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the futures of health
SPACES
+ PLACES
OF CARE

2. /3
the futures of health
SPACES + PLACES OF CARE

3. the futures of health
spaces + places of care
/04/03
05 Preface
09 Introduction
13 About this
Publication
16 The Goals
17 The Process
23 Design Principles
25 Themes
191 Embracing the
Futures of Health
193 Delphi Study
201 Applying the Futures
of Health
205 IC Health +
Foresight Practice
208 Appendix
Reframing Health + Disease
124 Overview
129 Shifts
135 Tension /
Uncertainties Matrix
137 World-Views
137 quad a
141 quad b
145 quad c
149 quad d
153 Conclusion
154 Design Principles
The Futures of Health: Spaces + Places of Care
Copyright © 2015 by Idea Couture
All rights reserved. No part of this publication may be reproduced,
distributed, or transmitted in any form or by any means, including
photocopying, recording, or other electronic or mechanical methods,
without the prior written permission of the publisher, except in the
case of brief quotations embodied in critical reviews and certain
other noncommercial uses permitted by copyright law.
First Printing, 2015
ISBN 978-0-9948265–1-0
Authors
Fiona Hughes
Mathew Lincez
Contributors
Paul Hartley
Elizabeth Kelley
Melanie Levitin
Shane Saunderson
Julia Schaeper
Vurain Tabvuma
Braeden Watts
Designers
Jemuel Datiles
Jason Luk
Sophie Qi
Production Designer
Anna Pateras
Editors/Copywriters
Kiley Bell
Morgan Gerard
Patrick Glinski
Caroline Leung
Esther Rogers
Special Thanks to
Idris Mootee
Content
04
01 02
0503
New Approaches to
Treatment
58 Overview
63 Shifts
69 Tension /
Uncertainties Matrix
73 World-Views
73 quad a
77 quad b
82 quad c
87 quad d
91 Conclusion
92 Design Principles
Caring Technologies
94 Overview
99 Shifts
101 Tension /
Uncertainties Matrix
105 World-Views
105 quad a
109 quad b
113 quad c
117 quad d
121 Conclusion
122 Design Principles
Health Delivery +
Community Care
28 Overview
33 Shifts
37 Tension /
Uncertainties Matrix
41 World-Views
41 quad a
44 quad b
48 quad c
51 quad d
55 Conclusion
56 Design Principles
Economic + Human Values
in Healthcare
156 Overview
161 Shifts
167 Tension /
Uncertainties Matrix
171 World-Views
171 quad a
175 quad b
179 quad c
183 quad d
187 Conclusion
188 Design Principles

4. the futures of health
spaces + places of care
/06/05
Preface
Healthcare is undeniably in
a period of transformation.
With new capabilities as a
result of technology, shifting
financial pressures as a result
of demographic changes,
changing power dynamics
in service delivery as a result
of open information, and
evolving global philosophies
around care, disruption is
coming from everywhere.
As leaders in the design
of care, we can either wade
forward blindly into the
unknown, or we can try to
anticipate what futures may
lie ahead. At Idea Couture,
we’ve chosen to do the latter.
As a team actively developing
new healthcare solutions,
we have a responsibility to
design for both today and
tomorrow. To create an
informed perspective, our
Health and Foresight teams
undertook a significant
yearlong effort to try and
understand where and
how care may occur in the
future. The team amassed
thousands of examples
of change, collected the
opinions of hundreds of
health leaders and experts,
and were given the time and
space to creatively explore
this mess.
The result is no crystal ball,
because everyone reading
this book has the ability to
influence the future spaces
and places of care. Instead,
the result is an envisioning of
many possible futures, each
representing a trajectory we
are currently on, presented
through the lens of major
tensions we are experiencing
today. Some of these paths
may be exciting, others
alarming; what’s important
to realize is that as someone
actively involved in the
strategy or delivery of care,
you are pushing towards
one of these futures. We
wanted to make this work
available so that you can
approach what you do from
an enlightened perspective.
Whether you’re designing
a new care service, setting
a strategic plan for your
organization, or plotting
out your college’s learning
and development plan, it’s
essential to think about both
the future you’re designing
for, and the future you want.
That’s the funny thing about
transformation. It can either
happen to you or through
you. We want to help shape
the trajectory of care rather
than simply react to it, and
we’re proud to have the
opportunity to help others
do the same.
/05 preface
If the path before
you is clear, you’re
probably on
someone else’s.
— Joseph Campbell
“
”
+++++

5. the futures of health
spaces + places of care
/07 /08
There is absolutely no
inevitability as long as
there is a willingness
to contemplate what
is happening.
+
Introduction
/07
For thousands of years, ‘place’ was how
we have defined ourselves and our
purposes. It was a vast, unknown
expanse for our earliest ancestors to
explore and populate. It was a
determining factor of social belonging
in our earliest settlements. It was the
sign of success in the Industrial
Revolution as we built more towns and
cities. It was a goal of our colonial
forefathers as they sought to capture
more and more precious land. It was
the focus of our dreams as we left our
homes to make new and better lives
for ourselves and our children abroad.
And it has driven us towards frequent
conflicts and wars in order to defend it
and our practices, values, and identities.
Today, as growing global numbers of us
‘go’ online, we find ourselves living in
new places and occupying new spaces.
Together, they have architectures,
boundaries, entry points, exit points,
and other people in them with whom
we develop very real relationships, roles,
rules, and socio-cultural worlds.
Most of us first arrived in these worlds
in the 1990s when, in a place we called
‘cyberspace’ or referred to as the
information super highway, we found
ourselves in chat rooms or forums
participating in the early internet
communities. According to Howard
Rheingold, an enthusiast of the 1990s
internet and a visiting lecturer in
Stanford University’s Department of
Communication, those of us who were
online at this time propagated the
metaphor of the virtual community
and, like Rheingold, talked of the
internet as a giant coffee-house with
a thousand rooms.
Today, we’ve got a million rooms, all
of them spaces or places. We ‘go’ to
Facebook every morning. We watch a
live stream on Periscope when we want
to be there. We play in borderless
nations like World of Warcraft and
Neopia. We log on to ‘get into’ art
galleries and museums. We live
alternate lives in other places through
avatars. We forage for local food
through apps like Ritual. We warn each
other about straying close to the
darknet. We talk more than ever about
being ‘connected.’ We use the internet
to research and book our next vacation
in a foreign place. And increasingly, to
reflect our new understanding and
experience of space as being so evolved
from the 1990s, we are now living in the
cloud and defying old world spatial
categorizations by being mobile.
over the last two decades,
our understanding and experience
of ‘place’ has been disrupted,
upended, reconfigured, and forever
transformed. we’re definitely not
in kansas anymore.
+++++
—Marshall McLuhan
“
”
introduction

6. the futures of health
spaces + places of care
/10/09
That these evolving conceptions of space,
place, and the kinds of relationships that
we pursue and experience in them have
disrupted and, in some cases, completely
taken over the likes of the music industry,
tourism, television, dating, education,
and even retail is, by now, old history.
This book represents our thinking on
history as it is being made both today
and tomorrow. Through the lens and
methods of strategic foresight, it
provides an opportunity for thought
leaders to connect with the next
industry that will face disruption thanks
to our evolving notions of place, space,
and the kind of relationships that occur
there: healthcare.
What are the possible futures of the
various spaces and places of care? This
is the question we explore in this book.
Think of the chapters that follow as an
opportunity to connect with emerging
future possibilities where we will likely
see a greater diversity of services,
service providers, and care spaces. In
them, our goals include: sharing specific
insights into what changes are taking
place within and around the spaces and
places of healthcare and the relationships
within them; uncovering and exploring
critical uncertainties related to possible
future ‘types’ of healthcare in terms of
new treatment and service models, the
design of care spaces and places and,
of course, outcomes; and building more
credible assumptions about how the
spaces and places of care might evolve
over the next ten to fifteen years.
Each of our chapters requires a healthy
dose of the imagination. Envisioning
a healthier future requires the courage
to challenge status quo ways of thinking
and doing to ask big questions about
how we can bridge the medical, social,
ecological, and economic divides that
currently disconnect us from ourselves,
from others, and from new forms of
well-being. It forces us to challenge
our views of the value for systems and
individuals, the expectations of
experience, and the very basic
definitions of disease and health.
To encourage this, we have divided our
book into five core themes defined to
help illustrate the different types of
future-oriented change occurring within
the broader healthcare context. These
themes are:
// Health Delivery + Community Care
// New Approaches to Treatment
// Caring Technologies
// Reframing Health + Disease
// Economic + Human Values
in Healthcare
Each of these five themes is accompanied
by a number of big shifts taking place,
design principles that are salient to these
shifts, a tension matrix that highlights
potentially contrasting or opposing points
of view, and world-views and scenarios
that explore related questions and
uncertainties about how these changes
might unfold in the future.
+++++ +++++
+
introduction

7. the futures of health
spaces + places of care
/12/11
+
/11
Spaces + Places
of Care
the futures of health
+++++++ +++++++
+++++++ +++++++
+++++++ +++++++
+++++++ +++++++
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the futures of health
spaces + places of care
/12

8. the futures of health
spaces + places of care
/14/13
About this
Publication
/13
+
+++++ +++++
Idea Couture’s Health and Foresight
teams are engaged in ongoing research
into future spaces and places of care.
It is our intent to develop topic specific
insights about the changes that are
taking place both within healthcare as
well as in adjacent non-healthcare
spaces, changes that are challenging
and disrupting the traditional
boundaries of healthcare. In our
research we uncovered and explored
critical uncertainties related to the
design of care places, spaces,
experiences, and outcomes. Exploring
various futures of health outside of
any limits or constraints allowed us
to imagine other ways forward for
healthcare, and also meant we were
able to think strategically, to build more
credible assumptions, and to consider
possible health solutions.
about this publication

9. the futures of health
spaces + places of care
/16/15
1/ How will evolving trends in
the health wellness space
impact future places
of care?
2/ What might these places
look like if inspired by a
different set of stories
about what we mean by
disease, treatment, the
role of technology in
health, communities
of care, and value?
3/ What are the emerging
design criteria for “care
spaces” and “care
technologies”?
4/ What is the medium
or interface of care?
Where and how will it
be delivered?
5/ Will we still see our
doctors in their office,
or will we connect with
our doctors online in
virtual spaces?
6/ Will the doctor even be
the primary care provider
of the future?
7/ Is a more caring,
comfortable, and patient-
friendly environment at
odds with high tech?
With the risk of
superbugs that are
resistant to all antibiotics,
will we even want to
congregate in spaces
with other sick people?
8/ How do we define
disease, as this will have
implications for what and
how we will be treating?
9/ Will who we are caring
for become more
important than what we
are treating?
10/ What are the new
partnerships and service
provider ecosystems that
could redefine the future
healthcare context?
11/ How can we measure
efficiency and success
in healthcare?
12/ How do we respect individual
values while generating
greater economic value?
key topics, primary areas of
interest, and initial research
questions guiding the path of
this investigation include:
The Goals
01
illustrate
different types
of change taking
place within
the health and
wellness context.
02
bring to life big
shifts taking
place and explore
questions and
uncertainties
that are emerging
as a result.
03
highlight
principles that
can be applied
to the design of
better healthcare
experiences.
+++++ +++++ +++++
the futures of health
spaces + places of care
the goals /16

10. the futures of health
spaces + places of care
/18
The Process
Overview
The health and foresight teams at
Idea Couture began this project by
conducting an overview of the critical
issues in healthcare today, in order to
create a series of hypotheses about
how the spaces and places of care
will change over the next 10–15 years.
Scoping and prioritizing a vast array
of scan signals we identified five key
themes that represent the chapters of
this book. We created insights based
on our ongoing analysis of emerging
signals, trends, and broader change
drivers. We questioned and probed
critical uncertainties about the changes
taking place from a systems level view,
and expanded our thinking about the
possible, plausible, and preferable
future states of healthcare that could
emerge as a result. We then used
world building and scenarios to bring
aspects of these big shifts, their critical
uncertainties, and potential futures to
life for broader audiences. From this,
we were able to extract and articulate a
number of design principles that can be
used to help guide planning and decision-
making processes.
01
09 design
principles
07 world-views /
meta-narratives
06 2x2 tensions
05 shifts
04 synthesis +
context mapping
03 environmental
scanning
02 scope setting
08 scenario
01 overview
signals
drivers
trends
traditional
unconventional
our process blends
divergent exploration with
convergent analysis to
better understand big
shifts taking place, and
to generate well-informed,
future-oriented hypotheses.
we test, refine, and
re-articulate these hypotheses
within scenarios that
place the human experience
at the center of how we
imagine the future.
/18the futures of health
spaces + places of care
the process/17

11. the futures of health
spaces + places of care
/20/19
Synthesis + Context Mapping
Throughout our scanning process,
we simultaneously prioritized and
integrated different signals, trends,
and drivers into each of the five core
themes. Post scan, more deliberate
sensemaking, synthesis, and perspective
building involved 1) the amplification of
weak signals (i.e. building critical/robust
assumptions about the trajectories
and potential impacts of emerging
science and technological capabilities,
human behaviors, and organizational
capacities); 2) the forecasting and
“anticipation” of where key trends
and drivers could manifest (i.e. come
to maturity) and what could be their
influence on the overall system, our
chosen themes, and key actors; 3)
a rapid, causal layered analysis of
the different relationships between
key topics, stakeholders, signals,
trends, and drivers. Together, these
sensemaking activities helped us to
illustrate the current state, and develop
more clear behavior-, technology-,
and design-related hypotheses about
the nature of spaces and places of
care — and the boundaries (principles
and requirements) defining potential
healthcare experiences over the next
ten to fifteen years.
Shifts
One critical output of our synthesis
process is the identification and
articulation of “big shifts” (changes)
taking place within each of the five
themes (i.e. the transitions from
one state, behavior, or capability to
another). These help us frame new
questions, establish future-oriented
points of view about the types of
change taking place, and define what
“design principles” may now exist as a
result. Shifts also help us illustrate how
new relationships, power dynamics,
roles, and responsibilities are emerging
within the broader healthcare context,
detailing the changing expectations
of people and stakeholders, tools,
capacities, and resources and what
impact or influence they might have
on the physical spaces and places of
care. In addition to framing new design
principles, we use shifts to surface what
tensions exist through dialogue with our
team and external experts.
04 05
Scope Setting
To begin with, we decided to focus on
future spaces and places of care and
how they might evolve in reference to
our five themes. We wanted to explore
the future of health from a macro
level that integrated the conventional
medical approach with an integrative
holistic approach. We also wanted to
delve into the patient experience and
speculate how relationships might
change, and how these might shape,
and be shaped by, spaces and places
of care.
In addition, we wanted to develop a
holistic point of view that integrated
topical areas, such as: mobility and
connectivity, wearables, telemedicine,
cloud computing, big data, virtual
care, personalized medicine, social
innovation, urbanization, health
economics, insurance and finance,
ethics, and value shifts. Lastly, we
acknowledged the need to look
outside the core health space for signs
of change and expanded our signal
gathering and thinking into adjacent
nontraditional health contexts, such
as retail, food, fashion, travel, and
hospitality, questioning or anticipating
how these nontraditional players might
begin moving towards influencing and
re-shaping healthcare dynamics.
Environmental Scanning
We began a comprehensive global scan
that focused on collecting and prioritizing
emerging signals, trends, and drivers that
exemplify both acute (small scale) and
broader, more persistent forms of change
taking place within the five core themes
and general healthcare context.
The scanning process involved
aggregating qualitative and quantitative
data and observations from multiple
expert and stakeholder interviews
conducted across the healthcare context,
as well as a comprehensive literature
review of key topical areas. In addition
to surfacing a number of thematic
problems, needs, opportunities, and
critical uncertainties inherent in our
conversations with experts and key
stakeholders, our team mapped out and
questioned how the characteristics of
emerging signals, trends, and drivers
gathered during our scanning and
literature reviews were also symptomatic
or reflective of patterns and bigger
shifts taking place within each of the five
themes. We discussed what tensions or
extremes existed and were assumed to
be emerging within each theme as a
result of these big shifts.
02 03
the process

12. the futures of health
spaces + places of care
/22/21
Scenarios
Scenarios are more specific narratives
that live within world-views. These
leverage storytelling techniques to bring
different alternative future experiences
of spaces and places of care to life.
At this point in the process, we challenged
a broader team of participants to write
scenarios based on their interpretation
of different world-views. These scenarios
introduce relationships between key
stakeholders, illustrate the motivations
behind their choices, and dramatize the
impacts of decisions and less directly,
the broader potential healthcare
strategies and approaches. They allow
us to critically assess and rehearse
multiple responses to plausible, possible,
and preferable futures. We believe
that scenarios are highly effective
prototyping tools that help mobilize
our imagination and place the human
experience, behaviors, and motivations
from individual and organizational
perspectives. As fictive spaces, they
allow us to sketch, experience, question,
and explore a spectrum of possible
futures from many perspectives — while
also providing a common artifact that
can be shared, critiqued, responded, and
reacted to. By creating well-informed
scenarios, stakeholders gain a better
overall picture of how possible futures
may evolve and manifest within each of
the five core themes.
08
+++++++++++++++
World-Views / Meta-Narratives
Meta-narratives or world-views exist
within a specific quadrant or area of
a tension matrix. They are used to
help bring tensions to life; define a
broader future setting; frame more
specific assumptions and points of
view about possible types of futures;
and to establish the rules, tone,
and contextual boundaries that the
scenarios will explore. As part of our
sustained foresight effort, we are
constantly updating and refining these
world-views, as well as the scenarios we
explore within them. Of course, world-
views set a much broader (macro) stage
to consider; using scenarios, we can
then explore more acute and specific
experiences or relationships and the
possibilities within them. Over time, we
aim to generate and explore multiple
scenarios within each world-view to
further enhance our awareness of how
possible futures could manifest.
2x2 Tensions
Several tensions representing opposing
points of view in light of emerging
paradigms and critical uncertainties
arise as a result of the big shifts taking
place. Tension matrices for each theme
were constructed to highlight contrasting
and opposing points of view and to begin
articulating more focused world-views
or meta-narratives about the future.
The extremes at each end of the axis
of a matrix and the quadrants within
them help us to further reduce the
scope and focus on specific possible
futures; to identify additional questions
and uncertainties about them; and to
explore the changing roles, identities,
behaviors, and relationships of and
among different stakeholders (i.e. care
providers, payers, patients, caregivers).
06 07
the process

13. the futures of health
spaces + places of care
/24/23
how did we develop
the design principles
in this document?
moving forward,
how should the
health futures design
principles be used?
Each of the five themes describe a
number of shifts that are taking place,
as well as scenarios that illustrate how
the changes might be experienced
in the future. Design principles are
based on these shifts and respond to
the needs and requirements of future
health and wellness solutions that are
anticipated in response to these shifts.
Design principles can be used to help
guide how teams might think about,
evaluate, and design for the next
generation of health and well-being
solutions. They are also intended to
help stimulate fresh thinking among
stakeholders in formal and informal
healthcare spaces to understand
what actions can be taken to address
emerging signals. We hope that the
Health Futures design principles
become a first stepping stone for
teams to identify opportunity spaces
to work within.
++++++++++
09
Design
Principles
design principles have
been created on the basis
of the identified shifts.
Design principles create a shared
language and set of overarching
guidelines for organizations. They
maintain everyone’s focus on what
is truly important to end-users
by ensuring new designs reflect a
collective understanding of purpose,
demand, and delivery capabilities
of the organization. Furthermore,
they can help teams break out of
organizational silos and align in the
development and delivery of new
ideas and initiatives. Design principles
provide a consistent framework for
how to approach organizational
challenges. Shared internally, they
can help team members set priorities
and make decisions when new
products, services, and systems are
designed. This is crucial since, as ideas
and concepts inevitably evolve and
change, these principles will enforce
that certain aspects of a new design
hold static or “true.”
+++++ +++++
the futures of health
spaces + places of care
the process /24/23

14. the futures of health
spaces + places of care
/26/25
this book is divided into five core themes.
these themes represent different entry
points for exploring the complexity of
multiple interacting components that
shape healthcare, components that are in
turn shaped by care spaces and places and
the relationships that occur within them.
/25
+
+++++
05 Economic + Human Values
in Healthcare
/26the futures of health
spaces + places of care
themes
Health Delivery + Community Care takes a critical look
at the public and private health systems that we have
built up over the past half-century. These systems
deliver services to populations using one-size-fits-all
approaches that no longer deliver the care that many
individuals need and want.
InNewApproachestoTreatment,werecognizethatwhile
modernmedicineisaboutthequestfornewer,better,and
moreprecisetreatments,weexplorewhatconstitutesa
treatment,withwhatintenttreatmentsaregiven,andwhat
theexpectationsofthosereceivingatreatmentare.
Caring Technologies explores our modern day faith in technology,
our belief that the right technology will solve our problems, or at least
help us manage them better. However, unlocking the secrets to our
health and happiness is perhaps not as simple as merely finding the
right key to fit the lock.
In our final section, Economic + Human Values in Healthcare, we
discuss how as healthcare consumes ever-greater proportions of
the GDP, there is a need to examine more cost effective options
and to consider how we go about getting more value out of the
system, while at the same time recognizing that medicine is not
just another marketplace commodity.
01 Health Delivery
+ Community Care
02 New Approaches to Treatment
03 Caring Technologies
04 Reframing Health + Disease
Reframing Health + Disease looks at disease not only as a fixed entity
defined and managed by the science of medicine, but also considers
changing conceptions of disease and the sometimes uneasy fit
between our experiences of disease and science’s attempt to order,
label, and define it.
Themes

15. the futures of health
spaces + places of care
appendix /215
idea couture inc. 2015. copyright ©
healthcare has seen a surprising lack
of progress in recent decades, and
the industry is ripe for disruption.
meanwhile, technology has redefined
what “place” means for us by creating
virtual worlds to interact in. as
technology advances into even the most
resistant of industries, what will
this mean for the spaces and places
of healthcare?
a collaboration between futurists,
anthropologists, and healthcare
professionals, the futures of health:
spaces + places of care explores the
possibilities of an age where an app
can be a doctor and a bedroom is the
hospital. presented through scans,
analyses, and scenarios, important
questions are raised about what the
future will look like, allowing us
to better prepare for it.