Enhancing healthcare software
quality with Shift Left testing

Imagine healthcare software development that is fast, efficient, and error-free!

With healthcare shifting gears, pivoting the narrative toward 'agile' healthcare software development is equally essential. This is where Shift Left testing fits in!

Shift Left testing is a software development approach that encourages testing earlier in the development process (literally, shifting the testing to the left) to improve quality, and accelerate time-to-market. This allows development teams to seamlessly roll out updates, introduce new features, and achieve unprecedented customer satisfaction while reducing costs.

It is a transformative philosophy that flips the script on traditional software development. In the established practice, testing has often taken a backseat, relegated to the final stages of the Software Development Lifecycle (SDLC). However, this methodology has its pitfalls, compromising software quality and customer engagement.

This article delves into the significance of Shift Left testing in healthcare while exploring the gaps in the traditional approach.

Challenges encountered in the absence of a 'Shift Left' approach

1. 1. Costs hit the roof
   • The Consortium for Information and Software Quality (CISQ) reported a $2.08 trillion loss for U.S. companies in 2020 due to poor software quality.
   • Unlike Shift Left testing, conventional approaches address software issues in later stages, resulting in higher resolution costs, revenue loss, and reputational damage.
   • Shift Left testing proactively detects and addresses problems in the initial phases of development, preventing cost escalations associated with late-stage issue resolution. 
2. 2. Defect, defect, and more defect
   • In any healthcare software development project, the absence of early testing can lead to unforeseen challenges—like data inconsistencies and user interface glitches.
   • The lack of proactive identification of these issues in the early stages jeopardizes the project timeline, delays time-to-market, and poses risks to patient safety.
   • This hurried approach results in compromised software quality and an increased potential for critical defects in the final product.
3. 3. Confusion, not collaboration
   • Traditional testing methods restrict continuous collaboration across software development teams.
   • QAs are typically excluded from initial product briefings and coding processes in conventional setups. When testing their codes, developers often require input from QAs to anticipate likely bugs and understand how to avoid them.
   • Enhanced collaboration between developers, QAs, and other stakeholders in the initial phases is essential to eliminate silos, foster collaborative creativity and align goals effectively.
4. 4. Delay, delay, and more delay
   • Traditional testing models are rigid and sequential and need help accommodating mid-development changes.
   • Additionally, regression and integration testing methods further delay the release of new features in dynamic healthcare environments.
   • Swift adaptation to evolving regulatory requirements in healthcare is crucial; delays between requirement specification and testing result in an outdated or insufficient system for current needs.

Benefits of Shift Left Testing 

Shift Left testing presents many advantages, such as:

Accelerated software development: Shift Left testing eliminates the challenges of traditional testing processes and facilitates the timely release of new features and updates, ensuring a consistent pace of development without compromising on quality.

Early issue detection and enhanced software quality: Shift Left testing supports higher-quality software by identifying and addressing bugs earlier in the SDLC.

Expedited feedback loops: Increased collaborations enable developers and other stakeholders to benefit from continuous feedback on their code changes, enabling swift iterations and refinements.

Strengthened collaboration: Shift Left approaches like Test-Driven Development and Behavior-Driven Development (discussed below) foster collaborative efforts among developers, testers, and business stakeholders—cultivating a shared understanding of project requirements.

Cost reduction: Shift Left testing enables expense cutting across the SDLC with proactive monitoring and optimized test automation, thus reducing rework costs and time-to-market.

Enhanced return on investment (ROI): As highlighted above, Shift Left testing enables significant cost reduction, resulting in a discernible uptick in profitability and ROI compared to traditional testing methods.

Elevated customer satisfaction: By delivering high-quality software punctually and within budget constraints, Shift Left testing contributes to higher customer satisfaction.

Best approaches to implement Shift Left testing

A frequently asked question is: what is the right way to implement Shift Left testing to reap the benefits? Depending on project needs, healthcare organizations can choose from any of the below four approaches:

Test-Drive Development (TDD)

TDD dictates writing tests before implementing code, prompting developers to envision and prioritize desired functionality and behavior upfront. With this method, developers can prioritize their code's testability from the project's inception.

Behavior-Driven Development (BDD)

BDD serves as a catalyst for shared understanding among stakeholders. This method is characterized by early-stage requirements gathering, formulation of executable specifications, and continuous collaborative engagement with stakeholders. BDD, thus emerges as a cornerstone in the effective implementation of Shift Left testing.

In-Sprint Test Automation

Positioned at the core of the Shift Left testing paradigm, this involves the seamless integration of automated testing directly into the agile development sprint cycle. Unlike conventional testing methodologies where automation is an afterthought, In-Sprint test places automated testing as an integral facet of the developmental process, further empowering teams to develop high-quality software. This approach also allows testers to redirect their efforts towards more strategic tasks, ultimately reducing overall costs.

DevOps Support

DevOps is pivotal in adopting the shift-left approach to software development by establishing infrastructure for both development and QA environments.

The implementation of DevOps practices encompasses the following:

• Automation of processes related to provisioning, configuration, and management of infrastructure.
• Ensuring that development and QA teams operate within consistent and reliable environments.

Popular DevOps practices like Continuous Integration and Continuous Delivery/Deployment (CI/CD) and Infrastructure as Code (IaC) further streamline the configuration and management of infrastructure for both development and QA purposes, reinforcing the ethos of Shift Left testing.

While implementing Shift Left with the above approaches offers numerous benefits, it also has challenges. One thing commonly experienced is the inherent resistance to change. To tackle this, proper training, continuous learning, an agile culture, and the right tools are the solution.

Expediting testing success with a cultural shift

To unlock the full potential of Shift Left testing, a cultural shift is imperative, urging a collective commitment to testing responsibilities from developers, QAs, business analysts, project managers, and architects across the SDLC. This collaborative mindset intersperses quality assurance into the organizational core, acknowledging each team member's contribution to software reliability.

In the healthcare context, Shift Left testing not only optimizes the development process but becomes a beacon for proactive healthcare innovation. As we navigate towards a future of patient-centricity, proactive behavior remains the driving force, illuminating our path toward delivering superior, steadfast, secure healthcare solutions for a better tomorrow.

References:

1. https://www.it-cisq.org/the-cost-of-poor-software-quality-in-the-us-a-2020-report/
2. https://www.forrester.com/blogs/its-time-for-shift-left-performance-testing/#_edn1
3. https://web.archive.org/web/20150905082941/https://insights.sei.cmu.edu/sei_blog/2015/03/four-types-of-shift-left-testing.html