The Future of Specialized Health Care Providers

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This project is for the game-changers and rabble-rousers working within health care to create much needed transformation within the industry. For those that are frustrated with the way things are and seek a better future, this project is an example of the power of foresight to provoke deep insights and inform thoughtful strategic directions.

This project was completed by Phouphet Sihavong, Uma Maharaj, and Josina Vink as part of Ontario College of Art and Design University’s (OCADU) Master of Design in Strategic Foresight and Innovation (SFI) program in Toronto, Ontario.

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The Future of Specialized Health Care Providers

  1. 1. The Future of Specialized Health Care Providers OCADU Foresight Project | 2011 Prepared by Phouphet Sihavong, Uma Maharaj, and Josina Vink
  2. 2. This project was completed within the time constraints of a twelve week semester by students in Ontario College of Art and Design University’s Master of Design in Strategic Foresight and Innovation program in Toronto, Ontario. For more information on this program please visit: www.ocad.ca Acknowledgements: A special thanks to our project ambassadors at the Mayo Clinic Center for Innovation for their ongoing input, guidance and support on this project. Thank you, Steve Bartz, Meredith Dezutter, and Allison Dunphy, for offering up your industry insights, sharing your strategic thinking and going back to the future with us! Also, thank you to our instructors Suzanne Stein and Greg Van Alstyne for your valuable feedback and dialogue with us as we experimented with new methodology. And to our brilliant classmates that make every Thursday worth getting up for, thank you for playing well in the sandbox and for continuing to raise the bar as we learn and contribute to the emerging field of foresight in Canada.
  3. 3. This project is for the game-changers and rabble-rousers working within health care to create much needed transformation within the industry. For those that are frustrated with the way things are and seek a better future, this project is an example of the power of foresight to provoke deep insights and inform thoughtful strategic directions. The Need for Transformation 4 About the Project 5 Project Process 6 Environmental Scanning 7 Trends 8 Drivers 20 Creating Future Scenarios 21 Back to the Future 26 From Scenarios to Strategies 33 Wind-Tunnelling 34 Three Horizons 35 Strategic Directions 38 Moving Forward 46 A Call for New Thinking 47 Appendix 48 References 49 3
  4. 4. The Need for Transformation/ C anadians brag about their health care. Universal health care is a strong Canadians brag about their health care. Universal health care is a strong part of our country’s identity. But the fact is our health care system is not measuring up. part of our country’s identity. But the fact is our health care system is not measuring up. 4 There are numerous problems with the system including issues around timely access to care, quality, safety, security, availability of services, and financial stability1 - not to mention the fact that interaction in the space often leaves patients feeling like they have been catapulted twenty years back in time. The status quo is not sustainable. The cost of care has continually increased in Canada. Health spending, which is administered by the provinces, has increased from nearly 35% of provincial budgets in 1999 to 46% in 2010. In Ontario, if nothing changes this number is expected to reach 80% by 2030.2 Furthermore, Canada’s aging baby boomers will put an unprecedented strain on the health care system3 comprising approximately 25% of the population by 2036.4 It is becoming more challenging for the traditional health care system to provide some of the basic levels of care to Canadians. The median wait time for being referred to a specialist and receiving treatment in Canada is 17 weeks.5 Furthermore, Canadians are looking to new sources of care as the outof-pocket payments of private households have grown to represent approximately 15 percent of total national health expenditures. If the health care system is going to meet the needs of future Canadians and survive the compounding pressures, transformation is needed. The complexity of the system, institutional cultures, financing, and evidence-based philosophies make health care a slow system to change. Foresight methodology offers hope for improved understandings of the range of future challenges and inspiration for refined long-term strategies for the industry.
  5. 5. This foresight project focuses on the future of specialized health care providers in Canada, with a strong spotlight on outpatient services – an area within the field of health care that will certainly face numerous challenges as the future evolves. The purpose of this study is to challenge specialist providers to consider health care reform through the lens of strategic foresight and to demonstrate the value of this emerging tool for those changemakers already working in this space. This work was completed by students in the Strategic Foresight and Innovation graduate program at Ontario College of Art and Design University. The work was guided by project ambassadors at the Mayo Clinic Center for Innovation through regular collaborative dialogues throughout the course of the three month project. The project began with general environmental scan of the industry and related systems to identify strong and weak signals of change. This led to the development of a small trend deck. Through analysis of these trends, their interactions and the underlying drivers, enablers and blockers, five key drivers were identified. The cone of plausibility method then used these drivers to develop scenarios. The scenarios helped to answer About the Project/ the following question: what will the future interaction between traditional health care specialists and patients look like in 2030? From the scenarios, strategic options were generated and a wind tunneling exercise was completed leading to the identification of the following three robust strategic directions: 1. Build a smart, electronic health system 2. Integrate service delivery 3. Improve the patient experience These strategies where then enhanced through the development of a preferred future and thoughtful analysis using the three horizons method. Lastly, a simple, modified backcasting method was used to establish milestones and signposts for moving forward. This document will provide an overview of each step in the process and demonstrate how these strategic directions came into view. For clarity, the definition of specialized health care provider used in this project refers to those health care organization that offer services provided by medical practitioners that generally do not have first contact with patients and offer a highly technical level of health care. 5
  6. 6. Project Process/ The diagram outlined below providers a snapshot of the key methods used in this project. The arrows represent the critical inputs and outputs of each step in the process. 6
  7. 7. Environmental Scanning/ Through discussions with the project ambassadors, some areas of interest for thinking about the future of the health care industry and its environment surfaced. Signals like the development of IBM’s Watson and crowdsourced diagnosis on the New York Time’s website surfaced immediately. This dialogue was extended through an environmental scan that looked for potential signals and trends related to or influencing the health care industry. By combing through sources like newspapers, scholarly articles, and social networks, patterns of change were identified. The STEEPV framework (social, technological, economic, environmental, political and values) was used to help ensure breadth within the environmental scanning process. Unfortunately, due to time constraints a comprehensive list of trends for each element of the framework was not fully developed. However, the twelve trends identified provided valuable directions for thinking about the future of health care. The result of this process was a set of trends that describe the signals, preliminary implications, extrapolations and countertrends in the health care space. The trend deck that follows mainly highlights trends in the social, technological and economic space. 7
  8. 8. Technology Trend Patients can stay home longer before needing long term care facilities. Implications for Providers: 5 Robot Assisted/ In-home robot assisted patient care. Overview: Robot assisted care works with an integrative health system that combines remote video communication, networked 24/7 on-call health support team and a mobilized robot to deliver in-home patient care. Robot assistant can travel with nurse practitioners or other health care workers to patient homes or retail clinics to provide remote Doctor check-ups. Signals: • • 8 • Care-O-bot® Mobile robot assistant14 Asimo Robot developed by Honda. Robot that can be controlled by human thinking15 Paro robots migrating therapeutic baby • • harp seal robot from Japan, to be used in health care facilities16 Kompaï is a robot developed by Robosoft specifically designed to assist dependent persons at home17 Android-F Android developed in Japan that have lifelike movements18 Implications for Patients: Users that are located in remote locations that have limited access to health care services can have the opportunity to stay connected and have remote visits from their general practitioner. Isolated users that require more care can have a live-in robot to help with their dependent living. Decentralization of care delivery with robots will see a rise in online health service platforms, health call centre services and remote services. Payments may be in the form of a monthly membership fee that is reimbursed. Demand increase for health call center services. Smaller companies will partner with other service providers to create a mash-up of health care services. Larger corporations will try to own the health service delivery channel to secure a stronger brand connection with customers. Extrapolations: In a decade, humanoid robots will become the new homecare providers. Built with sensors, they will be better equipped to detect changes in people’s biometrics to help alert and prevent medical problems. Countertrends: Patients may resist the remote care because they value in-person experiences rather than machine connections. Resistance against robots taking away human jobs can prevent adoption of new technology.
  9. 9. 5 Ubiquitous Health/ Access to health information at anytime. Overview: health discoveries20 SMART networked home design that help users manage their home more efficiently IBM’s Watson Supercomputer partners with Wellpoint Health Benefits to provide online diagnosing for patients21 Users access and manage their health information at anytime as part of everyday life. The seamless interaction between patient, doctor and expert database across a wireless network will revolutionize the delivery of health care. • Signals: Visualization tools along with data analytics will allow the user to diagnose their own symptoms. Users will become better informed and change their health care from being episodic to continuous care. • • Me MD is an online health care service that provides webcam consultations with health care providers that give diagnosis, treatment plan and prescription19 Genomera is a movement dedicated to using online crowd-sourcing to make new • Implications for Patients: Decentralization of care delivery will see the rise of lower cost health service solutions. Health insurance companies will start to take a more active role by partnering with technology companies to develop online personal health care programs to promote preventative care. Additionally secure cloud-based health databases will be required to store and process all the patient health informatics. Technology Trend Implications for Providers: Extrapolations: In a decade, the convergence of mobile technology and a connected health system will create a seamless integrated health care system that automatically alerts patient and physician to problematic changes in the person’s health signs. An integrative health system will allow users to also monitor and care for their circle of friends and family, thus fostering a community of care where the individual is now a caregiver by treating others. This could lead to “peer-to-peer MD”. Globalization of online health care services will help keep service costs down. Countertrends: Privacy and security concerns over the ownership of personal health information may deter users from subscribing to health monitoring. Complications with health legal liabilities may prevent level of adoption for both patient and service provider. 9
  10. 10. Technology Trend Implications for Providers: 5 In Vivo surveillance/ Wireless internal monitoring of the human body. Overview: in vi·vo [in vee-voh] noun (of a biological process) occurring or made to occur within a living organism or natural setting.6 In vivo surveillance is wireless monitoring done by nanobots from inside the human body. Doctors can give the patient a pill size nanobot to swallow, which monitors health signs remotely for three days before exiting the body. Signals: • 10 • Spider Pill is a remote control ingestiable pill that provides surveillance imagery7 Smart Pill transmits data continuously for • • 72 hrs about pressure, pH and temperature. Nanomedical capsule used in cancer treatment for targeted drug delivery8 Internal surgery using ingestible robots that assemble inside the human body9 Implications for Patients: Users don’t need to have boxes strapped to their sides or have tubes stuck down their throats. in vivo surveillance will provide a more non-invasive and painless experience for users. This level of real-time monitoring will allow health care service providers to become more accurate in putting together personalized treatment for patients. Stomach and colon procedures can be conducted internally without having to make any outside incisions. Costs will be greatly reduced for hospitals with less recovery time. The ability to monitor and do real-time surveillance on patients from the inside will lead to greater discoveries and may alter the course of drug administration which will disrupt the pharmaceutical industry. Imagine if a non-invasive cure for cancer was discovered through “smart pills”, what kind of negative economic impact it would have on businesses that relied on cancer treatment demand? Extrapolations: In a decade, there will be nanorobots that are atomic and molecular in scale. They can interact on the same level as bacteria and viruses, thus allowing nanobots to become the new medicine. Molecular size nanobots can body repair the human body without opening the patient for surgery. Countertrends: The “yuck” factor of knowing there is a robotic bug swimming inside you will generate resistance to the approach. There will be debates between science and ethics as to how far we go in repairing our bodies. There could be government resistance through the regulation and control of nanotechnology to prevent nano weaponry.
  11. 11. 5 Mobile Diagnostics/ Mobile sensing devices that assess patient health. Overview: The consumerization of mobile devices has created a new business line of emerging sensing mobile devices and accessories that capture users’ health data and provides diagnostic feedback almost instantaneously. Signals: • • Cellscope is a portable, low-cost microscopy that uses a cell phone camera to take high-resolution images of a patient’s blood cells10 New online mobile health monitoring service, MedApps, wins 2011 Best New • Product Edison Award 11 Use of RFID and GPS technology in patient medical wristband in hospitals to monitor patient location and transfers within the hospital12 Implications for Patients: Affordable mobile health accessories that measure and monitor health, means the patient has more control over the management of their own health because they are now better informed. Patients can get online medical diagnosis instantly without having to physically access a health care facility. In addition, real-time monitoring helps keep patients compliant with their health prescription. Health care practitioners can alter treatment quicker with more accuracy. Points of care delivery will change from a centralized model to more out-patient and convenient care options. Health care industry will experience a technology innovation shift from large fixed technologies to more compact lower cost technologies. This will force hospitals to be more competitive as patients have more choice in the diagnostics space. Technology Trend Implications for Providers: Extrapolations: In a decade, there will be pop-up mobile hospitals servicing communities based on recorded health patterns monitored by the city. Wearing a sensing device will become part of the norm in society. People will become obsessed with improving their health signals and more sensitive to slight shifts in numeric values that move above or below the norm. Countertrends: Complex privacy and security regulations around access to health information may prevent level of adoption from both patient and service provider. 11
  12. 12. Economic Trend Implications for Patients: How will patients navigate through the clutter? There are more options for patients to chose from, but it is difficult to know which alternatives are effective and trustworthy. Implications for Providers: 5 New Kids on the Block/ Everyone and anyone is providing health services. How will specialist providers compete with these new and different health service options? Care models will be forced to change to compete with low cost models. There is a deprofessionalization of services occurring where tasks that were once performed by physicians are being provided by nurses, personal support workers, devices, caregivers or patients themselves. Extrapolations: Overview: 12 There is a growing number of new providers with disruptive approaches entering the health care space. Among these new entrants are established technology companies, new entrepreneurial start-ups, employers, insurance companies and creative non-profits. As a result, there are more ‘mash-up’ products and services on the market that integrate health or health care services as ‘value-added’ to other products and services. While traditionally there has been a lack of competition within health care because of third party reimbursement, increasingly the traditional providers are not the only game in town. Signals: • • • • Best Buy recently partnered with Meridian to explore sales of health monitoring devices41 Safeway has an extensive health promotion program42 Genworth Financial created ‘CareScout’ a business that provides support services43 CellScope has developed and inexpensive technology that enables people to check ear infections at home44 In a decade, the market will be bombarded with so many providers that consumers feel paralyzed. Patients will buy and download health services from providers around the world like they do music on itunes today. Countertrends: There is a competing stubbornness among consumers around the growing need to trust the sources of their care and seek out traditional institutions and physicians that they can be confident will provide the best care. There is also a counter trend toward increased regulation and restriction of health care products and devices.
  13. 13. How will providers differentiate themselves among global competitors? Providers must compete for pricing and service options on a global scale and cater to an international market. 5 Made in China/ The rise of the Economic East brings a new global centre for health care progress. Overview: As the global economic power shifts East, there is an increasing reliance on countries like India and China for innovation and development in health care. Further, the East is playing an increasing role in dictating international health care policy and action through structures like the G-8 and the World Health Organization. With an increasingly globalized health care industry, medical tourism will continue to grow and people will travel to the East for lower cost, ‘Made in China’ health solutions and the Chinese population will look for Made for China solutions elsewhere. Signals: • • • The Central Government of China released its five year plan which invests in health care innovation45 Mayo announced the opening of a new hospital in India Canadians with Multiple Sclerosis traveled abroad for the new liberation treatment46 Economic Trend Implications for Providers: Extrapolations: In a decade, Canadians will purchase most of their health care products and services from multinational corporations. The wealthy and middle class will think little of going to the other side of the word for regular treatments. All of the top health scientific discoveries will be coming from the East. Countertrends: There is also a growing push to maintain and strengthen local services, such as that in rural communities. Additionally, there is a strong movement in the US and Canada to embrace and uphold western medicine as the only effective, proven approach to providing health care. Implications for Patients: Will patients choose their next vacation based on the location of their preferred health care provider? Patients will have more choice and will engage in more travel for specialized services. They will also nurture an increasing interest in Eastern Medicine. 13
  14. 14. Economic Trend Implications for Providers: There are not enough providers in the market to meet demand so existing providers are overwhelmed with users, often collapsing their systems. 5 Granny Breaks the Bank/ The rise in demand for seniors’ services results in broken health systems and insufficient funds. Overview: 14 Signals: As the population in the US and Canada ages, seniors comprise the majority of national health care costs and are beginning to suck the health care system dry. Their demands for quality, complex care are expensive and both state programs and families are beginning to feel the detrimental consequences to their pocket books. There is insufficient funding, labour and planning to support these seniors as desired. • • • American economists are projecting that Medicare will be bankrupt by 202449 Almost all caregivers in Mayo’s dementia support group report significant financial woes Ontario’s Long Term Care bed shortage has put a major burden on hospitals and families50 Implications for Patients: Patients experience troubles accessing a full system. There is increasing dependence on family members as caregivers with major financial restraints. Extrapolations: In a decade, there will be a new model of health care reimbursement because the old system didn’t work. There will be a reduction in reimbursements for seniors care, families will be forced to look after elders at home, and there will be a large rise in personal bankruptcies in North America. Countertrends: There is a major push toward reducing the costs of caring for the sick and aging population by encouraging seniors to stay at home. There is also a growing desire among users to seek a high quality of life rather than longer quantity of life resulting in choices not to get curative treatment.
  15. 15. Will patients have the money needed to get what they want? Patients will finally get more of the care they want, using the channels that they use for everything else. 5 Health Care On-Demand/ Economic Trend Implications for Patients: Implications for Providers: How will doctors offer impeccable instant services? Providers are expected to be more flexible, and will need to adapt to new care models. This will require alternatives to the ‘fee for service’ model for compensation. Get health care services anytime, anywhere. Extrapolations: Overview: In ten years, almost all of the care that we received in the hospital or doctor’s office will be provided through mobile technologies and completed at home or on the go, often instantly as needed. There is an explosion of low cost venues and channels that provide patients with instant health care communication, information and service wherever they are. Retail clinics are dotting the continent and there is a rise in the use of tele-health and virtual consults. These models alone are contributing to a significant surge in direct-to-consumer payment models where patients pay for health care products and services out-of-pocket Signals: • • • The development of the Mayo clinic store in the Mall of America51 GreatCall has a successful subscription-based program for a 24-hour nurse hotline52 mDhil provides services via text messaging, mobile web browser53 Countertrends: There is also a growing trend toward the centralization of specialized services. Furthermore, in some circles there is a growing emphasis on the in-person doctor-patient interaction demonstrated by the resurgence of home visits. 15
  16. 16. Social Trend concept of health care to be viewed in terms of the social, emotional and spiritual well being of people across cultures. Implications for Providers: 5 Health care for All/ Increased social entrepreneurship and advocacy for those without access to proper health care. Overview: Building on the idea of social justice, there is an increased focus on the gap between the haves and have-nots regarding health care. There are more groups self-organizing to advocate for equitable access to health care, to shine more attention on problem demographics and to increase participation for those on the fringes of society. Signals: • 16 Increased emergence of non-profit health organizations focused on ethnic, teen, children, bottom of the pyramid health issues22,23 • • • Growth of social entrepreneurship in the recent past, emergence of social entrepreneur online courses and partnership with global corporations24 Increased reporting of successes in community based health interventions in rural communities25 Evidence of corporate incentives/matching of funds for community based health interventions26 Implications for Patients: More patients will receive access to health care but treatments may not always align with their beliefs. Their influence will further challenge the Providers will experience competition for funding as now political, business, philanthropic and celebrity funds can now be redirected to non-traditional health care avenues for the redistribution of equitable health care. This puts pressure on providers to perform better. Patrons will have to be courted. There will be opportunities to partner with social entrepreneurs for health promotion and care. Having a greater focus on diversity of the larger patient base reached through health social entrepreneurship will be beneficial for providers and will also help in attracting health care professionals who can fit in and care for the respective cultures. Medical interpreters, translators and counsellors will be needed to work with patients to determine the most appropriate care. Extrapolations: The increased diversity of the patient base will have an impact on the definition of health care and future treatments will encompass a more holistic set of health and wellness services. Countertrends: Competition for funding may counter the effectiveness and impact of a growing number of health social enterprises.
  17. 17. Implications for Providers: 5 Patient Empowerment/ Individuals actively seeking out information and asserting control over factors affecting their health. Overview: Individuals are becoming increasingly involved in their health care – managing their clinical data, researching relevant medical info and having more informed discussions with their health care providers. No longer are doctors the ones with the medical knowledge. The internet and social media are democratizing medical information and individuals are not only benefitting from this knowledge to influence aspects of their health. Signals: • Increased emergence and success of • • • health information sites27 More social media courses being offered to health care professionals to improve their practice and engage their patients28 Increased number of health-related apps and tools available on the internet29 Increasing anecdotal evidence of the effectiveness of patient peer-to-peer support in healthcare30 Implications for Patients: Patients are torn between having access to health information and feeling overwhelmed by it. They will increasingly have power over their physicians To capitalize on the abundance of patient data in the public domain, there needs to be further integration of this data and that from assistive devices under approved guidelines into personal health records. Providers will have to invest in more collaboration and conflict management to maintain relationships with knowledgeable patients. Providers will work with government to revise government regulations/policies in health care re: blurred boundaries between personal/public health care and self-tracking/epidemiology. Social Trend in demanding treatment types. Their updated personal health records become tools for further patient empowerment. Extrapolations: In a decade, there will be increased transparency on mainstream social media regarding the health status of individuals. Health providers will be using social networks to determine health levers and will be capable of implementing a social intervention for society’s well-being. Countertrends: There may be individuals who choose not to get on the medical health bandwagon but may gravitate to alternative healing methods – Eastern medicine, spirituality, natural movement. The overload of information may cause individuals to become uninterested and disengaged. 17
  18. 18. Social Trend also question what data they own and what they allow others to access. Implications for Providers: 5 Quantify Oneself/ Measuring oneself in various situations in everyday life to improve mind and body health and performance. Overview: For some individuals, data is critical for them to understand what is happening with their bodies. Data is the only thing they can trust. They monitor quantities like weight, sleep, location, messages, genes, body chemistry, performance, productivity, or any other of a thousand metrics to view their bodies, minds, and spirits through the lens of data. Measurement can be done actively or passively through technology gadgets. Signals: 18 • Advances in cheap sensors, communication and data tools for tracking • • your activities and moods32 Increasing number of Quantified Self members and meetups in over 13 countries33 Increasing venture capitalist interest in the Quantified Self movement34 Providers have an opportunity to leverage all this data to create customized treatments for their patients but to effectively do this, they will have to build capability in data analytics and visualization to first understand the data and then explain its meaning to patients. Providers can also use this data to perform probabilistic medicine - predicting the likelihood of disease and proactively treating patients. Extrapolations: There will be increased transparency on mainstream social media regarding health status of individuals. Since the Quantified Self members are already measuring moods, in the future it will be possible to measure subjective states such as happiness, anxiety, or pain. This would allow researchers to find the neural correlates of personality and behavioural patterns (neurodiversity) with positive implications for removing the stigma on mental diseases.35 Implications for Patients: Countertrends: Patients will embrace the opportunity to measure and track their health metrics for customizable treatments that could come about with increased tracking. When their data starts to become integrated in health systems and used for disease prediction, patients will balk at the line between quantified self and ultimate surveillance. Some degree of their privacy will be sacrificed. They will Information overload and complexity may slow the growth of this movement. And as more self-tracking data is pushed to research organization and providers, increased government legislation in response to privacy concerns could counter the growth.
  19. 19. If unchecked, effects from climate change will plague patients in the form of new diseases, pandemics, increased stress and loss of life. Patients will look to providers as a source of security and comfort as they search for information on prevention and care. 5 Weathering Health/ Increasing adverse effects on society’s health related to climate change and environmental degradation. Implications for Providers: Government and provider collaboration is critical to care for the projected increase in patients with these new diseases. Providers will also play a greater role in disease prevention related to the effects of climate change as they collaborate with ecological partners in their attempt to do vulnerability mappings and health impact assessments for public health actions. Environmental Trend Implications for Patients: Extrapolations: Overview: Climate change results in environmental consequences such as sea-level rise, changes in precipitation resulting in flooding and drought, heat waves, more intense hurricanes and storms, and degraded air quality. These consequences adversely affect human health both directly and indirectly. Linkages have been made to an increasing number of conditions such as asthma, cancer, foodborne diseases, heat related morbidity, human developmental defects, health and stress related diseases, neurological, zoonotic and waterborne diseases. Signals: • • • • • Increasing frequency of deaths due to heat waves35 More variable precipitation patterns compromising freshwater supply and leading to water-borne disease outbreaks36 Rising sea levels and flooding causing vectorborne diseases like dengue37 Urban air pollution causing 1.2 million deaths each year, mainly by increasing mortality from cardiovascular and respiratory diseases38 Reports of natural catastrophes have more than tripled since the 1960s.39 Over time, confronted with decreased productivity and increasing costs to care for populations whose health is adversely affected by climate change, more governments will put climate change at the top of their agenda leading to greater international cooperation. Countertrends: Linking health effects due to climate change could create movement for mass conversion to alternative energy sources, reforestation, adoption of environmental agreements, which will cause an increase in support for the environmental movement. 19
  20. 20. Drivers/ Using the trends as a starting point for analysis, we set out to determine the driving forces behind some of the major changes that are happening in the health care industry. There was extensive dialogue about how trends influenced each other and underlying pressures within the system. Influence mapping was used to complete a basic systems analysis and identify key drivers, enablers, blockers, and friction. A simplified systems map is shown to the left identifying five key drivers. The key drivers identified were: 20 1. Access to Health Information – The ease with which patients and practicioners can obtain data and information on health issues. 2. Patient Engagement – Patient initiative in manging their health. 3. Complexity of Health – The advancement of illnesses and the number of conditions people have. 4. Personal Health Metrics – Collection of health data from individuals. 5. Patient/Physician Interaction – The relationship between patients and physicians and their cooresponding actions.
  21. 21. Creating Future Scenarios/ Using the key drivers identified, the cone of plausibility was used to develop future scenarios that would answer the question: what will the future interaction between traditional health care specialists and patients look like in 2030 in Canada? The purpose of developing the scenarios was to think creatively about what specialist providers want to know about the future to strengthen strategic planning and offer insights that would help them be leaders in working toward a preferred future. The cone was chosen because of its suitability to the slow-to-change health care industry with a logical progression over time, incorporated visioning and room for surprises. This method is also very applicable for strategic planning because of the strong linkages to the few key drivers. The cone of plausibility is a scenario planning technique that uses a series of drivers and key assumptions of the drivers to develop a range of possible future scenarios.54 The technique involves developing a base- line scenario with the logical extrapolation of the drivers and assumptions to the target date. Alternative scenarios are then generated by making small and radical adjustments to the key assumptions. In the case of this project, the basic method was modified as a preferred scenario was used instead of the baseline scenario with the idea that specialist providers want not simply to react to the future, but also create it. What will the future interaction between traditional health care specialists and patients look like in 2030 in Canada? The following section summarizes four future scenarios for 2030 that resulted from using the cone of plausibility. The graphic novel that follows brings these futures to life through a story about the Mayo brothers, the founders of one of the first collaborative specialist medical clinics. 21
  22. 22. Perferred Scenario Interconnected/ Engaged patients have personal, high-touch interaction with connected providers. In this world . . . When visiting the specialist provider, patients enjoy a seamless experience with personalized, high-touch interaction. Patients also have the benefit of new health care roles - health navigators and coordinators who ensure that the patient’s time is effectively managed at the clinic and that they understand all aspects of their treatment options. 22 Specialist providers are able to treat patients within a robust medical network. Specialists strive for effectiveness in their practice using a high degree of collaboration with primary care providers and caregivers to achieve success. Providers are reimbursed based on how effectively they treat patients and patient wellness. Patients have become more knowledgeable about their health and ways to manage it. The access to health information is high. There are several tools on the market that patients keep track of their health information and it is automatically fed into a central database within the health care system. For the chronically ill, the social worker becomes critical in providing interim communication and navigating the system. However, the cost of specialized health care has increased. Medicare cannot handle costs associated with the issues relating to complexity of health of seniors. A twotierred health care system in Canada is prominent. Typically, only the upper middle class can afford timely specialist care. Winners in this scenario: • • Patients who can afford high quality, specialized care Health care navigators and coordinators whose services are in demand Losers in this scenario: • • Patients who cannot afford specialized care Specialist providers who are highly valued and get reimbursed based on treatment effectiveness
  23. 23. Plausible Scenario Do It Ourselves/ Patients take on a leadership role in defining and administering their own treatment. In this world . . . • With increased access to health information, patients are highly engaged in managing health and are seen as experts of their own health. They derive great benefit from online networks where their questions are answered instantly and they can get an estimated diagnosis in a matter of minutes. Informal social networks gather around people who need support. Patients who do not have strong social supports are left behind. appropriate for them to prescribe their own drugs bypassing the physician. Pharmacists now become the gatekeepers of diagnoses and prescriptions of treatment. The reliance on health-related social networks and the health management tools for critical decisions means patients often make bad decisions regarding diagnoses and treatment. During interactions with specialist providers, patients often have disagreements as both have very strong views on what treatment is required. Specialist providers are caught between doing what patients think is best and growing malpractice liabilities. The Canadian government now penalizes citizens that chose unhealthy consumption and behaviour by imposing taxes on unhealthy goods and services. Winners in this scenario: • There are hordes of health management tools in a generally unregulated market. Patients are willing to pay out-of-pocket for treatments the way they want them. Most patients stay at home or in their community throughout the course of their illnesses. There is a growing role for life doulas and other medical coaches to guide patients through their many choices. Due to the increased competency of patients, it is now • Pharmacists who now have greater influence Engaged patients who demand treatments Losers in this scenario: • • Patients that face barriers to engagement in their own care or have low social support 23 Specialist providers who face pressure from patients and insurance companies
  24. 24. Possible Scenario Calculated Craziness/ Patients are bombarded with health metrics and measures. In this world . . . It seems like technology has taken over. Genome mapping is the same cost as getting blood work done is today and on-going personal biologic surveillance through accessory gadgets is the norm. Many technology companies are leading key developments in the health market and regulation can’t keep up. Real time health updates and availability of genetic information allows for immediate, completely individualized treatment for prevention of disease and timely reactions to condition changes. The high availability of information due to advances in technology allows for data mining of information. This enables the Canadian government to improve policy around promoting population health and promptly respond to emerging health issues. 24 Many self-monitoring devices are available on the market. Patients are increasingly involved in monitoring their bodies and its information. Patients often feel stressed, anxious and fearful because of a greater knowledge about their genetics and continual feedback from their health devices. There has been a significant rise in the numbers of patients with mental health issues. Specialists have a more technical role in care. Patients are supported by a prominent new role - the health data analyst. These practitioners synthesize information and help the patient understand their genomic profile and the implications for his/her health. Insurance companies have much more personal information and those with poor genetics have extremely high insurance rates. This information carries over into many spheres of life such as employment and even marriage contracts. This causes high levels of anxiety and stress for many who don’t understand the meaning behind the numbers. Ethical issues around sharing personal genetic information and genetic engineering of new life come to the forefront. Debates abound but there is no real direction or resolution. Winners in this scenario: • • Insurance companies have better information on “risky individuals” In-house genetic data analysts who assist patients Losers in this scenario: • Patients who have “bad” genes
  25. 25. New developments mean people can live to at least 150 years of age. Extreme Scenario Healthy Immortal/ In this world . . . Science offers a way to significantly extend human life through genetic reprogramming treatment. The production of synthetic organs is a quick and effective way to cure disease and injury. Patients are generally engaged in making healthy choices and they can live extremely long, healthy, and functional lives. Chronic diseases have been basically eliminated because of powerful medical and scientific developments. Patients tend to only interact with physicians for one-time quick fixes to deal with injuries and for assisted death. In this world, because of the high life expectancy, many patients decide when they are ready to die. Euthanasia has been legalized to accommodate this need. For those who are grounded in religion, there are conflicting values around lengthening and creating life. Because of the “immortality” that has been achieved due to technological advances, some people end up taking more risks because they feel more invincible and this behaviour is what fuels the demand for health services. Winners: • • Patients who get injured Specialist providers who can play “God” to heal and restore Losers: • • Those that don’t have access to medical advances Those that feel lost as they live long past their natural life-expectancy 25
  26. 26. Bringing Scenarios to Life Back to the Future/ T he following graphic novel tells the story of going back to the future with the Mayo The story goes like this. One day Charles was futzing around in the supply closet when he discovered this machine that had lots of blinking lights, dials and buttons. Brothers, the founders of the first integrated group practice in Rochester, MN. He wondered what it was. His curiosity got the better of him and he started pressing some buttons and turning some dials. The room started to rumble and shake. He saw a set of numbers turn to 2030 and he felt himself being pulled through thin air (which was actually a time worm hole). And Charles ended up in a different world . . . 26 The intention of the graphic novel was to help interested parties understand the world within each scenario and better determine potential implications for stakeholders.
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  33. 33. From Scenarios to Strategies/ T o utilize new insights garnered from the scenarios, a list of strategic op- tions were developed for specialist pro- Some of the options were recognized to be closer to the tactical level and removed from the process that followed. This left twenty-five options that were then clustered into a more manageable set of four possible strategic directions by grouping options that required consideration of each other in implementation. viders. These strategies were then tested against each of the scenarios for strategic fit. The process of options surfacing, eliciting existing organizational and industry strategies, and option generation, developing new strategy options were utilized to develop a relatively comprehensive list of strategic options First, informal conversations about potential strategies took place for the purpose of surfacing existing strategies and long-standing intentions. Then, the scenarios were used as triggers to generate additional strategic options by asking the question “what would a specialist provider want to do if this future was the reality?” Internal, external and transactional options were identified. The four strategic directions that resulted from the iterative process of refinement were: 1. Develop a smart, electronic health system 2. Integrate system delivery 3. Improve the patient experience 4. Serve more patients, more efficiently These strategic directions along with their corresponding options were then evaluated against the range of possible futures outlined in the scenarios. 33
  34. 34. Wind-Tunnelling/ Using a wind-tunnelling matrix, the strategic fit of each option within the environment of each scenario was determined and rated high (shown as a solid circle), medium (shown as a think circle), or low (shown as a light circle). The level of risk and uncertainty of each option was analyzed through these multiple futures. Those strategic options that were recognized as “robust” (or had a medium or high rating in the first three scenarios) were highlighted. The fourth scenario, the Healthy Immortal, was used not used to inform the overall level of robustness due to its ‘extreme’ orientation, but it became a useful trigger for thoughtful consideration and conversation. The wind tunneling matrix shows a quick overview of the results of this process. At 34 a glance you can see that the first three strategic directions were generally robust and appropriate for the range of plausible futures, while the fourth direction of ‘seeing more patients, more efficiently’ was rather uncertain when tested against each scenario. The three robust strategic directions identified offer important long-term approaches for specialist providers moving forward, but still the process of acting on these directions remains unknown. And rather than simply be reactive to the changing environment, the question remains, “How does a specialized health care provider lead in the creation a desired future?” Three horizons method helps to answer this question and strengthen implementation of these strategies. This wind tunneling matrix outlines the twenty five strategic options and four overarching strategic directions. . Each option is tested for strategic fit within each scenario and rated high (solid circle), medium (thick circle), or low (light circle).
  35. 35. The Three Horizons/ The three horizons method55 illustrated to the right represents the prevailing system (Horizon 1 - the Closed/Physican-Centric System), the unstable space of transition (Horizon 2 - the Decentralized Mess) and the vision for the future (Horizon 3 - the Integrated/Patient-Centric System). Horizon 3 was developed from a combination of the first three original scenarios. The Three Horizons model diagram shows the dominant system falling away followed by the rise of the patient-centred model of care with the transitional space in between made up of tensions and unresolved issues. The model also shows that there are “pockets of the future” embedded in the present that represent both Horizon 2 and Horizon 3. These weak signals of the patientcentred model of care include changes in reimbursement models toward bundling in other countries and signals of the decentralized mess include incidents of leakage of health information and growing numbers of people getting their health questions answered online. 35
  36. 36. The Three Horizons framework seemed particularly appropriate because of the radical transition that seems immanent within the health care industry and the strongly held vision of a desired future among many industry thought leaders . Descriptions of each of the three horizons are provided in thed diagram to the left. The framework offers indications of the range of strategic innovations that would help a specialist health care provider, not only survive, but lead in the development of the desired future. 36 In the short-term, Horizon 1 requires strategies that improve current operations or incremental innovations to help keep the system relevant longer. Horizon 2 requires strategies that extend current competencies and address the growing tensions within this space. Horizon 3 demands radical innovations that change the nature of the industry and bring to life the vision for an integrated, patient-centred system.
  37. 37. Three Horizons also calls out tensions between the status quo and the prefered state. These tensions are highlighted in the diagram on the right. It is finding strategic ways to navigate these tensions that will allow providers to successfully transition to a patient centric system. There is a tension between the traditional physician power and the growing patient empowerment. This suggests a need for colloration and partnership between patient and providers. In the transition, there is tension between the fragmentation of services in the current state and the integration that is envisioned in the prefered state. This calls for coordination to improve the patient experience within the mess of Horizon 2. The current model of medicine that is reactive to illness must transition toward prevention and prediction requiring partnerships with primary care providers and other practicioners within the community. The tension between standard treatement and individualized care requires new models of assessment and deeper understanding a patient profiles. The shift from valuing quantity of service to patient wellness will require new reimbursement models, ongoing health management and truly collaborative practices. The transition from complex processes within the health care space to easy to use systems suggests the need for appropriate technologies and systems changes. As specialized health care providers transition toward Horizon 3 navigating the tensions within Horison 2 will be critical. 37
  38. 38. Strategic Directions/ Bringing forward the robust strategic directions from the wind tunneling exercise, the following pages outline how these three directions can be thoughtfully implemented by using the Three Horizon’s method as a conceptual framework. The three strategic directions are outlined on the right. Together these strategies work to create Horizon 3 and a patient centred system of care. 38
  39. 39. Strategic Direction One Smart Electronic Heath System/ B ecause the health care transformation will be significantly information driv- en, one critical element of a patient-centred system for 2030 is a smart electronic health system. Access to health information and services that will meet the needs of the future patient requires the integration of multiple databases into one centralized electronic health record system that can be accessed at every point of patient interaction. This requires a solid information technology foundation that is scalable and flexible enough to meet the demands of many collaborating practitioners. The electronic health records system will lay the ground work for integrated delivery and ongoing health management. The system must provide a single unified comprehensive view of the patient, their medical history, and their biological profile that can be accessed using any device or system. Creating a smart visual dashboard, with an ‘at a glance’ view for patients and providers, will improve decision-making. Furthermore, the system must be able to learn from all the aggregated health information within it. The electronic health system needs built-in analytics to enable predictive modeling. Having a smart system will allow practitioners to gain actionable insights from data analytics. Unfortunately, implementation of this desired end state will not happen overnight. While the basics of this strategy is not a new aspiration for specialist providers in 39
  40. 40. Horizon 1: Determine Foundation of Electronic System Horizon 2: Position as Experimenting Expert Horizon 3: Establish Smart, Electronic Health System Incremental Improvements • Dialogue with patients system needs • Identifyexisting tools Utilize • • Establish design guidelines New Related Activities new tools/systems • Prototype technology Partner in • development • Position as think tank • Accredit technology System Changes • Shared e-health recordinterface • Standard platform and • Aggregate information prevention • Algorithms forin system Collaboration • Security safeguards • Canada, there have been significant barriers to progress and implementation over the last decade including: separate information silos, incompatible legacy systems, current time requirements for information technology, and the complexity of many systems currently on the marketplace. 40 The three horizons framework offers guidance on a stratified approach to implementation that is fit to weather the storm of the ‘decentralized mess’ that lies within the desired transition. Strategies appropriate for horizon 1 are incremental improvements to the current system that create the foundation for the electronic system and would help to prepare for the transition. These strategies include identifying the electronic needs of practitioners, patients and organizational operations and establishing design guidelines to share with technology developers. These steps will help to encourage the development of technology that is compatible with and useful for the provider. In addition, utilizing existing tools within current operations and services, such as using trusted iphone applications, has the potential to make improvements to services and establish practitioner readiness for more radical system changes. Engaging patients early on in conversation about their desired and current use of electronic health information will help to establish an understanding of what is needed from a patient perspective as well as establish trust in the space as the organization moves forward.
  41. 41. Actions appropriate for Horizon 2 and surviving the chaos are those that position specialist providers as relevant and trusted experts amid the clutter of other offerings. Activities include partnering with technology companies to assist in development of appropriate technology, openning up network to test out different points of interaction within the system, and providing feedback to improve the products for mutual benefit. In addition, acting as a thought leader by publishing white papers and calling out the next steps will help differentiate specialist providers and attract the right partners for moving toward the desired electronic system. Furthermore, to emphasize specialist providers as trusted experts, providers could investigate developing an accreditation program for tested, secure technology to help patients and providers alike navigate the mess and make better choices related to using information technology for managing their health. a standard platform for connecting, supported by cloud computing technology for point of care communication. The common system should then be utilized by aggregating health information from all collected patient data to gain actionable insights for more personalized care and to develop algorithms to help prevent diseases. The standard platform would then be used to move beyond connections between practitioners to collaboration among all patients, providers, communities, and beyond. In working toward the end goal of developing a smart electronic health system, several fundamental developments are needed including establishing a standard electronic health record early on and adopting Implementing actions for all three horizons is critical to the transition toward a smart electronic system that will in turn lay the ground work for integrated delivery and an improved patient experience. 41
  42. 42. Strategic Direction Two Integrated Service Delivery/ O ne critical element in the transition toward the commonly sought after patient-centred system is integration. While integration is not a new idea for Canada’s health system, there have been many barriers to progress in this area. 42 The Three Horizons method offers a framework for organizing the continuum of strategies related to integration and indicates how a specialist provider can move from the current state toward complete integration. The figure to the left identifies areas of strategic innovation that are appropriate for each horizon and can be adapted based on organizational readiness. The first diagram illustrates how the closed, physician-centric system that is dominant today can be improved by creating linkages between typically disconnected providers. Informal actions such as a phone call between a specialist and a primary care physician to provide an update on patient status, can improve the overall health management of the patient. In the same vein, other simple actions that can help create linkages in the current system include the utilization of shared patient artifacts (such as patient books written in by all providers); efforts by practitioners to help patients navigate the system (such as making referrals to community support organizations); and establishing collaboration protocol within specialist organizations. These actions don’t offer a sustainable path toward integration, but rather band-aid-type solutions that can help specialist providers remain relevant in the short term. Increasing integration within in the ‘decentralized mess’ requires investment in new tools, roles and partnerships that move beyond the status quo to the provision of services designed to coordinate the patient experience. Tools such as case management and care coordination do not change the overall integration of the system itself, but they help coordinate care, manage patients’ health, connect patients to appropriate resources, and improve resource
  43. 43. Horizon 1: Linkage Within The Current System Incremental Improvements • Informal communication • Shared patient artifacts • Practitioners act as navigators • Collaboration protocol Horizon 2: Coordinate Care Amid The Mess New Related Activities management • Casecoordination • Care points of entry • Single • Service partnerships • Care plans Horizon 3: Establish A Truly Integrated Delivery System System Changes • Shared e-health records • Co-location • Collective governance • Team-based care • Pooled funding The innovations directed at Horizon 1 and 2 fall short of establishing a completely integrated system for the future. These horizons are the testing and building ground for Horizon 3, the preferred state, which requires radical system changes. monitor, manage and share health information instantly between providers57. Pooled or bundled funding is another critical element which provides incentives for providers to collectively ensure patient health. Using this reimbursement model, there is a set amount of funding, regardless of services provided and a network of providers is collectively responsible for their wellness58. Co-location strategies, collective governance between providers, and team-based care have also proven effective in achieving system integration. One of the most fundamental elements of an integrated, patient-centric system is shared electronic health records. Electronic health records provide an efficient way to For specialist providers in Canada to continue to be leaders in their field, they must invest in strategic innovations to help them survive and thrive in the future across all efficiency.56 These tools are appropriate for specialist providers seeking to remaining relevant in a highly chaotic and decentralized system. These tools also lay the ground work and develop relationships critical for Horizon 3. three horizons as they transition toward integration. As illustrated in the Three Horizons Diagram, remnants of each horizon exist in the present and specialist providers need to implement strategies now to ensure they are prepared as the level of strategic fit of Horizon 2 and 3 increase with time. While each specialist provider in Canada is working in a different context and has a different level of readiness around systems integration, the milestones outlined below offer general indications of the progress necessary to lead the transition toward complete integration. These milestones offer providers a way to monitor their efforts and environmental change as well as provide an indication of when alternative strategies may be necessary. For example, if standard, shared electronic health records have not been implemented by the end of 2018, an alternative strategy for a local shared information network is needed in order to develop a provider network with collective governance and a truly collaborative practice. Similarly, if a bundled reimbursement model is not in place by 2024, other incentive for collective responsibility around patient wellness will need to be explored and developed. This general pathway offers a guide and targets for organizational decision-makers, but a individual time line for each provider is needed. 43
  44. 44. Strategic Direction Three Improve the Patient Experience/ I mproving the patient experience is at the core of the transition toward a system that is truly patient-centred. 44 Improving the patient experience is at the core of the transition toward a system that is truly patient-centred. Being patientcentred or organizing delivery of services around the needs of patients seems like a simple and obvious approach, but in a system as complex as health care, little is simple. While some specialist providers currently have organizational missions that reference a patient-centred approach, services are often far from patient-centred, leaving patients with an experience that is no better than mediocre. The fact that providers are giving lip service to ‘patient-centred care’ with little change in service provision is evidence of the growing tensions space in Horizon 2. More can be done to make a thoughtful and strategic transition toward a radically differ- ent patient experience enabled by patientcentred services. It requires a holistic, preventative approach that works toward wellness and quality of life, supports mental health, and involves friends and family in a patient’s care. Patient-centred services require ongoing communications and health management as well as easy access to personal health information. It means services that are transparent, flexible and convenient for patients, including providing services online and in locations where patients already are. Patient-centred care goes beyond expanded patient consultation to seeing patients as partners, key decisionmakers, and collaborators. It encourages and enables self-care and self-management. Patient-centered care for 2030 requires individualized, tailor-made interventions based on biological and clinical data provided in a compassionate, comfortable way by a trusted source. Getting to this desired end state requires simultaneous actions that: improve the patient experience in existing services, extend service and delivery options and offer holistic, individualized services with patients as partners. These three directions enable specialist providers to maintain and radically improve services by implementing actions appropriate for each horizon. In the first horizon, incremental improvements, such as training for practitioners on improved patient-service and relationship management, can significantly enhance the patient experience in the existing system.
  45. 45. Increased informal communication with patients can improve the connection between patients and providers and is proven to impact patients’ perception of quality of care. However, the shift toward patientcentred care is not minor one; it requires an important and thoughtful adjustment of organizational culture and values which can certainly take root in Horizon 1 starting with the messages and decisions of leadership. For those specialist providers looking to transition toward an improved patient experience enabled by patient-centred services, navigating the tensions within ‘the mess’ is critical. It requires specialist providers to ‘walk the talk’ of being patientcentred by expanding service and delivery options that reflect the paradigm shift. Extending wellness services and testing out new practitioner roles, such as mental health workers, data analysts, care coordinators, or wellness coaches, will help serve patients more holistically within an organizational environment that is still somewhat fragmented and an external environment that is increasingly cluttered. In addition to the types of services offered and roles, improving ways in which services are provided is also critical to competing in Horizon 2. Actions like implementing same day scheduling, enabling a patient to have all of their clinic work done in one day, or increasing communication channels between patients, providers, and families, help a specialist provider stay relevant and meet the changing demands of future patients. Horizon 1: Improve Existing Services Horizon 2: Extend Service and Delivery Options Horizon 3: Offer Services that are Truly Patient-Centred Incremental Improvements • Train practitioners • Enhance communication • Expand consultation • Family involvement New Related Activities new wellness services • Pilot new supporting roles Test • Improve scheduling flexibility • • Increase communication options System Changes • Patient collaboration • Individualized medicine • On-going health management • Core services online offerings • Holistic, preventative • Transparency and access of information Still the strategies aimed at preparing a provider for the decline of the status quo and the rise of values-related tensions is not enough create the radical improvements necessary to the patient experience that would reflect a system that is truly patientcentred. Horizon 3 requires a complete paradigm shift that supports patient collaboration and integrates holistic thinking and palliative care in all interactions – a proactive approach to care. Building capacity to offer a range of truly individualized treatments with preventative and predictive offerings, is instrumental to understanding and meeting the needs of future patients. For Horizon 3, seamless integration be- tween practitioners and other providers enables ongoing management by a team of professionals that are deeply invested and accountable for patient wellness. This means that patients see the right person, at the right-time, in the right place to address and prevent individual health issues. Such services would include the option of getting core services, such as key consultations and even diagnosis online. The effect is that the patient derives valued care from every touch point with the health system. Ensuring the most appropriate, personalized service for each individual will create a very different interaction and experience
  46. 46. Moving Forward/ An indicator of a growing horzon two is patient adoption of private health services. Monitoring uptake of these services can help to make sure that strategies targeted at Horizon 2 are implemented at the appropriate time for the environment. Similarly, the implementation of bundled reimbursement model is a signpost for the rise of Horizon 3. If this is not in place by 2024, other incentives for collective responsibility around patient wellness may need to be explored and developed. The organizational milestones offer a general targets for organizational decisionmakers, but an individual timeline for each provider is needed. These milestones are important check-ins along the journey for providers. The timeline above outlines key organizational milestones and environmental indicators for specialist providers. While each specialist provider in Canada is working in a different context and has a different level of readiness for these strategies, the milestones outlined offer general indications of 46 the progress necessary to lead the transition toward a patient centric system. These milestones offer providers a way to monitor their efforts and environmental change as well as provide an indication of when alternative strategies may be necessary. For example, if shared electronic health records have not been implemented by 2018, an alternative strategy for a local shared information network is needed in order to improve delivery integration and the patient experiene. This timeline should be used as a generic guide from which targeted timelines with milestones and signposts can be developed that are specific to each provider.
  47. 47. A Call for New Thinking/ T his foresight project challenges specialized health care providers and others working in the health care space to think differently about strategic planning. It demonstrates powerful, creative methods for pondering the future and offers thoughtful approaches for transitioning toward a desired future. Especially for one of the most valued and also outmoded systems in this country, foresight offers hope and much needed inspiration for change. 47
  48. 48. INTERCONNECTED POWER TO THE PEOPLE CALCULATED CRAZINESS HEALTHY IMMORTAL Appendix/ 1 Integrate with local community providers* H H M L service 2 Partner other specialist providers L H L L delivery 3 Integrate internal health care practitioners H M L L 4 Provide ongoing health care H H H L STRATEGIC DIRECTIONS STRATEGIC OPTIONS Integrate This matrix details the results of the windtunnelling excercise. Those strategic options that were recognized as “robust” (had a medium or high rating in the first three scenarios) were highlighted (identified in the chart with *). management* 5 M H M L Increase provision mental health services* M M H M 7 Increase use of palliative care teams L M H H 8 Expand preventative care offerings L H H M 9 Improve Increase front-end consultation* 6 Increase offerings for genomics based H M H H individualized medicine* the patient 10 Increase alternative medicine options L M L M experience 11 Increase remote care offerings* M H H L 12 Provide core services online* M H H L 13 Offer e-consultations for front-end and H H M L L H H H follow-up consultation* 14 Offer in-home services direct to patient and caregiver Develop 15 Develop capabilities for data analytics* M M H M a smart, 16 Partner with technology providers* M H H L electronic 17 Ensure strong security governance* H H H L system 18 Provide accreditation to companies L H H L 19 Develop centralised digital health record* H H H M 20 Improve transparency of care* M H M L 21 Reduce hospital stay-time* H M M H Serve more 48 22 Increase patient through-put L M M L patients, 23 Focus on more complex patients H L H L more 24 Further centralize specialty care H L L L efficiently 25 Stay comprehensive and treat everyone L M L L well
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