What can we learn from the standards of aerospace industries that can help us improve our Definition of Done?
Quite a lot, as it turns.
Based on learning from The Checklist Manifesto (Atul Gawande) and research by Peter Pronovost on patient safety, in this talk I make an analogy from real life ICU stories to software teams.
And finally also provide a short guide to help you bring your DoD to higher standards, one notch at a time
6. TEXT
LINE INFECTIONS
▸ ICUs put 5m lines each year
▸ 4% become infected, causing blood-stream infections
▸ In the US only 80,000 people become infected each year
▸ 5%-20% are fatal!
▸ Survivors ‘enjoy’ extra week in hospital
▸ Can be dropped to almost zero
10. CAN YOU IMAGINE JAVA RELEASING
A WORKAROUND, AND WITHIN ONE
WEEK ALL JAVA PROGRAMMERS
ADHERE?
AIRCRAFT MAKERS CAN. AND DO.
11. A PILOT NOT FOLLOWING
CHECKLISTS WILL NOT BE
ALLOWED TO FLY THE AIRCRAFT
12. PETER PRONOVOST
▸ Founded Quality and Safety group
in 2003
▸ Studied ICU infections since 2001
▸ Came up with a low tech tool that
saves 1,000s of lives
14. PART I : MEASURE. DON’T FIGHT CULTURE.
▸ Asked nurses to record adherence to the steps
▸ In one month >30% doctors missed at least one step
15. PART II : APPLY. HACK CULTURE WITH DATA
▸ Authorise nurses to stop doctors if they missed a step
▸ Over one year 10-day line infections dropped from 11%
to zero
▸ Outcome: reduction of 43 line-infections, 8 deaths, $2m
in costs
▸ All thanks to a simple checklist
16. CULTURE AND PATIENT SAFETY
▸ The main barriers are the lack of collaboration and a
culture that is resistant to change.
▸ There is also a lack of systems integration.
You can't buy a functioning ICU or hospital like you buy a
finished car.
17. CULTURE
▸ Doctors:
▸ Often over confident
▸ Believing things will go right
▸ Nurses:
▸ Typically have clear lines of authority for dealing with failure
▸ Often reluctant to question doctors
▸ Hospitals
▸ Typically don't pressure doctors for fear they will leave
▸ ……Sounds familiar?
18. PRONOVOST CHECKLIST
▸ A simple, easy to follow, checklist
▸ Effective
▸ When followed, line infections are almost eliminated
▸ Hard to implement
19. A PILOT NOT FOLLOWING
CHECKLISTS WILL NOT BE
ALLOWED TO FLY THE AIRCRAFT
20. A DOCTOR NOT FOLLOWING
PRONOVOST CHECKLIST WILL NOT
BE ALLOWED TO THE ICU
…BUT HOW?!
23. WHEN DOD MET CHECKLISTS
▸ Big Do-Confirm Checklist
▸ Really hard to implement
24. THIS IS XP’S TEST-FIRST READ-DO CHECKLIST
▸ Red
▸ Green
▸ Refactor
25. THIS IS SCRUM’S DAILY STANDUP READ-DO
▸ Answer three questions:
▸ What have I/we accomplished since last standup?
▸ What will I/we accomplish by our next standup?
▸ What is holding me/us back?
▸ Complete the round in less than 15 minutes
27. PAUSE POINT
▸ Definition of Done - when accepting a story
▸ Red-Green-Refactor - when starting a development task
▸ Daily standup - every day at x:xx am
▸ Fix CI - whenever build breaks
▸ …
29. HOW TO GO ABOUT IT?
1. Set a DoD change group, including senior management, middle managers and
engineers
•Autonomize engineers to act; Get managers to help with resources
2. Find an aspect of DoD to improve
3. Identify good pause-point
4. Come up with a preliminary checklist
5. Start with measuring data. No change in behaviour required.
6. Autonomize the right people to follow and enact checklist
7. Experiment frequently with checklist steps
8. When mastered, go back to (2) - find a new problem
9. Repeat forever
30. REAL LIFE EXAMPLE - MONITOR CUSTOMER LIVE SYSTEM
▸ Pause Point - Every day immediately following the daily standup
▸ Open customer monitoring dashboard
▸ Look for anomalies
▸ Urgent problem? Fix now
▸ Not urgent? Open defect for next sprint
▸ Not enough data? Add story to improve dashboard
▸ The team meets with manager and PO to prioritise defects and
dashboard changes
31. PRACTICAL TIPS
▸ If it’s not painful, maybe it’s not worth investing the effort
▸ Make it fun, wherever possible
▸ Don’t push people (Newton’s 3rd Law)
▸ Autonimize people to experiment and change
32. SUMMARY
▸ DoD = The Set of Standards
▸ Typically a big Do-Confirm Checklist
▸ Complement it by a collection of Read-Do Checklists
▸ If it’s not hard, it’s probably not done right
▸ It’s a journey, not a milestone. Think PDCA
45. SOURCES
▸ https://en.wikipedia.org/wiki/Peter_Pronovost
▸ The Secret to Fighting Infections, LAURA LANDRO, WSJ March 2011
▸ The Checklist, Atul Gawande, The New Yorker, December 2007
▸ The Checklist Manifesto, Atul Gawande,
▸ Code The Unit Test First, eXtreme Programming website,
▸ The Scrum Guide,
▸ www.vox.com/2015/7/9/8905959/medical-harm-infection-
prevention
46. IMAGES
▸ Remove before flight https://www.flickr.com/photos/8058853@N06/2502418431/
by Helgi Halldórsson
▸ BA38 crash https://upload.wikimedia.org/wikipedia/commons/5/5e/
BA38_Crash.jpg
https://en.wikipedia.org/wiki/File:Ice-Trent-800-Heat-Exchanger.PNG
▸ Pronovost Checklist http://www.vox.com/2015/7/9/8905959/medical-harm-
infection-prevention
▸ Recipe https://www.flickr.com/photos/maggiejane/4188717339/
▸ Before I die https://www.flickr.com/photos/javisanchezfotos/11690265575/
▸ Play / Rec / Pause Stop https://pixabay.com/en/buttons-stop-play-pause-
record-35531/