Agile and Lean concepts used by software developers have already been applied to developing computerized practice guidelines intended to standardize recommendations for EHR integration. However, these practices have not been applied to teams developing clinical practice guidelines despite their use in industries as diverse as automobile manufacturing, healthcare, and aerospace engineering.
Agility: ability to move quickly and easily
Guideline developers should strive to achieve agility in their programs. Agility is necessary to facilitate the release of timely, relevant, and updated recommendations for an entire portfolio of guidelines. Agility will allow guideline developers to be better prepared for future emergency situations, such as a global pandemic, without the need for resorting to the heroics seen in the COVID-19 guideline development. Agility will allow guideline developers to elevate the value they can create, while also creating better ways of working that result in higher fulfillment and less burnout.
To achieve agility in guideline development, guideline developers will need to:
map their development practices & processes and determine how to best establish “flow” with the goal of releasing completed high quality and reliable recommendations as soon as possible;
create feedback & feedforward loops that improve the quality and reliability of their work, with the goal of simplifying and automating as many feedback & feedforward loops as possible;
establish a culture of continual learning and experimentation, with the goal of promoting continuous improvement in their structures, processes, and practices.
To begin building agility into their guideline program, guideline developers should first prioritize their entire backlog of outdated recommendations within their portfolio (and any new topics identified and prioritized for immediate attention) to determine where to focus their initial efforts. Once the most valuable of the outdated recommendations have been identified, guideline developers should work on updating the backlog. Guideline developers should balance their workload to allow capacity for addressing future short-term needs (e.g., publication of practice-change evidence) and reserving time for innovation efforts.
What’s Next?
Achieving agility in guideline development is a learning journey, not a simple process change. This learning journey will require each guideline development organization to identify the structures, systems, and processes that work best for them. Organizations will need to:
maintain an appropriate sense of urgency to sustain the change efforts that will be required;
define the leadership models and team structures that facilitate their work;
establish an understanding and vision of what “agility” means to their organization;
identify the target practices and learning models that will help them work towards this vision.
Agile Guidelines will explore the application of ideas such as Lean, Theory of Constraints, Flow, Toyota Production Systems, Continuous Improvement, Learning Organization, and Agile & Agile 2 to the development of clinical practice guidelines.
The first step: Agile Guideline Development Framework
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