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Transforming a Healthcare Technology Company’s Quality Assurance Organization

Healthcare Services | QA and Testing

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A healthcare technology company partnered with TEKsystems to create and execute test plans for two major projects, as well as develop an overall testing strategy and quality assurance practice model.

Founded in 1998, our client is a national provider of technology-enabled solutions for Medicare and Medicaid plans. Our client, a subsidiary of one of the largest customer-owned health insurers in the U.S., serves 24 client plans and processes claims for over three million members annually. TEKsystems has partnered with this client since 2012.

When an organization is experiencing a business or operational issue, they often turn to an outside expert to assess the situation and provide recommendations on how to address the issue. For example, a company looking to improve the quality of its software might hire an IT services provider that specializes in quality assurance (QA) and testing to evaluate their development and QA environments and provide a roadmap for improving current practices to ultimately enhance the final product. This type of consultative guidance is beneficial to companies that require subject matter expertise in a specific IT competency that they do not necessarily have available in-house.

While the typical QA consulting partnership begins with a high-level assessment, taking a bottom-up approach to QA transformation also offers many benefits. Hiring a third party for an immediate tactical need gives the partner an introduction to their client’s environment, enabling them to see how things work—processes, people and technology—in a real-time situation. This also gives the consultants more insight into the client’s QA function and helps build relationships and support with the client’s front line.

Compared to traditional QA consulting, this more tactical, bottom-up approach can enable a more comprehensive QA and testing strategy that will better address areas in need of maturity or eligible for automation.

Data warehouse, ETL, SQL data definition language (DDL) and data manipulation language (DML), Oracle

Our client, a provider of healthcare technology solutions for Medicare and Medicaid plans, was over budget and behind schedule in delivering a product to one of their biggest customers. The product of concern was a Web-based tool that their customers (i.e., healthcare payers) used for insurance services such as employee enrollment. Their customer was frustrated because of the delay and because several issues were still being identified in production (i.e., when it was delivered to the customer). To reduce the number of flaws being found in production, the client realized that adding testing cycles would be critical to bring this project to completion. If the client didn’t invest in QA now, they would risk losing business from a major customer.

The client approached TEKsystems to supply a skilled senior-level QA consultant to review current testing standards within the client, and to develop a test plan for this project (hereinafter referred to as “Project A”). We had a pre-existing relationship with the client, having been a local provider of high-quality resources for a few years, and they were aware of our depth of testing knowledge and experience and ability to scale to meet their needs.

Because of the business-critical nature of this project for our client, TEKsystems invested one of our top QA resources to serve as the practice architect. Over a five-week period, the practice architect would work on site, providing a QA practice model and test plan for Project A, and building out a comprehensive strategy and resource plan to leverage when testing products for additional customers.

While our practice architect was working on the ground with the client’s QA team, he discovered many deficiencies within their QA organization, including:

  • An overloaded team: Over the past few years, the client had experienced increasing work volume, with expectations of continued growth—IT demands were growing faster than their current processes could sustain. The team was undersized and overextended.
  • Lack of formal training: The few testers that were on staff had not been through formal training; QA best practices were not being followed and processes varied by project.
  • Low engagement/retention: Morale and motivation on the QA team were low. The company did not recognize the value and investment in QA as critical to their operation. Testers were leaving the organization with decades of institutional knowledge that had not been documented.
  • Poor QA-development alignment: He discovered that the development team was delivering subpar code, which was causing problems in production that were being inaccurately attributed to QA. Also, the development team was an Agile operation and the QA team was not familiar with Agile processes or how to work within an Agile development environment.

Based on our firsthand experience working within the client’s QA environment, our practice architect identified these key areas of improvement early. We provided the client with our third-party perspective regarding these issues; realizing the fate of Project A, a business-critical initiative, and the future success of the entire QA organization was at stake, the client sought additional support.

Based on the client’s true needs, we proposed a higher level of service. Since our practice architect had been working on the line levels of the client’s QA organization, we would be able to offer significant insight into how to improve the overall QA practice while creating the test strategy for their customer’s delayed product (Project A).

Through the development of the test plan for Project A, we would establish a foundation for a mature testing program with documented processes and templates that would provide greater consistency in testing. In addition to Project A, we would also create and execute a testing plan for another project (hereinafter “Project B”), a state product serving a major payer and customer, by modifying Project A’s testing plan per Project B’s targets and running the same program. Both test plans would define resource requirements, set a schedule based on functional testing results and the number/complexity of test cases for new functional components, and identify risks or issues, as well as their mitigation strategies—therefore developing an overall test strategy companywide for future projects.

We would also address one of the key QA issues the client had: the effectiveness and maturity of their internal QA practice. As previously mentioned, resources were overwhelmed with their workload, disengaged and undertrained. We would address workload overload by bringing in a team of QA professionals—one financial QA tester, two enrollment/fulfillment testers and one EDW tester—to support testing for the two projects. While working side by side with the internal QA team, we would socialize the new strategy and direction for the client’s QA organization with the team. This would help mitigate any uncertainties that members of the QA team may have about their future role at the company while coaching them on key skills. We would also include the entire team when sharing our findings and recommendations with leadership to create better channels of communication between the two; this would cultivate collaboration, so that moving forward, pain points could be communicated both upward and downward to make changes where possible.

Finally, a key component to our strategy and new direction for the client’s QA organization was hiring a full-time QA manager who would provide continued leadership and oversight for the internal team, as well as own the company’s overall QA strategy post-engagement. After the development of Project A’s test plan, our practice architect would transfer project and process knowledge and activities to the QA manager for oversight of its implementation. A TEKsystems resource would fill this role during our engagement while we supported the client in their search for a full-time QA manager.

The TEKsystems team successfully created a comprehensive test strategy for our client, as well as strategic test plans for two high-profile end customers. We also supported the launch of Project A. The previous versions’ issues had left the client’s end customer wary of the product; to support our client, our practice architect joined them on an on-site customer visit to walk the customer through the product and solidify our client’s credibility and the end customer’s confidence that our client was doing proper testing.

Our transformation of the client’s QA organization included implementation of QA standards and best practices, such as a establishing a common set of templates and process flows and developing project-specific test strategies that aligned with the overall enterprise plan. We also gave focus to and helped empower the client’s QA team. When our practice architect discovered that the subpar code in production was not the fault of the client’s internal QA team, the real issue was addressed—which helped rebuild QA’s credibility.

We also transformed the QA organization into a more Agile environment, implementing and coaching the team through simple—but highly effective—Agile QA standards and best practices, such as stand-up meetings, test plan templates, effective status reporting, and proper defect flow and management. This straightforward, mature approach helped make testing’s activities and value transparent, which helped improve the confidence of the internal QA team as well as the client’s faith in their QA organization. Moreover, we clarified roles and responsibilities, instituted training and knowledge transfer, and set a career path for QA at the company.

Overall, our practice architect played a key role in this engagement. He was able to provide critical support for the client when they most needed it—when their business risk was running high due to a major project for a top customer running way past deadline and burdened with flaws. Our practice architect was able to stabilize this project and be transparent with the client about where the issues were.

Expanding the partnership: Automation implementation services

While Project B was wrapping up, the client expressed interest in implementing HP Application Lifecycle Management (ALM) as a comprehensive enterprise testing tool and strategy for their customers. The client desired an automation solution due to repetitive testing demands that were racking up a lot of man hours. The HP ALM toolset would also significantly reduce the time and effort required to build and maintain components of the testing framework, including test release management, test requirement management, component design, test case design and supporting test case inventory and defect management.

The client again partnered with TEKsystems, this time for our expertise in the theory and effective application of the HP toolset, to maximize the key benefits and features of the software. We proposed a 14-week automation implementation service engagement (AIS) that would cover the following:

  1. Review, staging and strategy: Providing expertise for the installation, configuration and use of the HP ALM software in alignment with the TEKsystems AIS methodology
  2. Implementation project plan execution: Applying the toolset and methodology to complete a project utilizing the AIS team in conjunction with the implementation project team
  3. Knowledge transfer and training: Educating and training client resources on applying the TEKsystems AIS methodology utilizing the HP ALM toolset, including:
    • a. Hands-on coaching and mentoring for four client resources in a train-the-trainer model
      b. Classroom training sessions for 10 client resources

When complete, the QA automation project will further advance the client’s QA functionality. With TEKsystems’ support, the client’s QA organization has been able to successfully transform from a once isolated, inconsistent environment to an effective, integrated part of their product development process.

  • QA expertise. As a longstanding partner of the client, we understood there was an urgent need for support for the beleaguered Project A. We tapped one of our top QA experts from our TEKsystems Quality Management practice to serve as the practice architect to develop the original test plan and strategy. Because of his expertise and his observations of the QA environment and the disconnect between development and QA, we were able to deliver a higher level of service that helped the client address the root causes of their issues.
  • Bottom-up approach. Since we began with a hands-on, tactical project, rather than a high-level assessment, we were able to gain a better understanding of the client’s true operation and make recommendations that made sense to the team. Also, we were able to build relationships with the internal team, making it easier to socialize change from the bottom up. For example, we proposed redirecting staff to work against the remaining list of project needs that made sense to them. This helped the line-level team feel more invested in the solution. Where before there was confusion around testing activity, our practice architect was able to provide clarity and implement processes that were definable and executable. Moreover, this hands-on approach helped demonstrate and realize the value of automation for the client.
  • Knowledge transfer and retention. Our practice architect was extended on the project to transition oversight of the QA team and plan to the QA manager. The overlap aided in knowledge transfer, including how to run daily standup meetings, understanding and coaching on updated processes that were established in the creation of the Project A test plan, and assisting in the development of Project B’s test plan and the overall strategy and direction moving forward.
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