This document discusses the use of scenarios for robust decision making in uncertain times. It provides examples of how scenarios have been used effectively in healthcare planning and diagnostics. Scenarios allow exploration of different possible futures rather than single forecasts. When used for healthcare in the UK, scenarios led to changes in policy focus but some key decision makers were not engaged. Scenarios developed for a diagnostics company helped establish a vision that was robust across multiple futures. Scenarios were also used to identify health and safety risks of emerging green technologies. By challenging assumptions and exploring alternatives, scenarios can enhance strategic planning.

1. Robust decisions in uncertain times
Foresight: Exploring the Future, Shaping the Present
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Using Scenarios
Why use scenarios,
and how to make sure they are effective
Gill Ringland
CEO & Fellow, SAMI Consulting
July 2013

2. Robust decisions in uncertain times
SAMI
• Our offer
– To enhance the capability to anticipate
– To transform emergent thinking into strategy and
implementation
– Consulting, executive education and research to deliver
“robust decisions in uncertain times”
• “You can never plan the future by the past”
– Edmund Burke, 1729-1797
• Formed in 1989
– Until 1999 based at St Andrews University
– Now virtual, owned by Fellows and Principals
– Celebrated our 20th anniversary at the Royal Society
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3. Robust decisions in uncertain times
Agenda
• Why use scenarios
– Scenarios & forecasts
– Early indicators
• Using scenarios: examples relating to Health
– Radical thinking in the National Health Service
– Scenarios lead to a rethink
– Scenarios for the future of diagnostics
– Health & Safety impacts of “Green” jobs
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4. Robust decisions in uncertain times
0
2
4
6
8
10
12
1951 1961 1971 1981 1991 2001 2006 2011 2016 2020 2030
Actual Forecast now
London population
1991
forecast
“A trend is a trend until it bends”
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5. Robust decisions in uncertain times
Forecasts
Today Trends 
Range
Of
Uncertainties
Timing ?
Forecasts are over-precise
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6. Robust decisions in uncertain times
Scenarios
• Forecasts focus on “the right” answer and a partial
“right” is often viewed as wrong
• Scenarios are
– “an internally consistent view of what the future might be”,
– “not a forecast but one possible future outcome”
• Scenarios explore different possible futures
Forecasts Scenarios
Source: Professor Michael Porter, “Competitive Advantage:”, (Free Press, 1985)
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7. Robust decisions in uncertain times
Line manager, Corporate Strategist Scenarios Future
Engineer manager thinker
Early indicators Portfolio Ideas & systems Alternate “843” trends
Decisions, management Planning worlds interconnected
Timelines Options
Decisions
Thinking styles
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8. Robust decisions in uncertain times
Early indicators
• Early indicators are a powerful way of engaging the
organisation
• Are clear “events” which would be a sign that a scenario
is evolving
• Shell & gas fields
– Gorbachev promotion as early indicator of changes in Russia
– Decided not to buy gas fields as Russian ones would change
pricing
– Shell bought Russian gas after the price had collapsed
• Often ask a group to think up newspaper headlines that
would signal a scenario, as a way of “thinking in” to a
scenario.
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9. Robust decisions in uncertain times
Using scenarios
• Public policy
– Radical thinking in the National Health Service
– Challenging assumptions about the Green economy
• Inside organisations
– Scenarios lead to a rethink in planning
– Scenarios for the future of diagnostics create a vision
• Will cover for each case study
– Process
– Presentation and communication
– Outcomes
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10. Robust decisions in uncertain times
NHS – Hemingford scenarios
• New Head of Planning at Department of Health, National
Health Service (NHS), Richard Walsh (now a SAMI
Fellow)
• Focal question: what and who is the NHS for?
• 30 people consulted on clinical practice, public values,
context for health care, demography, disease trends
• 12 people in a 2 day workshop at Hemingford
• 4 scenarios developed, with implications for
– Primary care led NHS,
– Health and health care
– Public involvement
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11. Robust decisions in uncertain times
Drivers of change
Role of
NHS
Climate
change
TechnologyBudget
Changing
lifestyles
Increasing
population
Demographics
+?
+++-- -+++
+
++
+
Deficit reduction
National?
Centralised?
--
+/-? +/-?
Wellness
or
illness?
+++?

12. Robust decisions in uncertain times
Scenario matrix for NHS
Forecastable
“trends” Uncertain
Less important
Important
Demographics - ageing
Increasing population
Changing lifestyles
Technology advances
Disease orientation or well-
being oriented?
Health national vs
international?
Centralised or decentralised
management?

13. Robust decisions in uncertain times
Visualising the scenarios
Wellbeing as you like it
CentralisedDecentralised
Wellbeing Illness oriented
International
National
Health is wealth
Science makes the big push
Renewed welfare order

14. Robust decisions in uncertain times
The outcomes
•8/4/2013 www.samiconsulting.co.uk Page 14
• The scenario team designed and delivered briefing
events for senior management in the NHS to great
acclaim
• They went to a number of NHS sites and held lunch time
events with heated agreement
• They did not engage with the public
• They did not engage with the politicians
• When the next government came in, the new Minister
was not aware of the work & thought that the only task
was to spend more and make NHS more efficient at high
tech treatment of illness (Science makes the big push)

15. Robust decisions in uncertain times
Wanless Report
SAMI Consulting 2006
• Treasury report chaired by Derek Wanless
– “Securing Our Future Health: Taking a Long-Term View” (to
2022)
• Discussed the role of demographics, changing
patterns of disease and cures, technology
• 3 simple scenarios – used a numerical model for
demands, and for costs
– Solid progress: less change in preventative care
– Slow uptake: NHS performance improvements
– Fully engaged : changes in demand
• Showed that
– within any possible expenditure on the NHS
– changes in patterns of demand were needed to balance the
books between demand and supply
– Neither Solid Progress or Slow Uptake were viable

16. Robust decisions in uncertain times
The outcomes
•8/4/2013 www.samiconsulting.co.uk Page 16
• The report upset the “official future”
• Science makes the big push
• Started the understanding that technology is only part of
the answer
• Change in UK health policy focus towards changing
peoples’ behaviours
• Reduction in obesity
• Increase in anti-smoking campaigns
• Promotion of exercise
• GPs offer yearly check ups
• Also a move towards self help via pharmacists, etc

17. Robust decisions in uncertain times
• SAMI Fellow Michael Owen ran GSK’s first scenarios
project
• Interviews & desk research
• Workshops to develop scenarios for the global health care
industry, explore strategic options
• Led to new focus on global initiatives & new technologies
• Also projects in R&D, marketing, manufacturing & supply,
regions
• SAMI asked back to work with manufacturing and
supply, using scenarios to plan for flexible (“agile”)
manufacturing processes
• Scenarios later used to set vision for diagnostics
new business

18. Robust decisions in uncertain times
The diagnostics background
• Since the science and technology of
genetics was developing fast
– Should GSK develop their capability in
diagnostics and prognostics?
– If so, should this be by acquisition or
inhouse development?
• Decided to set up Predictive Medicine
Group
• Needed to set vision, mission, long
term goals
– Scenarios project coached by Clem Bezold
of Institute for Alternative Futures
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19. Robust decisions in uncertain times
Creating the scenarios
• Assumptions: we will be able to predict in the near future
– Who is likely to develop a particular disease
– How treatments will work with different individuals
– Likely outcome of treatments
• Scan for drivers of change, group into clusters which
were scored for probability and impact on Glaxo’s
business
• Create 4 scenarios
– Best guess Health care gains continue
– Hard times Recession slows health care gains
– Paradigm shift Integrated biosciences pay off
– Visionary paradigm shift Globalhealth.com
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20. Robust decisions in uncertain times
Using the scenarios
• Team identified the drivers which were important in all
four scenarios
• Drivers which were only found in one scenario were
used to develop early indicators
• The vision needed to be robust across all scenarios
– Improving lifelong healthcare through predictive knowledge
• The mission included integrating novel diagnostics and
prognostics with therapeutic interventions (GSK’s
traditional business)
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21. Robust decisions in uncertain times
Presentation
• Recognised difficulty of presenting
plausible futures to operational
managers
• Chose to use a mock television
interview around “The Fifth Colony”
• Four colonists had been in space and
developed a health care system for
their scenario over 10 years
• Why were they different?
• The Fifth Colony represented the ideal
future which captured the learning over
10 years from the colonists (scenarios)
»
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22. Robust decisions in uncertain times
The outcomes
• Predictive Medicine Group’s recommendations accepted
• Scenarios widely used by Glaxo
– Briefings across the company
– Scenario brochure describing the scenarios distributed across
the company
– Scenarios used by other groups to formulate strategy
• Released to the public at an industry conference
– Then presented in seminars etc as a contribution to public policy
in medicine
• Early indicators used by Business Development to seek
new opportunities
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23. Robust decisions in uncertain times
Health risks associated with
‘green’ technologies
• Project for European Agency for Safety and Health at Work (EU-
OSHA) http://www.samiconsulting.co.uk/4EUOSHAreport2013.pdf
– SAMI team led by Fellow John Reynolds worked with UK Health and
Safety Laboratory (HSL) and Technopolis
• Looked at new and emerging risks from new technologies in ‘green
jobs’ to 2020
• Selection of (16) key drivers of change and (8) key technologies
• Developed a set of base scenarios
• Developed timelines for each key technology
• Analysed new and emerging risk for safety and health at work
• Presented across Europe, sponsored by Health & Safety
organisations
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24. Robust decisions in uncertain times
Main Drivers of Future Change
1. Economic Growth
• Growth In Europe
• Global Growth rates
2. Green Culture and Values
• Public Opinion
• Government Incentives and controls
• Energy Efficiency and Resource Use
• Waste Management and Recycling
3. Rate of Innovation in Green technology
24

25. Robust decisions in uncertain times
GreenValues
Economic Growth
Deep Green
Strongly green
culture and values
Bonus World
Strong Growth
Global and European
Win - Win
High innovation
in Green Technology
VeryStrong
Low Growth High Growth
Weak
Three Scenarios

26. Robust decisions in uncertain times
Win - Win
Defined by
– Strongly Green Values
– High economic growth
– High rate of Innovation in Green
Technologies
• Green growth is sustainable.
• Green activities are seen as a major contribution to
economic growth rather than simply as a cost
• Technology is delivering on its promise to make green
growth achievable
26

27. Robust decisions in uncertain times
“I guess
every smart
grid needs a
call centre
but it’s still
pretty
stressful”
“We scored
8 out of 10
in the last
green
audit… how
can we do
even better
next time?”
“every day we
continue to re-
design the
human-machine
interface...”
“welcome to
the L.Z.C.
Safety &
Health @
Work training
module. Today
we look at
everyday
hazards...”
Win-Win Human systems

28. Robust decisions in uncertain times
Win-Win Manufacturing
now that robots
or “co-bots” do
most of the
work.... What’s
there to worry
about ???
Boredom ... insecurity
... Keeping up with
innovation ... And,
what if they do not
keep out of our way...
+++ THIS
HUMAN HAS A
POOR
TRAINING
RECORD+++
KEEP HER
UNDER ACTIVE
SURVEILLANCE
+++

29. Robust decisions in uncertain times
Bonus World
Defined by
• High economic growth
• Low Green Values
• Medium rate of Innovation in Green
Technology (directed towards profits)
29

30. Robust decisions in uncertain times
Deep Green
Defined by
• Strongly Green Values
• Low economic growth
• Medium rate of Innovation in Green
Technologies
30

31. Robust decisions in uncertain times
Outcomes
• The scenarios provided a a neutral and safe
environment for important discussions between different
groups of stakeholders
– Many current assumptions were challenged (including targets
that are unlikely to be met)
– Some organisations realised that their plans were not robust
• The scenarios could be used for the analysis of a
broader range of technologies and policies
• The scenarios were a robust tool for the anticipation
and analysis of future challenges; and developing
more robust ‘future proofed’ strategies and policies
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32. Robust decisions in uncertain times
Summary
• Why use scenarios
– Scenarios & forecasts
– Early indicators
• Using scenarios: examples relating to Health
– Radical thinking in the National Health Service
• But failure to communicate to decision makers
– Scenarios lead to a rethink
• Numerical models changed assumptions
– Scenarios for the future of diagnostics
• Communication to operational managers
– Health & Safety impacts of “Green” jobs
• Cartoons to highlight the different values embodied in the scenarios
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33. Robust decisions in uncertain times
Thank you!
www.samiconsulting.co.uk 33
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The NHS case study is in “Scenario Planning”,
published by John Wiley. The GSK case study is in
“Scenarios in Business”, also published by John Wiley
The Report from the “Green Jobs” study is on the SAMI
web site www.samiconsulting.co.uk. .