This experience report describes the transition of a large medical organization which develops computed tomography modalities towards more agile and lean approaches that improve the speed and the “flow” in the organization and the products it produces. It describes the broad set of challenges that are faced, especially when developing complex software-intensive systems in a safety-critical and regulated medical domain. This practical case study details the concrete set of activities, insights, and “lessons learned” that were done in this organizational-wide transition in a structure that allows persons or organizations with similar challenges to apply them to their own organizations.

Furthermore, this experience report describes how we apply DevOps approaches not only to software, but to software-intensive cyber-physical systems. Minimizing downtime of systems during updates is a vital aspect for our customers as well as the robustness of in the field updates. In a world of complex cyber-physical systems of systems that is an far from easy task and requires early continuous * activities including continuous deployment to in-house systems before the subsequent final release as well as an extremely high transparency of the installed base through a regular feedback loop and data analytics methods.