Traditional Hospital Culture

• Historically hierarchical, specialized organization
• Deference to authority and expertise
• Separation between clinical and administrative domains
• Risk-averse, given patient safety concerns

Resistance Points

• Unfamiliarity with agile principles and roles
• Middle management concerns about changing responsibilities
• Skepticism about applicability to healthcare
• "This isn't software development" objection
• Concern about trade-offs with patient care

Limited Agile Experience

• Agile methods still not widespread in German hospitals (Deloitte, 2023)
• Limited local examples to reference
• Few healthcare-specific agile resources
• Executive uncertainty about benefits

Mitigation Strategies

• Intensive education and persuasion efforts
• Start with willing early adopters
• Showcase quick wins with tangible benefits
• Connect agile practices to clinical values (patient-centricity, evidence-based practice)
• Gradually introduce stakeholders to agile practices
• Create healthcare-specific examples and case studies
• Address fears openly and honestly

"Cultural change is often the most significant challenge in healthcare SAFe implementations, requiring patience, education, and sensitivity to the unique context of patient care."