A story about Acceptance Criteria and a medical procedure to help your Agile team

The following story is designed to help get your teams thinking about the topic from the “How can we learn this together” approach.
There are many detailed books with different points of view about acceptance testing.  I created this story as a way for teams to discuss this in a common language and figure out what works for them.

While you read this, I hope you see many similarities to the Agile Frameworks of your choice.  Perhaps quizzing your team on how many they find might be fun? (a different topic).

Please don’t give me a hard time about the medical inconsistencies.  I’m not a doctor and don’t have a medical degree.  It’s just a story and is completely fictional.

Fade in…..  The patient walks into a moderately lit room with an uncomfortable black chair that looks like it’s 20 years old, sitting next to a medical examination table.  The patient sits on the little black chair to discover it also feels that way.  He is going to be the patient for a long series of medical procedures to solve some medical problems.  The patient knows it will take many surgeries to get to where he wants to be.

Surgeon: So, we’re going to remove your appendix this week.  The team is anxious to get rolling.

Patient : I’m pretty nervous.  I don’t really know what to expect and I know I have all these other operations that need to get done for me to be totally healthy.

Surgeon : Don’t worry.  We have a really good team.  We also want to make sure you are 100% satisfied with the work we do.  We know that you want to get some cosmetic work done in the future and you have other important surgeries to do, but for now, let’s focus on the appendix removal, OK ?

Patient : Sure

Surgeon : We want to make sure we have a common understanding of what you want from us.  So, we’re going to ask you a few questions OK ?…Can I get the team in here ?

Patient : Sounds good.


Surgeon : Well, for this to be considered a successful operation, what kind of things are you looking for?  I already know, that to me at least, successful means two things.  1- The appendix is out and 2 – you don’t die during the surgery.  Well, actually, the not dying part is part of every surgery we’ll do for you.  We’ll assume that every surgery needs you to live.

Patient : I’m glad you said that!!! Phew.. I feel better already.  And ya, I agree, it would really be a drag to do the surgery and not end up with the appendix out.  I agree with both of those things.

Surgeon : We need to put a caveat.  If we start and see that it’s impossible to finish for some other reason, we’re going to abort the surgery.  We won’t continue if we can’t be successful.

Patient : Yes, that makes sense.

Surgeon : So, we’re agreed then.  Let’s go ahead and get you prepped.

Anesthetist :  Not so fast, I need to speak.  We want to make sure you don’t have any allergic reactions.  Have you ever gone under?  Do you have any allergies ?

Patient : I’ve been under before, and have had no problems.

Anesthetist : Great.  Let me just record that on our surgery card.  We’ll need to know that we can make adjustments as we go if something bad happens.  Is that OK ?

Patient : Ya, whatever you need to do.. Go ahead and switch to another chemical if you need to.  I’ll be happy if you don’t kill me and you’ve done what you can if you notice an allergic reaction.

Patient : Since I’m on the topic, I would like to have a very small scar and not a big one. I am willing to pay extra for a smaller scar and therefore, for me, I won’t be happy unless the scar is small.

Surgeon : Well, that will make the operation harder and we might need to put off some work where we were prepping for your next surgery until a future date. The reason is that you can only be under a limited amount of time.  It won’t cost you more because the price of the surgery is fixed.  You might have to give something else up later.  Can you live with that ?

Patient : Yes, if I have a big scar, I won’t be happy. I am willing to pay the extra over the long run and maybe I’ll have something less done later.  I really don’t want big scars as we move forward.

Surgical Resident :  Hold on, that’s way too subjective.. What might be big to you could actually be a really small scar.  What does a small scar mean?

Here are some examples.  Which on of these is considered small enough for you?

(shows a batch of photos).

Patient : I’d like it to be at least this small.  (picks one).

Surgical Resident : OK, the scar will be under 30 CM in length and 1 CM in width.  Does everyone feel we can do this and this?

Everyone : Yes

Surgeon : Anything else?

Patient and the rest of the team : No.

Surgeon : Well, then, we’re a go.  Now that we all know what will be considered acceptable and a sign of success, let’s get prepped tomorrow morning first thing…

Fade out…

Fade in.. .the day of the surgery…. (beginning of the Sprint)… the patient is rolled in…

Doctor : OK team, let’s quickly review our acceptance criteria… Patient Alive, deal with allergic reaction and the patient expects a scar of under 30 CM and 1 CM in side.  I expect everyone on the team to help me make sure we meet these requirements.  Can everyone agree before I cut?

Team : Yes.

(Surgery is moving forward)

Surgical Resident : Doctor, if you do that just a little differently, perhaps you will be able to shave a few millimeters off the size of the scar.  What do you think ?

Surgeon : Great idea.. Thanks for that.  Why don’t you hold onto the medical gizmo while I do the next cut. Sure, that will make it easier for both of us to do this together.

Anesthetist : Hey guys, hold on, let’s just talk about this.  if you do that, his blood pressure will go up and you risk killing him.

Surgeon : Wow, thanks. I doubt we would kill him, but we’d probably have to do some extreme surgery which would definitely give him a huge scar. Let’s think about this.

(discussion takes place)

Team : Glad we figured out how to do that. We can safely do that without causing any risks to the patient in the future.  Let’s go for it…

(surgery continues)

Surgical Resident :  Hey Doc, we’re almost half way through the time for the drugs and allocated time for the surgery.  Can we all agree about how much work is left so we don’t keep him under too long ?  OK, we have about another 2 hours of work do here. We’re still good.  No need to worry.  Let’s update the surgical status board to say “surgery progressing appropriately” so his family knows everything is on track.

(surgery continues).

Surgeon : OK, let’s finish up.  Anything missing ?

Surgical Resident : Yes, don’t forget to take out that sponge.

Surgeon and Anesthetist :  Yikes!

Surgeon : Thanks for catching that.

Anesthetist : No kidding.  That wouldn’t be very professional and people probably wouldn’t think we’re very good at what we did if we left stuff undone and had to come back and fix it later.

(surgery is finished successfully and the patient gets rolled out).

… fade out

… fade in….   patient in recovery and the team comes to check on him.

Surgeon : So, the surgery went really well.   You’re obviously alive, your appendix is gone.  Only one last thing…..

(the doctor removes the bandage and shows the patient the size of the scar).

Patient : Wow, that’s exactly what I asked you for.  It hurts a lot, is that normal? I wasn’t expecting that!

Surgeon : Yes, that’s normal.  Once the swelling goes down, it will be even smaller.

Patient : Thanks Doc.

Surgeon : Thanks to the team. Everyone really worked hard to make this happen.

Patient : Ya, thanks team.

Surgeon : Oh, by the way, we had to correct an adhesion we discovered while working.  Not to worry, we didn’t charge you extra.  We charge for the amount of time we spend doing the surgery.  We just fixed it while we were in the area.  (yes, I can see the malpractice lawyers cringing.. this is just a story).  We knew it wouldn’t extend the amount of time for the surgery and we knew you would be happier with the results.

Patient : Thanks. The team is amazing!

Surgeon : Is there anything you didn’t like or any special comments you’d like to give the team for the next surgery?

Patient : Ya, I wish you would have warned me about how much it would hurt.

Surgeon (whole team nods) : Thanks for that.  We’ll consider that in the future.

…. fade out ….

… fade in ….   Medical Team room.

Surgeon : Well, that went very well.. any comments about what could have gone better?

(some discussion happens).

Surgeon :  Great, we’re agreed then.  For the next surgery and all the ones we do in the future, let’s have an open discussion with the patient ahead of time about the expected amount of pain so it doesn’t cause them alarm when they come out of surgery. It will be a better experience for them and improve our professionalism.

…. fade out….

Mike Caspar





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7 thoughts on “A story about Acceptance Criteria and a medical procedure to help your Agile team”

    1. Hi Glen,

      Thanks for the comment.

      What is important to note is that all the final results weren’t completely known until after the procedure was completed.

      There was some “base” information agreed to and confirmed before they started.

      However, the team realized that some adjustments were needed during the “operation” through collaboration and discussion. The patient needed to Trust the team to do what they felt was correct while still adhering to the initial goal.

      It is also important to note the feedback loop from the patient for possible future improvements. The hope would be the team uses that information to improve the next “operation”.

      Thanks for the post :->

    1. Hi Chris,
      Thanks for the feedback… Always appreciated.
      If you feel up to it, I’d be curious as to which parts of the story stood out for you to improve your understanding?
      It might help others out.

  1. Here is my attempt to put this in our user story format:

    FY16 Goal
    Get Patient totally healthy

    Story Title
    appendix out

    User Story
    As the patient, I want to remove my appendix so that I can become more healthy

    Acceptance Criteria
    Appendix is out
    Patient does not die during surgery
    Small Scar – 30cm by 1cm

    It seems that the authorization from the patient to switch to another chemical for anesthetic (if necessary) is not an acceptance criteria but a possible strategy the team is discussing. Why would that option be an acceptance criteria?

    1. Hi Mark,

      Great observation and great question!

      Unnecessary Acceptance Criteria definitely add unneeded complexity and should be avoided when possible. They hurt the team’s self-organization and inhibits their ability to do what they do best. Think for themselves!

      I really like how you thought about this as being potentially unnecessary waste and something the team might do on their own as part of their quality. Why add this complexity?

      The idea was to show collaboration between the stakeholders (surgeon and team) and the client to determine acceptance criteria (even until the very last moment).

      In this case, I was probably thinking with my fake lawyer hat when I wrote it and imagined that the patient might not consent to the change for some reason and they needed to get this as part of their specific process of acceptance to allow them to do this. (governance type situation…Yes, or No required and was missed).

      I also imagine that since we just asked the client moments ago about this question, we might acknowledge it for them to show we listened. That being said, a good team would of course expect to be able to make the appropriate decision on their own.

      You’d expect the surgical team to have done some preparation with the client ahead of time about how things work. Hopefully the patient didn’t meet their team today for the first time. (thinking in an agile context of course) :->

      If it’s par for the course for the team, I would likely not add it as a specific Acceptance Criteria on the story card itself and mention it to the client as an acknowledgement. The team was just asking a clarifying question. Happens all the time (and the whole team was there).

      Actually, if taken to it’s conclusion, I might not include “patient does not die” on each story either. I would suggest researching “Definition of Done” for the team. Think of Definition of Done as the minimum quality standard for the team for *All* Stories.

      If I followed where your thought process is going and if the team had a Definition of Done, the Acceptance Criteria for the story would simply be: Appendix is out, Small Scar – 30 cm by 1cm

      Some could argue to record it on the story card. Others might suggest you record decisions somewhere in a separate log. It really depends on legal and governance context.

      The important part of the story is shared understanding and shared goal, conversations and knowing when and if you’re complete.

      Make your own judgement here. Or, better yet, ask your team how to keep the level of complexity down to allow them to self-organize. What’s just the right amount?

      Based on your question and your interpretation of the situation and team, I’d probably go with you on this one and NOT include it on the story card itself as the team in your conclusion would take care of it anyway.

      Thanks for the great question…. You’ve got the right idea…

      Mike Caspar
      Passionate About Agile

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