(IJACSA) International Journal of Advanced Computer Science and Applications,

Vol. 15, No. 4, 2024

Challenges and Solutions of Agile Software

Development Implementation: A Case Study
Indonesian Healthcare Organization
Ulfah Nur Mukharomah, Teguh Raharjo, Ni Wayan Trisnawaty
Faculty of Computer Science, Universitas Indonesia, Jakarta, Indonesia

Abstract—One healthcare organization in Indonesia has develop. The condition creates scaling problems, which
implemented Agile software development (ASD) to complete require head adaptation and expansion of basic dexterity
software development. The organization's problems are post- methods [2]. The problem is also the case in Saudi Arabia,
deployment system bugs, and some software development where participants agreed that adopting Agile can be difficult
projects must carry over to the following year. This study aims to when dealing with customers from government bodies, as the
assess and provide recommendations for improving agile working style tends to be based on Waterfall. They are
software development by identifying the challenges faced. usually unwilling to be involved in the development team
Research conducts literature reviews on previous research to and require comprehensive documentation.
identify challenges in ASD in several organizations. Research is
also conducted using quantitative methods by surveying software One of the organizations in Indonesia provides health
development teams to validate implementation challenges and services to the people of Indonesia of 265 million
provide recommendations for these challenges. The results of this participants. In providing health services to all participants,
study were in the form of a survey attended by thirty-one the organization collaborates with health facilities in
respondents. The study results found that 14 challenges were Indonesia, such as hospitals or doctor's clinics. The
faced in other organizations, and 11 were faced by one healthcare organization is a public legal entity, a government, and a
organization in Indonesia. Healthcare organizations in Indonesia bureaucrat with racy characteristics. The organization runs
can apply recommendations to make awareness related to
the business using technology and digitalization. The
understanding agile software development culture and make
demand for IT development is increasing, in addition to the
adjustments to project documentation by aligning with agile
values.
demand for speed in project completion, and the limited
numbers of teams are challenges in completing system
Keywords—Agile Software Development; challenge solutions; development. Organizations have IT resources in the
IT projects; information technology; application implementation; software development process.
healthcare organization; Literature Review Ninety-six applications are run and developed by the
I. INTRODUCTION organization's development team, most of which use the
waterfall method. In 2022, project development will be
Information technology (IT) can improve customer dominated by projects with a high urgency category, with a
service and become an efficient tool. IT implementation is percentage of 43%, as shown in Fig. 1 [5]. This development
often considered one of the most challenging initiatives for request requires a rapid completion of development, but
organizations, including in the government sector [1]. there are unclear requirements due to policy changes in the
Several organizations have changed their software organization.
development methods from Waterfall to Agile. By adopting
the Agile method, organizations get several benefits, such as The organization in the case study implemented an agile
shorter time, increased flexibility in handling changing software development project. However, in its
needs, increased productivity, and better alignment between implementation, standards or frameworks have not been
business and IT [2]. Agile methods also need to maintain implemented as a reference. The problems were that some
predictability and controllability [3]. Another agile principle projects carried over to the following year, and there were
is to welcome changing software development needs and complaints from application users post-implementation. The
produce software that works regularly with a preference for number of bugs adds work to the I IT development team,
shorter timeframes [4]. where the same group currently holds the development and
maintenance functions [6].
However, transforming into an organization operating in
the public sector, especially in an organization with a In study [6] by looking at some of the existing problems
complex hierarchical structure such as government, is not and impacts, evaluating and improving the software
easy to change the existing bureaucracy. The existence of development process using Agile is necessary. This
layers of bureaucracy can hinder the application of agile evaluation is for the software development process to
methods [1]. Large organizations usually have many become better, achieve targets, and produce quality products
products and products that are too large for a single team to as stated in the organization's vision and mission and the
organization's vision and mission. Evaluation is being done

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Vol. 15, No. 4, 2024

to find out the challenges and recommendations in A. Previous Research

implementing agile software development. Implementing Several previous studies identified Agile software
Agile software development requires effort and time, but the development; however, no research has been conducted on
results can significantly benefit most software development organizations with public sector and bureaucratic
programs [7]. characteristics in Indonesia, and projects have been carried
out internally.
Previous research [8], [9], [10], [11], [12] challenges
were identified in ASD in organizations with characteristics
of the public sector or government and bureaucracy.
Previous research [8], [12] was conducted in Indonesia, but
both studies had specific problems with projects undertaken
by external resources. The difference with research [8] is
that the research was conducted by observing project
documents to validate challenges. Another study [9], [10],
[11] was conducted in other countries, namely Brazil, United
Arab Emirates, and New Zealand, to identify challenges
faced by organizations in the public sector. These five
studies serve as the basis for a survey to validate the
challenges faced by Indonesian health sector organizations.
B. Agile
Agile is an approach or software development method
that emphasizes flexibility, team collaboration,
responsiveness to change, and continuous delivery of
valuable customer results [13]. Agile methodologies have
many methods (e.g., Scrum, Extreme Programming [XP],
Fig. 1. Software development data by project category. Kanban) that have their unique processes, terms, techniques,
and timelines [7].
After determining the root of the problem, they
considered the existing conditions in the organization and the The development of Agile methods is a response to the
implementation of Agile software development at the failure experienced by organizations to use the more
Indonesian Healthcare Organization. The questions for this traditional waterfall methods. The Waterfall method is
research are: commonly used in large software development projects.
Many view the Waterfall process as a heavy and expensive
RQ1: What are the challenges of Agile Software document, and the Waterfall is based on significant initial
Development in the Organization? planning. In each phase of the project, it is necessary to
RQ2: What are the recommendations for improving Agile complete a sequence of steps before moving on to the next
implementation in the Organization? stage. The linear approach used in Waterfall is in stark
contrast to the incremental and iterative empirical methods
Previous research has been carried out on projects with used in Agile development [1].
external resources using different methods, namely
document observation. The novelty of this study is a case Agile Methodology has recently expanded into several
study on organizations with characteristics of the public branches. The most popular extensions are probably
sector or government or that have bureaucracy and use associated with the Scrum framework, which breaks down
survey methods to respondents to validate the challenges the entire list of requirements into smaller batches. The list is
faced. The composition of this research paper includes the titled product backlog and is formed by product backlog
following: introduction, literature study, methodology, results, items. Following specific instructions, the product is
and recommendations and it ends with conclusions. developed in stages without sticking to predefined sequences
while respecting any changes the customer requires [1].
II. LITERATURE STUDY INTRODUCTION
C. Challenge and Issue Agile Implementation
This section will discuss the basic theory used in the
Based on previous research, researchers found 14
research. These theories relate to Agile and Prior Research.
challenges faced in implementing agile software
development. The fourteen challenges can be found in Table
I.

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TABLE I. CHALLENGES OF AGILE SOFTWARE DEVELOPMENT FROM LITERATURE REVIEW

No Category Challenges References

1 Technique & Ceremony Lack of discipline in the development processes [8]
2 IT Infrastructure Lack of IT infrastructure in deploying the system. [10]
3 Project Documentation Lacks sufficient documentation to support a project [8], [9], [10], [11], [12], [14]
The organization shows resistance or lack of encouragement in transitioning to an agile
4 Cultural behavior [9], [10], [14]
approach.
5 Communication Communication and coordination among team members are ineffective. [8], [12]
The project schedule is delayed, requirements are unclear, and there is little anticipation
6 Managed requirements [11], [12]
in handling changes.
The roles of the team were unclear, leading to minimal contributions and duplicated
7 Roles a project team [11], [12]
work.
8 Top Level Management Lack of top management support, with little knowledge of the execution process. [10], [11]
9 Internal policy Inadequate Compliance with standards, policies, regulations, and organizational vision. [10]
Team collaboration is limited because team members are spread out in different
10 Collaboration [8], [10], [12]
locations.
11 Organization Structure Organizing meetings is challenging due to convoluted bureaucratic processes. [8], [11]
12 Interpersonal Conflict There are personal conflicts within the team. [11], [14]
13 Individual Competence Inadequate agile adoption of skills, experiences, and knowledge. [11], [12]
Lack of openness and transparency during the development process leads to a lack of
14 Agile Values [11]
information.
(issue) OR (solution) OR (recommendation)). Based on this,
III. METHODOLOGY 262 documents were obtained. Then, a selection is made based
At the methodological stage, the researcher divides the on predetermined search criteria, as shown in Table II, and
research into three phases [8]. The three phases can be seen twenty-four documents are produced.
in Fig. 2. Phase Research Methodology and the following 3) The next stage is screening, namely selecting by
sections discuss the details of each step. reading the title and abstract related to the research question
and producing twenty-four documents.
4) The next stage is eligibility, which is done by searching
the complete version of the research document and, in the last
stage, reading the entire contents of the paper in 24 copies.
5) The final stage is to obtain ten documents by the
research questions. All documents obtained are considered
relevant to the research topic and can be used as a reference
for this research.
The overall description of the literature selection process
can be seen in Fig. 3. It shows stages of searching for
Fig. 2. Stages of research methodology. literature studies.

TABLE II. LITERATURE STUDY CRITERIA

A. Phase 1
Phase 1 is the initial stage of the research, where No Criteria
document observations and initial interviews are carried out 1 Publications within the last five years, 2018-2023
to explore existing problems. Then, an analysis is conducted
to determine the research questions. Based on the following 2 English language
research questions, literature research was conducted using 3 Publication of a journal
PRISMA (Preferred Reporting Items from systematic Publication in the form of a journal
4
reviews and Meta-Analysis). This method was used in Complete publication and can be downloaded in full (full text)
previous studies [1]. Following are the steps of the SLR in
this study:
1) The first stage is identification on the online database.
The database used to search related research consists of IEEE
Xplore, ScienceDirect, ProQuest, and Scopus.
2) Search using the keywords (agile software Fig. 3. Stages in SLR.
development) AND (Organization) AND ((challenges) OR

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B. Phase 2  Strong Not Agree (SNA)

Researchers use quantitative data collection methods by  Not Agree (NA)
conducting questionnaires to the software development team.
Questionnaire questions use challenges and categories from  Neutral (N)
Table I. After the questions were compiled, a test was carried
out by an experienced team in the field. The software  Agree (A)
development team will distribute questionnaires, including  Strong Agree (SA)
Manager IT, IT System Specialist, IT Business Analyst,
Programmer, Quality Control, and Junior Staff IT. The questionnaire results contained 14 challenges, which
received a percentage of more than 50%. In other words, the
C. Phase 3 respondents agreed and strongly agreed to the challenges in
At this stage, an analysis will be carried out to determine Table III. In addition, two different challenges were
what challenges are relevant to the literature review and identified in the case study.
other challenges in the organization. The analysis results
above will provide recommendations for improving the agile
software development process. Recommendations are given
by looking at the best practices from previous studies.
IV. RESULT AND RECOMMENDATION
This stage explains the results of the questionnaire that
has been distributed and analyzed. This section also answers
the research questions mentioned in the introduction. The
challenges of implementing agile in health organizations in
Indonesia and recommendations given to overcome these
challenges
A. Result
Based on the research questions formulated, researchers
conducted a questionnaire by obtaining 31 respondents from
the software development team in the organization. Fig. 4
describes the percentage of the team from 8 positions in the
software development team. Respondents with programmer Fig. 4. Percentage of 31 respondents by the position.
positions were 39%, Junior IT Staff 10 %, Head of IT
Department 6 %, IT Business Analyst 13%, It Quality
Control 13%, IT Quality Assurance 3%, IT Strategic Plan 3
%, IT System Specialists (System Analysts) 13%.
In Fig 5, 45% of respondents have more than > 5 years of
work experience from their current position. Then, 23% have
1 to 3 years of experience, 21.7% have 3 to 5 years of
experience, and 8.7% have less than one year of experience.
Overall, the technical team that filled out the questionnaire
had over three years of experience.
The questionnaire consisted of 17 questions: 1) two
demographic questions related to position and work
experience, and 2) demographic questions were used to aid a
deeper analysis of the questionnaire results. Furthermore, 14
questions are related to the 14 challenges contained in Table
I. At the end, there are open-ended questions to identify
other challenges that have not been included in the
questionnaire. Questionnaire answers use a Likert scale (1 to Fig. 5. Percentage of 31 respondents by work experience.
5) with the following information:

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TABLE III. RESULT QUESTIONNAIRE FROM 31 RESPONDENTS

No Challenges factor SA A N NA SNA SA+A

1 Technique & Ceremony 29% 26% 22% 13% 10% 55%
2 IT Infrastructure 10% 16% 19% 32% 23% 26%
3 Project Documentation 39% 45% 6% 6% 3% 84%
4 Cultural behavior 42% 35% 10% 6% 6% 77%
5 Communication 29% 23% 19% 6% 23% 52%
6 Managed requirements 42% 32% 6% 6% 13% 74%
7 Roles Team 39% 19% 16% 13% 13% 58%
8 Top Level Management 45% 26% 6% 16% 6% 71%
9 Internal policy 26% 29% 19% 10% 16% 55%
10 Collaboration 32% 23% 19% 10% 16% 55%
11 Organization Structure 35% 19% 13% 19% 13% 54%
12 Interpersonal Conflict 3% 23% 13% 29% 32% 26%
13 Individual Competence 22% 23% 10% 16% 29% 45%
14 Agile Values 32% 26% 16% 13% 13% 58%

Fig. 6. This graph shows numbers representing the percentage of 31 respondents from the one that strongest agrees to the not agree.

1) A Challenge of the highest percentage: Fig. 6. shows each documentation requires the approval of each
three challenges with high percentage values, including unit". In previous studies [2], many organizations faced
project documentation, managing requirements, and cultural challenges related to inadequate documentation and the
behavior. Most respondents agree with these challenges in opposite issue of excessive documentation that wastes
time and resources on unnecessary information. Agile
implementing agile software development in organizations.
development presents a solution through a streamlined
 Project documentation. This factor gets the highest approach to comprehensive documentation that
percentage in the context of technology. One requires less time and effort. However, it is crucial for
respondent mentioned in answering an open-ended upper management to support this approach and for
question on the questionnaire that "current project customers to agree upon it from the project's inception
documentation is not yet flexible. The characteristics of [3], [11].
documentation are currently still waterfall-based where

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 Culture and structure of an organization. In previous these challenges are challenges in implementing agile
research [3], it was also stated that the primary software development.
challenge in adopting Agile lies in the culture and
structure of an organization. For Agile to thrive, there  Interpersonal conflict. This factor gets the lowest score,
must be a genuine embrace of Agile values and namely 26%, meaning that the team is good enough or
principles. A hierarchical organizational structure often has no internal conflict, which is a challenge in agile
poses a significant hurdle to Agile adoption since it implementation. Leadership challenges get the highest
necessitates redistributing power and responsibility score, namely 65.2%, then agile values, 60.9%, and the
from management to the development team. other three challenges, namely personal commitment,
Additionally, Agile thrives in a dynamic, supportive, decision making, and individual competence, get the
and collaborative environment, which rigid same deal, 52%.
organizational cultures can hinder.  Competency is not a challenge in implementing agile,
Respondent's statements related to this challenge were "It and this has something to do with demographic results
takes a common understanding between the IT team and because most respondents are workers with more than
UKPF in implementing the agile process," Statements from five years of experience, so they have abilities in their
other respondents, "The entire team must understand the goal fields.
of agile," and "The team is not yet familiar with the concept 3) An Additional Challenge from respondents: Different
of agile comprehensively."
challenges are identified from the case study based on the
The current organizational structure is still suitable for open-ended question at the end of the questionnaire, in which
the Waterfall methodology. One of the respondents the organization experiences another challenge, namely
mentioned, "Basically, the organizational structure is still Overloading work. Based on one of the respondents' answers,
waterfall-based, and each unit works on unit coordination. It "Another challenge is the unbalanced workload of each
should be project-based, and an agile team should be more
programmer. A programmer must be able to do many things
independent and committed."
briefly simultaneously, causing stress from the programmer's
 Managed Requirement. The challenges faced by IT psychological side. Something like this needs to be resolved
project management received the highest score, by the project manager on how user needs are balanced with
namely, 34.8% agreed, and 52.2% strongly agreed. existing resources," and the other, "The challenge is the lack
This factor is a challenge to the organization's agile of resources so that one person holds several applications that
implementation. Regardless of project management
are being chased by the dateline at the same time."
tools, the respondent stated, "There are no valid tools
that are used for project monitoring. So far, they have B. Recommendation
relied on Excel". There are no tools for project Based on the challenges faced by the organization, the
monitoring or tools that can be used for standard team researchers then provide recommendations that can be taken
collaboration by the entire team. The team found it in the future to make changes to current conditions. Later, it
difficult to see the progress of each process in system is hoped that the organization will get better results from
development. Another problem is that there is no agile implementation and support organizational goals. The
project manager role in the team, making it difficult for recommendations are as follows.
the team to conduct project development tasks.
The following are recommendations based on previous
2) A Challenge of the lowest percentage: Based on Fig. 6, research, and recommendations are given based on the
3 challenges with high percentage values are project results of questionnaires that get a percentage of agree and
documentation, management requirements, and culture strongly agree with a value of more than 50%. The
behaviour, which get high scores. Most respondents agree that recommendations are given in Table IV.
TABLE IV. RECOMMENDATION IN TECHNOLOGY CONTEXT

Challenge Recommendation
Technique & Ceremony  Use tools or technologies to support Agile work in the organization [3]. E.g., Trello or Jira
Lack of discipline in the development processes  Build a Continuous Delivery pipeline with stages involving both sides[4]
Communicate only essential points that need to be documented. Agile identifies critical
important points to include in documentation, which is the main focal point for each
Project Documentation
methodology.[15] Meetings assist individuals in a proper understanding of how to collect
Lacks sufficient documentation to support its development
information and through what medium the process of gathering information will be
beneficial [15]
 A strong culture requires a deep understanding of the organization's goals
Culture Behavior & Agile Values
 Show success stories of agile adoption.
The organization shows resistance or lack of encouragement in
transitioning to agile values.  Provide training and increase employee awareness and acceptance of new culture [3].
[3]
Communication  Running an effective meeting [16]
Communication and coordination among team members are  Regular face-to-face meetings should be established, as they provide clear communication
ineffective. [7] [13]

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Challenge Recommendation
 Transparency and efficiency in communication [4].
Agile teams operate differently from traditional project management structures as they do
not rely on project managers. Instead, Agile methodologies like Scrum and XP outline
Management Requirement specific roles such as the product owner, scrum master, and coach. These roles are designed
The project schedule is delayed, requirements are unclear, and there
to facilitate effective collaboration and ensure the smooth execution of Agile practices. By
is little anticipation in handling changes.
assigning responsibilities to these distinct roles, Agile teams can streamline communication,
enhance productivity, and adapt quickly to changing project requirements. [17].
Roles in Project Team Reorganize the team by forming small teams, like the scrum team, to create a dedicated
The roles of the team are not clearly defined, leading to minimal team responsible for agile development [18].
contributions and duplicated work.
 Involving top-level management in the change planning and implementation process can
Top Level Management
increase the sense of ownership and responsibility.
There is a lack of top-level management support and little
knowledge of the execution process.  Hire outside experts to be involved in team adaptation as this can provide a better
recommendation of benchmarks [18].[15]
Internal Policy Creating standards for IT software development on an internal basic policies and supporting
Inadequate agile adoption of skills, experiences, and knowledge. existing management can support agile implementation [1]
Collaboration Use tools or technologies to support Agile work in the organization [3]. E.g., Trello Jira or
Team collaboration is limited because team members are spread out bit bucket [4]
in different locations.
Organization Structure  Create a small project team like the Scrum team [1].
Organizing meetings is challenging due to convoluted bureaucratic  Arrange a dedicated team that is responsible for agile development [18].
processes.  Channeling expert's efforts to address high-level issues and to manage collaboration [4].
 They used to meet weekly and later twice a month, only when required and usually
Overloading of work after working hours.
This factor is a challenge in agile implementation. Individuals get  Skipping the daily meetings affected the learning process between the team members.
more than one job at the same time. This factor eventually led to the failure to learn and implement the agile method
correctly [11].
awareness related to agile culture among all IT employees.
V. CONCLUSION Regarding problems in Project Documentation, organizations
Researchers conducted a literature review of several can adjust project documentation to align with agile values.
previous studies and identified challenges in implementing Problems in organizations with bureaucracy, such as
ASD in other organizations with characteristics of the public government, making changes in the development process
sector, government, or bureaucracy. Researchers use become obstacles because of the many administrative
quantitative methods with surveys to validate and facilitate processes and approvals given to superiors. Therefore,
the exploration of the challenges in implementing ASD in organizations can adjust the project team to match the role in
One healthcare organization in Indonesia. This method is Agile. Agile using the roles contained in scrum. By
simple but can solve the problems faced. It is a differentiator assigning responsibilities to these different roles, Agile
from previous research [8] studies used challenge validation teams can streamline communication, increase productivity,
using document observation. and adapt quickly to changing project requirements [17].
Based on several previous studies, 14 challenges faced by 1) Research implications: Other similar organizations can
organizations were obtained. This study's findings determine use the results of this study to see the challenges in agile
what challenges and recommendations can be provided for implementation and solutions from best practices suitable for
the organization. Based on the survey results, researchers organization healthcare or bureaucratic governance.
found 11 challenges with a percentage value above 50%, 2) Limitations of suggestions for further research: This
agreeing that challenges to other organizations. The three
study has several limitations on the respondents. Respondents
challenges with the highest survey results are project
documentation, IT Project Management, and cultural are still limited to the software development technical team.
behavior. At the same time, the 3 challenges with the lowest Future research can be carried out for other IT teams, such as
survey results were below 50%, which means that most IT operations and IT infrastructure.
respondents disagreed that these challenges were felt today
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