Improving Speed and Stability of Software Delivery Simultaneously at Siemens Healthineers

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Key Takeaways

  • At Siemens Healthineers teamplay digital health platform an organizational and sociotechnical transformation towards faster and more stable software delivery has been driven in a highly regulated medical domain. Both speed and stability of delivery improved at the same time. 
  • Driving the software delivery transformation in a larger software delivery organization operating in a regulated domain is going to take a significant amount of time because it requires fundamental changes to the regulatory quality management system. 
  • Measuring speed and stability of software delivery during organizational transformation towards faster delivery provides a valuable set of data-driven goals to work against and assess progress. 
  • The book “Accelerate” provides solid and popular research on successful software delivery practices based on a survey of about 400 software delivery organizations. It identifies clusters of low and high performing organizations based on speed and stability of software delivery. 
  • The identified clusters of organizations from “Accelerate” are the same for speed and stability. That is, speed and stability go together when it comes to software delivery. Fast delivery is stable. Slow delivery is unstable. This was confirmed by our transformation: speed and stability improved at the same time. 

Driving a software delivery transformation in the healthcare domain

In this article, we focus on the software delivery process at Siemens Healthineers Digital Health. The process is subject to strict regulations valid in the medical industry. We show our journey of transforming the process towards speed and stability. Both measures improved at the same time during the transformation, confirming research from the “Accelerate” book.

Domain

Siemens Healthineers is a medical technology company with the purpose of driving innovation to help humans live healthier and longer. Within Siemens Healthineers, the teamplay digital health platform is the enabler of digital transformation for medical institutions with the goal of turning data into cost savings and better care. The platform provides easy access to solutions for operational, clinical and shared decision support. It provides a secured and regulatory compliant environment for integrating digital solutions into clinical routines fostering cross-departmental and cross-institutional interoperability. Moreover, the platform provides access to transformative and AI-powered applications for data-driven decision support – from Siemens Healthineers and curated partners.

To date, there are more than 6.500 institutions and 32.000 systems from 75 countries connected to the platform. This makes more than 30 millions patient records accessible across institutions. The platform is open for SaaS and PaaS partners alike. SaaS partners make their existing applications available through the teamplay digital marketplace. PaaS partners develop new applications and services leveraging teamplay APIs.

The teamplay platform is cloud-based. It is built on top of Microsoft Azure, with privacy and security by design and default. The speed and stability of software delivery are central to teamplay. In 2015, the speed and stability were insufficient. With this insight, the transformation of the software delivery process at teamplay began the same year. The goal of the transformation was to make the software delivery faster and more stable. In order to achieve the goal, a large number of people, process, technology and regulatory changes were implemented over the years.

Transformation roadmap

As part of the transformation process, a whole host of new methodologies were introduced: HDD, BDD, TDD, user story mapping, pairing, independent deployment pipelines, Test DSL, SRE and Kanban. These are described in detail in a previous InfoQ article, “Adopting Continuous Delivery at teamplay, Siemens Healthineers”. The adoption and “stickiness” of the methodologies differed by team. The following picture maps the major milestones of the transformation over time.

In 2015 the need for transformation became apparent. As a nascent platform in the enterprise, delivered based on the enterprise-wide regulatory quality management system (QMS) for both hardware and software products, we were challenged by the product speed and stability demand we could not meet. The product owners were entering the digital services market totally new to the company at the time. There was no knowledge available as to which services would resonate with the users, which ones the users would be willing to pay for and which feature sets would be most valuable. Thus, the need for fast experimentation with ideas turned into software was high. Fortnightly or monthly software releases, and immediate hotfixes on-demand, would be welcome by the product owners. This was far from the software delivery the organization was set up for doing. It was obvious that the changes to the QMS would require significant expertise from the regulatory department. We started a long-term initiative towards making the QMS more lean. Internally in R&D, we increased our emphasis on automated testing.

In 2016, we started the BDD movement. This was done as part of the automated testing improvements. It had a broad impact on requirement specification, automated testing, test implementation, test reporting and understandability of test results by all roles. Whereas in the past requirements were big, the introduction of BDD forced the product owners to break them down into rather small user stories. Each user story started being broken down even further by the entire team into a set of small BDD scenarios (specification by example using the Given / When / Then statements). The teams welcomed these changes as they addressed a long-term developer concern that the requirements were too big and bulky to implement in a short time frame. Smaller requirements led to smaller automated tests. Smaller automated tests led to more stable automation. Despite these great and necessary improvements, the overall speed of transformation was rather slow. In terms of QMS changes, we performed an analysis of how the reduction of the number of roles, deliverables, activities and workflow breaks could be done while still maintaining the required regulatory compliance.

In 2017, we brought in Continuous Delivery consultants to speed up the transformation. Dave Farley from Continuous Delivery Ltd. provided strategic consulting as well as training for managers, product owners, architects and developers. Many consultants from Equal Experts Ltd. worked alongside our product owners, architects and developers at all locations in order to jointly deliver features using many methods and techniques new to our teams. Specifically, the application of BDD, TDD, user story mapping and pair programming was the focus during the consulting activities. By co-working with our teams, the consultants showed our developers, architects and product owners firsthand how to work in new ways, implement independent deployment pipelines, put in place initial observability, etc. In addition, we brought in medical QMS consultants from Johner Institute GmbH to discuss our analysis of QMS changes and confirm that the changes could be done while preserving regulatory compliance.

In 2018, we continued working with consultants adopting the Continuous Delivery ways of working in a deeper manner. This time it was not about introducing new methods, but rather ingraining the methods introduced before into the daily lives of teams and team members on a sustainable basis. In the spirit of the Japanese martial art concept Shu-Ha-Ri that describes three stages of learning on the path to mastery (Shu – follow the master, Ha – learn from other masters and refine your practice, Ri – come up with your own techniques), we transitioned from the Shu to Ha stage of learning. The goal was to embed the new ways of working to the point where the involvement of consultants would no longer be necessary to sustain the new practice. We reached a stage where Continuous Delivery ways of working became the standard for all new digital health products. On the…

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