An Agile, Scaled Approach to Governing and Delivering Health IT Modernization
BY JILLIAN GATES AND MICHAEL ROSE
An Agile, Scaled Approach to Governing and Delivering Health IT Modernization
Large-scale health IT modernization efforts often adopt Agile frameworks with the expectation that better outcomes will follow. In practice, many leaders and practitioners have seen frameworks implemented without meaningful improvement in delivery, governance or mission impact, often still experiencing late risk discovery and unclear trade-offs that result in avoidable surprises.
This article clarifies how an Agile, scaled operating model, when grounded in mindset and reinforced by disciplined practices, can support governance and delivery in a complex federal environment, using our support of the Department of Veterans Affairs (VA) Electronic Health Record Modernization (EHRM) initiative as context.
Mindset First, Structure Second
Successful Health IT modernization is driven less by any single framework and more by how organizations think, learn and adapt under real-world constraints. At VA, our work supporting EHRM is grounded first in an Agile mindset, one that prioritizes adaptability, transparency, shared ownership and continuous learning in conditions defined by uncertainty, interdependencies and high operational risk.
Like many federal agencies, VA uses the Scaled Agile Framework (SAFe) as part of its modernization approach. However, SAFe is not treated as the starting point or the goal. It serves as the minimum structure needed to coordinate work across multiple teams, vendors and stakeholders while preserving the ability to respond to change. Agile principles provide the foundation; SAFe provides the mechanisms that allow those principles to function at scale.
Rather than declaring maturity outright, progress in the EHRM effort shows up in observable ways. Teams increasingly plan in shorter horizons and adjust based on feedback. Leaders use transparency as an operational behavior, not just a reporting requirement. Risks, dependencies and trade-offs are surfaced earlier, enabling decisions to be made closer to the work. Taken together, these patterns reflect measurable progress toward a more consistent Lean-Agile operating model, without sacrificing adaptability.
Why Agile Matters at Scale in Health IT Modernization
Large-scale Health IT modernization rarely follows a linear path. Requirements evolve through engagement with clinicians and operational staff. Technical dependencies span systems and vendors. Policy, security and compliance constraints shape delivery choices. In this context, Agile principles are not aspirational, they are necessary to manage complexity responsibly.
Agile at scale enables organizations to:
Respond to change without losing alignment
Keeping priorities tied to mission outcomes even as conditions shift
Shorten feedback loops
Allowing teams to test assumptions, identify issues and adjust before risks compound
Increase work visibility
So leaders can see what is in motion, what is blocked and where decisions are needed
Reduce late-state surprises
By surfacing risks, dependencies and trade-offs early enough to act on them
Incremental planning that supports learning
Teams plan in increments that acknowledge uncertainty rather than attempting to lock in long-range commitments based on incomplete information. Near-term objectives are defined clearly, while longer-term plans are treated as hypotheses to be refined. This approach reduces decision latency and allows teams to adapt as technical and operational realities emerge.
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Incremental planning
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Work visibility that strengthens governance
Tools such as Jira and Kanban boards are used to make work, flow and constraints visible, not simply to track tasks. Leaders and stakeholders can see cycle time trends, aging work and blocked items, enabling earlier intervention. This transparency supports governance by improving decision quality without slowing delivery.
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Work visibility
02
Coordination across technical and operational boundaries
In EHRM, technical delivery and operational readiness must advance together. Shared planning forums and SAFe constructs help teams identify dependencies and align sequencing. More importantly, they create shared understanding across disciplines, reducing friction and rework as priorities evolve.
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Coordination
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Ceremonies as enablers, not obligations
Structured ceremonies support alignment and continuous improvement when their intent is preserved. Teams are encouraged to adapt cadence and practices based on outcomes rather than perform rituals for compliance. When retrospectives lead to measurable adjustments in flow or quality, ceremonies reinforce trust and accountability rather than bureaucracy. Both teams and leaders share responsibility for ensuring those improvements are implemented, monitored and sustained over time.
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Ceremonies as enablers
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Governing Change in a Dynamic Environment
Modernization work at VA operates in conditions where change is constant. Agile principles provide resilience by reinforcing:
- Short learning cycles to validate decisions early
- Incremental delivery to limit risk exposure and enable course correction
- Clear visibility into work, dependencies and constraints
- Shared planning that keeps teams aligned while adapting
SAFe supports these behaviors by enabling coordination at scale, but it is intentionally applied as a supporting structure, not an additional layer of control. Governance is achieved through visibility, disciplined planning and timely decision-making rather than rigid stage gates. That visibility enables clearer priority trade-offs, allowing leaders to make informed decisions as conditions and constraints change.
Why This Matters to the Mission
This operating model is not an end in itself. Improved flow, faster feedback and clearer decision-making directly support operational readiness, system reliability and ultimately the Veteran and clinician experience. When delivery teams can adapt quickly and leaders can see and act on real signals, modernization efforts are better positioned to meet mission needs without sacrificing stability or trust.
Final Thoughts
Agile did not originate as a framework; it originated as a mindset for navigating complexity. In large-scale Health IT modernization efforts like VA’s EHRM, that mindset is the enduring capability. SAFe provides the structure that allows Agile principles – adaptability, transparency, learning and shared ownership – to operate coherently across teams and organizations.
As this work continues, progress is measured not by adherence to a framework, but by improvements in flow, visibility, decision-making and outcomes. When culture leads and structure supports, organizations are better equipped to govern complexity and deliver value in environments where change is the norm, not the exception.
About the Authors:
Artemis Health Communications Expert Jillian Gates brings deep experience translating complex health IT modernization into clear, human-centered stories that drive adoption and trust. She leads an award-winning communications team supporting VA Electronic Health Record Modernization.
Mike Rose is a senior IT and Agile delivery leader at Artemis with more than 20 years of experience supporting complex, mission-critical federal environments. An expert in the Atlassian ecosystem, Mike specializes in Agile and SAFe enablement and workflow automation that improves visibility, flow and governance at scale. He has led Agile transformations, optimized ITSM and DevOps pipelines and trained thousands of practitioners across DoD, FBI, and civilian agencies, with a consistent focus on secure, compliant delivery that strengthens operational outcomes.