggested such as networking,
re-engineering, high-performance organization, employee empowerment, flexible
manufacturing, and just in time (JIT) [1].
According to WHO, there are some following factors required to maintain a good
healthcare system, which are sophisticated financing mechanism, trained and skilled
workforce, trusted information on which to base decision and policies, and robust
mechanism to deliver quality medicine and technologies. And these factors are influ-
enced by the disparate player and they are patient stakeholders, non-governmental,
commercial, academic as well as local, and regional political forces [2]. Recently,
experts from industry and academia have been trying to manage these turbulences
to provide effective and efficient healthcare.
Apart from this, there is also some internal complexity to deal with these com-
plexities healthcare organizations, adopted process development strategies, and lean
healthcare management to provide improved quality and safety to the patient [3].
Although lean thinking is beneficial to the organization, there are some limitations
of applying a lean approach in healthcare due to the limited consideration of external
effectiveness; hence, lean seems inadequate to deal with instability and complexity
of external environment as well as dynamic demand [4]. To cope with this insta-
bility and complexity, it is essential to understand the requirements and constraints
of the marketplace and need to adopt new strategies which ensure the needs of the
supply chain and the end customer. To fulfill the higher variety of demand of cus-
tomer in terms of services and products where the degree of uncertainty is high, the
organization should be equipped with agile practice [5].
On the basis of the literature review, the goal of this paper is to update the reader
regarding the implementation of the agile system in healthcare organization. In this
article, analysis emphasizes the definition of agile in health care, and implementation
procedures, factors, barriers, enablers, issue, and results of implementing the agile
system in health care.
Agile System in Health Care: Literature Review 645

2 Methodology

The compilation of this review paper initiated through the comprehensive explo-
ration of the various databases which include ScienceDirect, Interscience, Springer,
Emerald, Elsevier, IEEE, etc. An attempt was also made in search of databases of
medical journals; for example, BioMed, Telemedicine, and e-Health and journals
from several areas such as quality management, operational management, health-
care management, and business and economic. The search criteria include the papers
from year 2000 to 2017, almost 200 papers was reviewed using key words such
as “agile health care,” “agile healthcare organization,” “agile management in health
care,” “agile software development in health care,” “barrier and challenges in health-
care organization,” and “agile implementation in health care.” This spacious search
strategy was required because the paper on agile health care has been published in
a wide range of journals in many fields. On the basis of the above survey, nearly
60 most relevant papers related to agile health care are selected to write this review
paper.

3 Literature Review

The reviewed paper is segregated into three parts, namely agile healthcare delivery,
agile healthcare management, and agile healthcare software development which are
shown in Table 1.

4 What Is Agile Health Care

The report nominated the twenty-first century Manufacturing Enterprise Strategy has
originally presented the concept of “agile.” This report revealed the consideration of
the chief representative of management principle from the US industry, government,
and academia [6]. Agile strategy empowers the organizations to deliver efficient,
customized, and standard quality service on time at an optimized cost. In health
care, lean only focuses on process and eliminating waste within the organization but
agile makes the healthcare organization flexible which considers the turbulence in
the environment within and outside the organization [7]. In healthcare organization,
the agile practice involves a group of parameter termed as agile characteristic listed
in Table 2.
646 R. Sindhwani et al.

Table 1 Review of “Agile HealthCare System”

S. no. Field Sub-field Paper reviewed
1. Agile Patient flow and Towill and Christopher (2005): This paper helps
healthcare planning to develop the healthcare pipeline, putting the
delivery process patient in centered and considering the vision of
NHS, using a suitable architecture which covers
the great extent of patient demand [5]
Rahimnia and Moghadasian (2010): It is the case
study, conducted in hospital focuses on supply
chain regarding health care using the concept of
leagile strategy [13]
Portable Robertson and DeHart (2010): Emphases are
healthcare clinic given on how to provide healthcare facility in the
rural and remote area. Using artificial
intelligence [14]
Kai et al. (2014): This paper supports and
strengthens the healthcare worker to identify
non-communicable diseases in an inaccessible
located area with the help of portable health
clinic (PHC) [15]
Medical product Mehralianan et al. (2015): Supply chain model
supply chain has been developed in this paper for the
pharmaceutical industry and trying to show the
most dominating factors using agile concept [16]
Nabelsi and Gagnon (2016): In this paper,
authors trying to show how supply chain
management affect the cost involving in health
care. Cost relating to SCM is more than 40% of
hospital operating budget [17]
2. Agile Organizational Keating (2000): This paper provides the
healthcare structural symptoms of weak organizational structure and
management advice to modify those focal areas so that
organization can respond turbulence
environment [18]
Rust et al. (2013): This paper suggests a
procedure to adopt an agile approach while a
lean approach already used in healthcare
organization [19]
Tolf et al. (2015): To increase internal efficiency
and external effectiveness, need to redesign the
organizational structure in optimizing the way in
the hospital using the concept of agile principles
[20]
(continued)
Agile System in Health Care: Literature Review 647

Table 1 (continued)
S. no. Field Sub-field Paper reviewed
Managerial Kitzmiller et al. (2006): This paper proposes the
strategies implementation of agile technique into the
traditional organization without obsoleting it [21]
Patri et al. (2017): This paper suggests the
manager of healthcare organization that
organizational structure, management–employee
cohesion, implementation of employee and
patient’s suggestion etc are an important enabler
and should be highly focused to achieve agility
in the organization using TISM technique [11]
Agile workplace Michael et al. (2003): To achieve agility in
management healthcare organization, we have to first make
workplace agile [22]
Moore et al. (2008): To scale agile practice at
large extent in healthcare organization, it
demands to build agile tribe using the power of
information [23]
3. Agile software Electronic Lenz and Kuhan (2004): This paper provides
development health record documentation technique based on an
application framework and rapid application
development [24]
Bamiah et al. (2012): This paper concludes that
how an organization can use the cloud computing
paradigm to make electronic health record [25]
Ozcan (2013): This paper examined the
feasibility electronic care report form (e-CRF)
using open source software (OSS) [26]
e-healthcare Chiu et al. (2007): In this paper, e-healthcare
network network is developed using medical informatics
standard called health level 7 (HL7) [27]
Bender and Sartipi (2013): To develop
e-healthcare network it is necessary to make
system interoperable [28]

5 Agile Implementation in Health Care

The literature review suggests that implementation patterns for agile health care are
same as lean healthcare implementation pattern. To implement the agile strategy in
healthcare, the following key measures are identified [1, 8].
• Conduct agile training
• Start pilot projects and
• Executing improvements
In the first step, management appoints an agile manager who states the basic
agile principle, methods, and tools to the all employee and staff of that organization
648 R. Sindhwani et al.

Table 2 Overview of agile healthcare enabler cum characteristics

Agile characteristic
Organization structure
IT integration
Process design
Employee empowerment
Customer feedback management
Training for the workforce
Outsourcing
References Description
[1, 21, 29, 30] A flat and horizontal organization
with less distinct authority having
decentralized knowledge and
effective influence should be
preferred
[8, 29, 31] Through the adaptation of IT in a
healthcare organization,
information exchange takes place
easily and quickly with help
multimedia devices
[4, 29] Process design ensures high level of
safety and reliability to the patient
and provides the scope of
self-improvement to the
organization
[1, 29] Need to provide some authority to
an employee to take self-decision
without consulting higher officials
in some cases
[31–33] To make organization efficient and
effective patient suggestion should
be incorporated into the system,
there should be the separate
department to manage the customer
feedback and its implementation
[29, 8] To enhance the productivity and to
adopt a new practice in organization
training project should be initiated
frequently for the workforce
[34, 35] Some resources could not be
available in organization and
purchasing may be more expensive
then it is better to outsource from
outside

followed by training [9]. This step creates the base for commencing practical work. A
strong leadership is required, the person who has all concept of agile system and can
lead the whole team, for this purpose because when changes occur in any organiza-
tion, a certain degree of resistance is offered by the member of the organization. And
this resistance can be reduced by creating interest and motivating them regarding
agile system [10].
The second steps start with the concept of agile on the ground with the help of a
pilot project. Initially, a pilot project was a segment of education program but now it
is directly connected to the training program. The basic idea behind this project is to
Agile System in Health Care: Literature Review 649

let people know the idea of agile and also try it within the organization to get a fast
result [4].
The third steps start with executing improvement in the organization with the
help of fully involved employees. This step involves troubleshooting of problem
using agile techniques and tools and incorporates those changes in the organization.
And also find out the main reason behind the problem, and provide the optimum
solution for that problem by analyzing it at various levels [4].

6 Barriers and Challenges to Agile Implementation

The major barrier need to overcome in agile implementation is followed.

• Adaptivity
• Convince staff
• Training
• Customer focus
The first barrier is adaptivity and it is the indicator of the ability to adopt a change in
organizational structure, working pattern, etc. To implement agile practice in health-
care organization, degree of adaptivity should be high [1]. It makes the organization
professionally flexible and helps to learn new paradigms and responsibilities that
enable the organization to respond rapidly [11].
The second barriers are to convince the staff. When a change takes place in the
system, a certain level of resistance is offered by the employee against that change.
Hence to implement agile system successfully in health care, organization need to
convince staff by changing mindset to adopt new culture [1]. However, when training
is offered, the staff gradually realize that this system makes our organization more
efficient.
Training itself is a third challenging task because, in healthcare organization,
there is a lack of people who have real-time exposure to agile practice having sound
knowledge, principles methods, and tools of agile production. The instructor who is
hired from manufacturing sector often uses manufacturing language which is difficult
to understand for healthcare staff [8].
The fourth problem is customer focus and to implement the agile system in health-
care organization; therefore, it is essential to understand the agile principle, the
demand of the customer, and delightness. The word customer is not straightforward
in health care, although patient is the primary customer in health care regarding
the market economic perspective that patient is not a customer because customer
generally does not pay directly for services [12].
650 R. Sindhwani et al.

7 Conclusion

This survey shows that agile is mostly used in health care as agile software develop-
ment is still a great scope in the agile healthcare delivery system followed by agile
healthcare management. Agile health care applied in the system to overcome the
ineffectiveness of lean principles is due to constantly varying demand of the cus-
tomer. Implementation in health care faces some vibrating challenges which are lack
of training, inadequate infrastructure along with resistance offered by a staff member,
and lack of customer focus. For successful implementation of the agile system in
health care, it is essential to understand, what is the meaning of agile health care and at
what degree it deviates from the agile system which is implemented in the industrial
and manufacturing sector. This technique can be interpreted with help of academia
and expert who has real-time exposer of the agile system. While implementing agile
in healthcare organization, health characteristic which is listed in this paper, play a
very crucial role because these characteristics work as enablers and also helpful to
find out agility in healthcare organization. Initially, in healthcare organization, agile
technique is used to develop software to overcome the problem regarding documen-
tation, but present demand is that agile approach should be thoroughly adopted by
healthcare organization to meet the customer demands.

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