NHS Blood and TransplantAgile Transformation in a Highly Regulated Environment
“Adopting SAFe has set in motion the skill development and mindset for successful organizational change even as we scale to new programs, release trains, and people.”
—Gary Dawson, Assistant Director, Solutions Delivery
NHS Blood and Transplant (NHSBT) is a joint England and Wales Special Health Authority that provides a blood and transplant service to the National Health Service—supplying blood to hospitals in England, and tissues and solid organs to hospitals across the United Kingdom. Each year, donors give approximately two million donations of blood and 3,500 organs—saving and transforming countless lives.
Safeguarding the blood supply and increasing the number of donated organs involves collecting, testing, processing, storing, and delivering blood, plasma, and tissue to every NHS Trust in England. NHSBT also matches, allocates, audits, and analyzes organ donations across the whole of the UK.
With an increased need for its services, the organization recognized that effective technology is crucial to the delivery of safe products and services for patients. While looking ahead to its corporate 2020 vision, NHSBT identified several goals: replace an aging IT infrastructure, migrate to SaaS cloud-based services, and replace the critical operational applications underpinning its activities while ensuring they remain compliant with external regulatory monitoring.
NHSBT sought to revolutionize the way it interacts with blood donors by taking full advantage of the opportunities afforded by digital technologies. That means careful consideration of the realities of existing interdependencies between the national databases and NHSBT services, systems, data, processes, and people.
NHSBT identified the need to improve the business processes and the supporting IT environment in two major programs: ODT Hub and Core Systems Modernization.
“NHSBT was embarking on its most complex transformation program ever, initially focusing on the Organ Donation and Transplantation (ODT) area of its business,” notes Gary Dawson, Assistant Director, Solutions Delivery. “It needed to modernize a significant percentage of its core systems, platforms, and architecture along with re-aligning the infrastructure to more modern cloud-based technologies. The impact on the current business and practices couldn’t be underestimated across the organization—we were anticipating changes in how we work and how the system worked.”
It’s All About the People
NHSBT employees truly care about the organization and its work. Dawson, working with the wider NHSBT ICT organization, felt that it was important to correctly evaluate IT needs in line with organizational changes and be able to guide the system changes with the people using them.
“We recognized that both the overarching change and the adoption of a new technical platform and architecture—the effects on the culture of the organization—could, if not managed strategically, create a complex management problem and have an impact not only on the core business, but also the working relationships of the people within NHSBT,” Dawson says. “We needed a system and guidance to adapt and benefit from the changes and we were clear that the waterfall methodology that we had previously relied on wouldn’t support this change. We have dedicated and passionate people who work here, who really care about the cause and want to achieve the goals of the organization, but this change would only work if everyone was on the same page and we could go through the journey together.”
A New Approach to Adopt Change
The Chief Digital Officer had set the strategy for implementing Agile into NHSBT and brought on Dawson specifically with this in mind. From day one he worked extensively and closely with the Business, IT, and Program Delivery stakeholders to ensure cross-organizational support. After an initial meeting, they knew that an experienced consultancy like Ivar Jacobson International (IJI) would aim to understand NHSBT and work collaboratively to deliver solutions and training so that internal changes were manageable.
IJI suggested NHSBT use Scaled Agile Framework® (SAFe®) to help support the governance and manage both the organizational and technical changes. The ICT Leadership Team immediately took the view that this was the right methodology to achieve NHSBT’s goals and looked for an appropriate vehicle in which to introduce it. They decided the Organ Donation and Transplant (ODT) Hub Program as the most appropriate place to start implementation. ODT was initializing a hands-on software delivery and its timeline aligned well with the cadence of delivery that the framework provided. In addition, funding was in place and all the teams involved were based in one location. It would act as an ideal start and pilot for other elements of the organization to observe.
Because ODT was the first in a series of transformational changes, it would also be the model that other parts of the organization would take as an example, so it was crucial to get it right from the start. “IJI’s expertise with Agile transformation programs was a perfect fit with what we were aiming to do. Because we’d be working with new team groupings, we wanted to assist employees with transitioning to new working relationships and processes and also address the naturally risk-averse elements,” Dawson says. “We had to stay within regulatory standards. Rapid and vast change, if not done properly, has the potential to be disruptive, and actually hinder advancement. We chose Ivar Jacobsen International to provide company guidance, including coaching and training services, for the implementation of SAFe at NHSBT.”
A Proven Framework in SAFe®
SAFe offers a broad range of content and phased implementation for organizations looking to increase productivity, change system structures, increase employee training, add solutions-based management and develop greater efficiencies across company platforms and people.
Because proper preparation is critical to set the stage for smooth adoption, IJI delivered a two-day workshop, ‘Leading SAFe,’ that engaged managers interactively while explaining what SAFe was and how to implement it properly.
Meanwhile, Dawson and IJI also began to structure team units. They identified product managers and product owners working collaboratively to define their roles within SAFe and guided them on SAFe practices. Training roll-outs started with 10 or 12 courses, ranging from large-room sessions of 30-40 people for SAFe overviews and discussions of how it could work within NHSBT. These were followed over a two-month period by smaller and more interactively focused sessions for product managers and owners intended to further guide them and increase engagement. Sessions included six to 10 people with the appropriate attendees to maximize the interaction and cross-functional engagement—even at the point of training.
Meanwhile, program managers, with Dawson, started to work on organizational components, such as planning sessions across the organization (75 – 80 people). Planning included who would be involved, as well as logistical challenges. Dawson spent considerable time explaining the rollout and SAFe implementation to all levels of employees to facilitate understanding and new team groupings. IJI was on hand at all stages of implementation to guide, coach, teach, and assist teams to transition to SAFe, following a strategic Program Increment (PI) cycle that ensured SAFe was adopted by employees with secure checkpoints and feedback along the way.
Over the first Program Increment (PI), NHSBT’s ODT program came through on most of its deliverables. “It was amazing how much we were able to do in such a short time,” Dawson notes. “Now that we’ve done that, we can see what we need to do for future PIs and are continually able to refine and understand the teams’ velocity; it’s all falling into place and people really are committed.”
In that first PI, they were able to develop and learn to work effectively as a team and were able to deliver a committed, finite number of product features, as well as prioritize IT operations alongside the business element of the organization.
During the short introduction phase of three to four months, they were able to not only onboard and train all the teams aligned to the Release Train, they were also able to get the business component of NHSBT aligned with IT. There were challenges—such as integrating business managers into the teams and defining product owners—but “show and tell” sessions (every two weeks) and then a mid-PI retrospective helped the business see the benefits of the change process and really feel part of it.
“We would never have had that level of interaction in a waterfall delivery,” Dawson says. “To achieve the levels of understanding of both the technology and deliverables—along with all the interdependencies—would have taken months of calls, meetings, and discussions. We planned the next three months in just two days and now we retain that level of engagement on a daily basis.”
SAFe has become part of everyday procedures at NHSBT, with a series of checkpoints and loops that ensure communication is clear and efficient between teams and individuals. IJI understood that it was important to Dawson and NHSBT that change occurs but not at the cost of quality or control, and that value to the business should be equal to the ability of the organization to cope with the rate of change. NHSBT was able to build Agile confidence across the ODT program—senior stakeholders could support the cultural change because SAFe provides the governance required to build in the needs of Quality Assurance and regulators.
Successfully Scaling to New Programs
Having delivered the first MVP (Minimum Viable Product) of the ODT Program, it is clear that the introduction and embedding of SAFe within NHSBT has begun to provide early delivery of significant business benefits.
NHSBT has now run two SAFe big-room planning events for its Core Systems Modernization (CSM) Program, which is potentially a much larger program to replace its core blood offering system relating to blood, blood-derived products and tissues.
“We’re definitely not standing still,” Dawson says. “We are building momentum and will continue to run with the same rhythm that SAFe has provided us with our ODT program. Adopting SAFe has set in motion the skill development and mindset for successful organizational change even as we scale to new programs, release trains, and people.”