Lessons from Software Development Could Help Create Dynamic Clinical Practices

It amazes me how seemingly disparate ideas, when considered together, can create new ways of seeing the world. Bear with me for a minute, and I’ll share an insight I’ve received lately based on two seemingly unrelated ideas.

Here’s the first idea: NY Times bestselling author Bruce Feiler gave a TED talk a couple of years ago about how to apply the concept of agile programming to families. He said that when using an agile programming model, teams meet once a week to answer three questions:

The project leader doesn’t answer the questions; the team does. And the team decides how to respond, based on their understanding of the answers. Many business books have been written about the efficacy of using this approach in situations that have nothing to do with programming. Feiler introduces the idea as a way to create calmer, happier families with parents who are less stressed. He describes a model that includes children both in setting goals for the week and in judging performance.

Here’s the second idea: Medical Economics recently published an article titled Millennials in Medicine that discusses how the preferences of younger doctors and patients might reshape the clinical experience. In the article, Jeffrey Bendix, senior editor, wrote that “creating an atmosphere of inclusiveness through transparency and ongoing dialogue” is essential to integrating younger doctors into medical practices.

Considered together, I think Bendix’s observation and Feiler’s out-of-field application of agile programming could provide an emerging model for clinical medicine. Bendix quoted Dea Robinson, director of the Medical Group Management Association Healthcare Consulting Group, as saying, “It’s amazing what you can do when you get everyone in the room together and say, ‘here’s the problem, what do we do about it?’ They [millennials] would much rather help solve the problem than be told the solution.”

Robinson is describing one aspect of agile programming – the weekly team meeting – and I think the model could work for everyone on staff, not just younger doctors. I also believe implementing such a model is important for two reasons.

The first is that millennials (people born between 1980 and 2000) are the largest population cohort in the United States, and have recently become the largest cohort in the workplace. The number of doctors in that age range interested in entering clinical medicine, however, is declining. In 2009 about 29 percent of graduating medical students planned a career in clinical practice. By 2013, the number had decreased to 25 percent. Conversely, the number of millennials planning to work as salaried hospital employees has increased, as has the number of those planning careers on university faculties. As access to healthcare increases, however, the profession will need more doctors practicing in clinical settings.

As millennials continue to enter the workforce, not all Baby Boomers are ready to retire. People in the trailing edge of the cohort still have 10 years before they will retire and members of Gen X will have longer still. For at least the next five to 10 years, practices could employ doctors in three different generational cohorts. Finding management structures that meet the needs of all three groups will be essential, and involving all staff members in practice decision-making could be a method for helping multigenerational partnerships thrive.

And multigenerational practices can only be good for patients. The experiences from each generation can help the others provide increasing levels of excellence in patient care.

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