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    Owen J. Dahl, MBA, FACHE, LSSMBB
    The medical practice world is becoming more complicated, forcing healthcare leaders to change and improve offerings to patients to survive. Evaluating options for improvement should be done regularly, and looking at successful businesses in other industries is a great way to become agile.

    The concept of being agile is widespread in many high-tech firms, as it originated in the arena of software development, where vendors have long worked to quickly satisfy customer needs with frequent upgrades to apps.

    The agile manifesto for software development emphasizes four key principles:
    1. Individuals and interactions over processes and tools
    2. Working software (projects) over comprehensive documentation
    3. Customer collaboration over contract negotiation
    4. Responding to change over following a plan

    Rather than using a predetermined approach to a solution, the agile way promotes working together, focusing on what needs to be done, working together independently and honestly and responding to needs. An agile behavior or process uses cross-functional teams to respond to the ever-changing environment. Working with other teams and using a project management approach, an agile team seeks solid outcomes rather than focusing on outputs. 

    In healthcare, that could mean shifting focus to customer satisfaction, overall business growth or an improved bottom line as outcomes rather than on outputs such as MACRA participation or patient visits per day.

    Consider a cross-functional team of front-office staff, medical assistants, technologists, nurses and/or doctors who join forces to boost patient satisfaction. This could include reducing wait time or improving communication. Most practices already work on this, but the big difference in an agile workplace is that leadership gives the team the freedom to improve or solve the problem on its own rather than a solution being dictated from above. The administrative side instead provides guidance to a self-governing team and rewards success.

    An agile team values openness (considering the opinions and ideas of each team member), respect, flexibility and commitment to the specific purpose, which normally is focused on customers. Communication often is most effective through face-to-face encounters. While a team is self-governing, leadership can provide direction by emphasizing a commitment to continuous improvement, use of Lean tools, and reporting or milestones. A manager or project leader for a team may be appointed, formally or informally.

    The successful agile program requires a commitment by everyone in the organization:
    • To do things differently
    • To recognize the talent and skills of those who do the work
    • To adopt a cultural change.
    This also requires the need for individual(s) who understand the role of coaching and the agile concept. The coach will be critical to a team as its members evolve through their own process management and growth. 

    Agile terminology draws from the game of rugby, in which (as with most team sports) the major objective is to score. This is done through a “scrum,” as all participants have a role to play, they understand their role and they work together through sprints to score. On an agile team, the scrum results in a project being completed in a short period of time. 

    A recent Harvard Business Review article suggested that being agile at any size or scale should begin with an inventory of work to be done and a taxonomy of teams to help focus on particular components, including customer experience, business processes and technology.1 Consider the logic of this sequence of events: An organization begins by understanding customer needs and the work done on their behalf that brings value. Then, the organization identifies potential waste — work that does not add value. Finally, it is a process to integrate as much of the work through available technology, aligning business processes with customer need and an organization’s capability.

    The article also notes that an agile team should be:
    • Focused on a major business activity
    • Responsible for specific outcomes
    • Trusted to work together on the project at hand
    • Committed to the values and characteristics noted
    • Empowered to work with customers, both internal (fellow employees) and external (patients, vendors, referral sources)
    • Capable of creating a solution and implementing a pilot test
    • Supported by upper management for resources and for implementation throughout the business.
    How would this work in a medical practice?

    First, it would require recognizing that there are problems in your current process. These problems erode the joy of working, the satisfaction of providing care to patients, patients’ satisfaction with the care provided and financial outcomes. When you recognize this, decision-making processes and the overall culture of the organization should change.

    Second is the question of control. When a team is given flexibility and the authority to make changes without direct or total involvement with the doctor or administrator, the model of telling people how to do things no longer works. Leadership must recognize the need for change and give the team the authority to solve the problem while at the same time holding the team accountable for the outcome.

    Third, a practice should not be apprehensive about ditching a slower, methodical approach. A more rapid response to the market may lead you to the results necessary to survive or thrive amid industry consolidation, competition and referrals.

    Finally, an agile approach does not mean changing everything immediately. Start with a small area that needs focus: Identify team members, give them guidance, ask for milestone reporting and see how it goes. If successful, try the model in another area or give the team additional opportunities to continue to improve on what they first worked on. This pilot study approach will reveal results and could help lead the way to culture change and continuous process improvement.

    Your medical practice can and should be agile. As the medical practice industry seeks to improve, we can and should learn through the examples of other industries. We should not be afraid to seek improvements and change the basic model if it will lead to a more efficient and effective way of meeting our customers’ needs by bringing value and eliminating waste. An agile approach is a blueprint for long-term success in a high-performing medical practice.  


    1. Rigby DK, Sutherland J, Noble A. “Agile at scale.” Harvard Business Review. May-June 2018. Available from:

    Written By

    Owen J. Dahl, MBA, FACHE, LSSMBB

    Owen Dahl, MBA, FACHE, CHBC, LSSMBB, is an independent consultant with more than 40 years of experience managing medical practices and providing healthcare consulting services. Owen has worked as a chief executive officer (CEO) for a physician practice-management company with combined revenues of more than $75 million and 18 groups under contract, as CEO for a merged hospital with a 300-bed facility, and as president of a physician practice-management and billing company. Owen has presented at several state and national MGMA meetings, as well as to audiences from the Association of Otolaryngology Administrators, Association of Dermatology Administrators/Managers, American College of Rheumatology, American Academy of Dermatology and others. He has also authored Think Business! Medical Practice Quality, Efficiency, Profits; The Medical Practice Disaster Planning Workbook; coauthored Lean Six Sigma for the Medical Practice: Improving Profitability by Improving Processes, and written several articles and provided interviews for numerous journals. Owen is an adjunct professor at the University of Houston, Clear Lake, and is conducting a distance learning program at the University of New Orleans. He has also taught at Our Lady of Holy Cross College and Loyola University.

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