Thoughtful Scrum for Health and Wellness(Or…how I used Agile Principles to Lose 40 lbs.)

Alexander BrownScrum Gathering, San Diego

April 10th, 2017

1

Goals for this session

Explicitly NOT to sell a new weight-loss method!

• Use personal weight loss experience to illustrate thoughtful Scrum

Discuss how to think creatively about applying Agile principles and Scrum/XP practices in new and creative ways

Get back to the empirical roots of Agile vs. dogma or canned methodology

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Introductory context – about me

Alexander Brown – Principal, Glaessel Ventures & CST• Connect thoughtful strategy, consumer insight and effective product/service development & delivery • Help range of companies implement agile transformations that achieve sustainable success

Affiliate Partner, Recon Strategy & Topline Strategy• Focus on Healthcare and eCommerce strategy, respectively• Expertise in consumer behavior, product & service innovation.

COO, Scrum Inc.• Learned Scrum directly from Scrum creator Jeff Sutherland • Implemented Scrum as organizational framework for running the firm…act as ”living lab”• Developed Scrum Inc’s Agile Leadership, Product Owner, and Scaling Scrum curricula • Implemented quantitative backlog prioritization that tripled company profits in 18 months

Principal, Boston Consulting Group• Led >20 projects to improve competitive positioning, transform fortune 100 companies to leaner and

more agile operations. • Cases in healthcare, retail/consumer, IT, manufacturing, finance, service outsourcing, government.

Education• B.S. and Masters in Engineering from Cornell University• MBA from the Wharton School of the University of Pennsylvania

Homebrewer and avid foodie!

alex@glaesselventures.com

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Context is very important!!! Everyone’s path is different - how I reached the point of wanting to lose weight

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1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Cornell University Cambridge Systematics Wharton Business School

The Boston Consulting Group (BCG)

Scrum Inc. & Recon Strategy

WeightWaist size

PhysicalActivities

Weight &Waist Size(approx.)

• Hiking• Rock Climbing• Squash (intramural)• Rowing (briefly)

• Hiking• Rock Climbing• Mountaineering• Cycling

• Hiking• Climbing• Cycling

• Hiking (infrequently)• Sailing• Running (off and on)• Fly fishing

• Hiking (less frequently)• Gym (weight training)• Fly fishing

Era

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Motivation: Obesity a large and growing health problem worldwideSolution clear, but hard to implement because requires changing patient behavior

Could the principles of Agile and the mechanics of Scrum be effectively used to address this challenging societal problem?

But weight gain/loss actually formulaic and well understood

= -Total calories

consumedΔ Weight

Active calorie burn

Base metabolic

rate+f

What makes it difficult is that individuals’ behaviors must maintain this balance:• Day after day over years of our lives, even when we don’t focus on it• In spite of distractions from regular physical activity and temptations to eat more than we need• And overcome the reality that our bodies are genetically designed to gain weight over time

In the US alone, Obesity causes or contributes to health problems costing from $147B to $210B1 annually

Source: 1) Cawley J and Meyerhoefer C. The Medical Care Costs of Obesity: An Instrumental Variables Approach. Journal of Health Economics, 31(1): 219-230, 2012; And Finkelstein, Trogdon,

Cohen, et al. Annual Medical Spending Attributable to Obesity. Health Affairs, 2009

Eat fewer calories Get more

activity

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Clear Goals and a Definition of Done are EssentialThe pre-determined Goals for my weight loss experiment

Reduce waist size by at least one inch

• Use weight as leading indicator that can be measured regularly & easily

• Weight = Velocity in a Scrum context

Don’t lose strength or have otherwise unhealthy weight loss. Stop or slow down if:

• Weight loss starts to impact strength want to lose fat, not muscle

• Lose more than 5lbs per week rapid weight changes generally considered unhealthy

Don’t be the guy who neurotically counts calories or only eats kale smoothies

• Emphasis on minor behavioral shifts vs. draconian changes

• Don’t entirely deny anything, since I will only crave it more

Do this in a sustainable way that can keep going indefinitely

• Keep the weight off for at least one year before declaring victory

• Ensure that you are actually happier with the new norms than before

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Always helpful to go back to first principles…Agile and Lean principles applied to this problem

Lean/Agile Principle Description What this means in practice

Take a “Systems” perspective

Keep the big picture in mind and don’t get lost in the details

• Have clear goals for the experiment• Ensure what you are measuring actually ties back to the goals• Remember the big picture – Don’t obsess on minor details

Divide and conquer Break complex or difficult goals, activities or behaviors into smaller independent pieces to make them more manageable

• Track progress in one-week “sprints”• Define behavior changes and clinical guidance explicitly as discrete

“user stories” to accomplish

Make work visible We focus on what we can see and measure progress against, so ensure key goals and needed activities are highly visible

• Have a Scrum board of stories to accomplish• Use tools to track weight, steps, activity, etc. regularly in visible place• “Legitimizes” health as level with work goals

Inspect & adapt for continuous improvement

Use regular experiments and structured feedback to inform and update the plan, hone results, and eliminate waste

• Conduct explicit cause/effect experiments with different foods,activities, and meal times

• Revisit weight goals every few sprints• Increase activity targets over time

Focus and prioritizeYou won’t always be able to do everything, so focus on what is important

• Prioritize stories from things to always do to thing to try and do• Accept that you won’t do all of them every week

Avoid absurdity and unreasonableness

set reasonable incremental goals and accept that there will be variation and backsliding in progress

• Recognize that weight fluctuates and will sometimes go up too• Never set near-term weight loss goals >5lbs• Allow for +/- 5lb weight range• Don’t “forbid” any foods entirely, just adjust mix

Leverage gamification Find ways to “keep score” and use this mechanism to provide emotional incentives

• Set calorie/activity targets or construct games to incent new behaviors• Leverage social influence, if helpful

Have FUN!“If you aren’t having fun, you aren’t doing it right!” -Jeff Sutherland

• Make sure you are still eating foods and participating in physicalactivities you actually enjoy

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“User stories” to meet my weight loss goals came directly from tailored root-cause analysis of behaviors I wanted to change

…Resulting in a backlog of 7 user storiesfor losing weight

As someone trying to lose weight, I want to…

Two weeks of tracking & root-cause analysis identified several key insights…

…Eat my last meal of the day before 8:00pm, because my body stores unspent calories overnight as fat

…Walk at least 7,000 steps/day (avg. >10,000 steps/day over any 30-day period) to ensure I maintain a minimum level of regular activity

…Only drink alcohol with others, since this is when I enjoy it most and otherwise it is a lot of empty (delicious, but not nutritious) calories

…Get dedicated exercise (gym, running) at least twice a week because this helps maintain the muscle mass that consumes lots of calories

…Try to get at least 7 hrs. of sleep each night, because when I don’t my body tries to substitute calories for rest

…Be mindful of bread, pasta and sugars I eat to shift mix to more vegetables, because these carb-rich foods are very calorically-intensive

During “baseline”, I tracked calorie intake

closely in addition to counting steps and

recording physical activity and sleep

• Ate dinner very late (often around 10pm)

• Standard serving size considerably smaller

than I thought

• Surprising share of calories from beer, bread,

pasta and cheese

• Generally active… (~6,000 steps/day, gym

2x/week)

• …But occasional very inactive or big meal

days drove majority of net positive calories

• Not sleeping as much as I thought (only avg.

6hrs per night, with some nights much less)

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…Not have second helpings at meals, because this adds significant calories without exploring new tastes

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The results were shockingly good – Lost 40 lbs in the first 6 monthsReal success is long-term weight maintenance in spite of life’s inevitable interruptions

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Initial baselining

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Europe for Christmas holiday (relaxed discipline, no access to scale)

Started playing squash regularly

(keeping weight up becomes challenge)

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Long business trip to Chicago

Actual weight Target weight range Average daily steps

Minimum step goal a key activity driver

during depth of winter

Noticeable reduction in strength below 170lbs sets weight target floor

Significant natural increase in steps during vacations

Start rowing regularly, significant body comp.

change (relaxed carb user story for summer)

Step count declines based on hours spent on the

water without pedometer relax step goal for summer

New Apple watch has better step count integration during

workouts

Christmas 2017 with family

followed by 2mo. travel-heavy

project

2016 20172015

Playing regularly in

Squash league

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It has not all been smooth sailing…

Prioritizing healthy habits involves sacrifices• Earlier dinner times means few weeknight meals with

my wife – which I really miss• Making time for exercise means saying no to some

projects with terrible work-life balance

Gamification & continuous improvement can go too far• Overshot weight goals, and started having trouble

maintaining weight

New routines can also be broken• “Real life” constantly tries to insert itself• Deadlines, stress and business travel big disruptions• Takes about 6 weeks to cement new routines, and

only about 2 to break them

Challenges with maintaining the program

Losing weight defies cultural norms and expectations• Weight gain as a sign of age, wisdom and career

progression

Body fat has useful traits too - you notice its absence• I get cold & intoxicated more easily than before

The experience has changed my relationship with exercise and food, not always for the better• Now get cranky during long periods without exercise• Started to think in terms of “enjoyment return on

calories invested”

And not all outcomes are desirable

…However, at the end of the day I feel terrific, and would not choose to go back

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Photo source: iStock www.eanlybia.com; feelgraphics.com

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• Already owned (no new cost)• Powerful & multi-functional• Carried in pocket most days

• Not carried for most exercise activities (mis steps)

• No explicit activity tracking

• Easy food scan, lookup, entry• Charts and historical reports• Nutritional tracking• Free app

• Limited, one-way link to apple health data

• No ability to export data• Manual entry process

• Better exercise/activity log • Daily & weekly goals• Tracks sleep & UV exposure• Multi-function (eg. mail, text)

• Poor apple data integration• Not waterproof• Bulky & fragile form factor• Short battery life• Product discontinued by MS

• Excellent apple data linkages• Powerful multi-function tool• Hydration tracking• Waterproof (swim & row)

• No UV exposure tracking• Only daily goal gamification• Less flexible activity options

Tools & technology can help make new routines easier and more transparent, which has important implications for behavior change

My Diet Diary App Microsoft Band Apple Watch 2iPhone

Roles/TasksSupported

Pros

Cons

All technologies had minor (+/- 10%) errors or inaccuracies in tracking steps, calories, sleep or forecasting weight. But the important thing is INCREMENTAL PROGRESS, not absolute accuracy!

Data nexusStep counter

Calorie consumption logWeight forecasting toolActivity tracker

Sleep monitorActivity & goal tracker

Step counter

Activity & goal tracker

Step counter

Product

Sleep monitor

11

What does “empiricism” mean in this context?

Experiment with the Agile process

Examples:

• Add and subtract user stories to determine their effectiveness or lack of effectiveness

• Try different activities – what’s enjoyable, works with schedule

• Do/don’t track calories consumed explicitly or set activity goals

Experiment with different supporting tools

Examples:

• Compare accuracy and ease of use ‐ +/- 10% steps and calories

• Calibrate forecast weight from calorie counter

‐ Shoot for forecast ~10lb less than current weight

Fine tune balance of diet and exercise

Examples:

• Test the impact of specific foods on weight

‐ Granola vs. Greek Yoghurt for Breakfast

• Test the impact of different quantities of exercise

‐ 30 vs. 60 minutes of running

Results in sustainable and very deterministic and quantified ability to control weight

A B C

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Conclusions: How did I do against my original goals?

Reduce waist size by at least one inch• Use weight as leading indicator that can be measured regularly &

easily• Weight = Velocity in a Scrum context

Don’t lose strength or have otherwise unhealthy weight loss. Stop or slow down if:

• Weight loss starts to impact strength want to lose fat, not muscle

• Lose more than 5lbs per week rapid weight changes generally considered unhealthy

Don’t be the guy who neurotically counts calories or only eats kale smoothies

• Emphasis on minor behavioral shifts vs. draconian changes• Don’t entirely deny anything, since I will only crave it more

Do this in a sustainable way that can keep going indefinitely• Keep the weight off for at least one year before declaring victory• Ensure that you are actually happier with the new norms than

before

Actual OutcomesStated Goals

• Reduced waist size from 37” to 33”• Reduced weight from 205lbs to a stable 165-170lbs

• Maintained strength• Found I could control rate of weight gain and loss by

adding or withdrawing marginal user stories in each sprint

• I Do still eat all sorts of foods…• …But experience has profoundly changed my

relationship with food (e.g. thinking about caloric costs as well as benefits)

• I feel great, have much more energy, and am noticeably more productive in work

• It now just feels like the new normal

?

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Takeaways: Five broader implications for adapting Agile to novel applications

1. Consider the specific context in which you are working• What are you hoping to achieve?• What constraints do you have? – constraints can actually force better solutions• Which Agile principles are most relevant/important to leverage?

2. Set clear goals and a definition of success up front to serve as your “North star”• A clear Definition of Done is both a minimum quality check and a finish line

3. Make sure tracked metrics tie back to the goals and outcomes you want• Include both leading indicators and core metrics• Err on the side of making metrics more visible – it can drive unexpected innovation

4. Return to “core principles” rather than following “rules”• Rules are inevitably wrong in some contexts, whereas there may be many actions consistent

with core principles

5. Use empiricism to your advantage• Deliberately structure experiments, measure outcomes and refine your process as needed• Be honest and open about what is working and what isn’t

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QUESTIONS?

Union Boat Club 3.0 Team – 2017 Massachusetts squash championships, March 30, 2017