Doing a retrospective in a hospital Trust

I’m a Deputy CDIO — which means a whole range of things — but what it’s meant in the last few weeks is introducing some Agile practice into the Trust.

We’ve been using a Kanban Board to manage our response to Covid-19 and we’ve started doing retrospectives. Initially within the Digital portfolio but it’s taken off so well we’re using it to support the Trust wide Reset activity.

If you’re working in a digital fashion already, if you’re part of GDS or NHS Digital you already know what a retrospective is, and you might think it an obvious thing to do. But imagine a typical NHS Trust, with mostly clinical professionals, use of Agile terminology and practice is still a pretty novel thing to do. So let me share my experience of introducing some Agile practice to a hospital Trust…

Why do a retrospective?

Because:

• It’s a safe space for a ‘no blame conversation’ — as per Norm Kerth’s prime directive of retrospectives “Regardless of what we discover, we understand and truly believe that everyone did the best job they could, given what they knew at the time, their skills and abilities, the resources available, and the situation at hand.”
• It gives everyone a voice — it’s democratic — and this is reinforced by everyone having an equal vote (if you vote)
• It creates a shared understanding — which means any actions agreed are by the whole group
• It’s time-bound (max 2 hours) — so guards against prolonged discussions
• It encourages ‘one thought per card’ — which untangles people’s ‘streams of consciousness’
• It’s time out to reflect — to look back
• It’s normally done as part of an Agile sprint cycle — so after every sprint (e.g. 2 weeks of activity) a retro is done — ostensibly to celebrate what’s been done well, to reflect on what went less well, and to identify things that could be improved. It’s part of the review, retro, planning cycle.
• Doing it virtually saves post-its, self-documents (and avoids people’s terrible handwriting), and allows people to join no matter where they are.

The tools we looked at

I shouted out to Twitter-land and old colleagues mentioned a number of tools — I centred on Retrotool and FunRetro.

On balance I like Retrotool as it has the built in ‘actions tab’ and you don’t need to login, but I like the suggestions for retro structures/templates in FunRetro — see below:

I mean, who doesn’t want to do an Elvis retro???? In Retrotools you can create as many columns as you like, and change the titles of those columns — so hey — why not mix and match?

We also did our due diligence as we knew we might use this quite widely — Retrotool is a Polish company and they use Google Commercial Cloud datacentres in Belgium. This means the data doesn’t leaves the EU, and under the transition period we still count as EU for these purposes.

In terms of formal guidance the only thing we state is that retros should not contain any personal data.

How we did it

• Retros traditionally have 3 categories or boards e.g. ‘what made you mad, bad, sad’ and then actions
• We booked in 90 minutes for a Teams meeting and we had 13 people on the call
• The retro board was shared beforehand and people asked to keep cards private before we met, but to pre-populate if they wanted to (it might allow deeper thought)
• The Retro board lends itself to one thought per card — and we reinforced this
• In the meeting we set the scene and reminded it was ‘no blame’. We didn’t on the day, but elsewhere you’d check how safe people felt in airing their views — usually on a scale of 1 (not safe) to 5 (very safe). If you do this, be aware you need a plan if lots of people don’t feel safe (i.e. change the retro, stop the retro etc)!
• In this retro we used the Marie Kondo groupings — so we had 3 categories ‘what brings joy, what will be thrown out, what will be upcycled’
• I knew time was tight, so I committed to doing the actions afterwards, but making sure we had good consensual discussions to inform the actions
• We agreed timings — which was 20 mins for each column — roughly 5 mins to write cards privately and 15 mins to discuss (I knew we’d overrun)

And we began…

• We were all on Teams so I used the list of people to get folks to move their cards from private to shared
• After each person we had a ‘clarity check’ i.e. did the group understand what the person had written
• We tried to group cards as we went along, but in practice the interface was a little sticky so grouping wasn’t as smooth as we would have liked (grouping is useful, not just to de-clutter the screen, but also to group comments when you download the record)
• As we moved cards up I gave some comments to try and keep the mood jovial ie when Richard posted a single card in one column I said “single but strong”. At least I thought it was funny…
• Inevitably the cards/comments were not even across all columns — there was less stuff to ‘throw away’ than ‘keep’ for example
• In other retros you would vote on what cards/or clusters to discuss in more detail — particularly if some thorny issues cropped up. We didn’t on this occasion (a) as we were tight on time but (b) because we had a lot of common themes
• I made sure before we ended the call that we had consensus on the actions to take forward, and when I’ve finished writing them up I’ll write another blogpost!

Besides the issues we talked about, and the actions we flagged — it was also a ‘good vibe’ thing for the team to do — which was nice given this was a ‘response to Covid-19’ retro.

And I tweeted about it — because as well as doing things — we like to talk about them openly!

An ode to DMs

As a postcript — in Retros I have always been the Product Owner — and the Delivery Manager did all the hard work. Having carried out that DM role in recent retrospectives (however badly…) it reinforced the aspects of ‘servant leadership’ that many DMs perform, and often do thanklessly.

So, I’d like to give a shout out to Sarah, Dom and Mo at NHSD — I took you for granted! I probably didn’t appreciate enough your diplomacy skills, your hard work to maintain harmony, and also to manage difficult conversations when needed.

So a belated thanks!

(I did thank you at the time, just brings it home to me more….)