Dossier health care final

OCADU Foresight Project | 2011
Prepared by Phouphet Sihavong, Uma Maharaj, and Josina Vink
The Future of
Specialized
Health Care
Providers

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 ongo-
ing 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
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

4
The Need for
Transformation/
C
anadians 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.
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.
There are numerous problems with the sys-
tem 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 ad-
ministered 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
compris-
ing approximately 25% of the population by
2036.4
It is becoming more challenging for the tra-
ditional 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 Cana-
da is 17 weeks.5
Furthermore, Canadians are
looking to new sources of care as the out-
of-pocket payments of private households
have grown to represent approximately 15
percent of total national health expendi-
tures.
If the health care system is going to meet
the needs of future Canadians and survive
the compounding pressures, transforma-
tion 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 chal-
lenges and inspiration for refined long-term
strategies for the industry.

5
About the
Project/
This foresight project focuses on the fu-
ture of specialized health care providers in
Canada, with a strong spotlight on outpa-
tient services – an area within the field of
health care that will certainly face numer-
ous challenges as the future evolves. The
purpose of this study is to challenge special-
ist 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 work-
ing in this space.
This work was completed by students in the
Strategic Foresight and Innovation gradu-
ate 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 col-
laborative dialogues throughout the course
of the three month project.
The project began with general environ-
mental 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 driv-
ers were identified. The cone of plausibility
method then used these drivers to develop
scenarios. The scenarios helped to answer
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 identifica-
tion 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 mov-
ing 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.

The diagram outlined below providers a snapshot of the key
methods used in this project. The arrows represent the criti-
cal inputs and outputs of each step in the process.
6
Project
Process/

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. Sig-
nals 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 poten-
tial signals and trends related to or influenc-
ing the health care industry. By combing
through sources like newspapers, scholarly
articles, and social networks, patterns of
change were identified.
The STEEPV framework (social, technologi-
cal, 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 ele-
ment of the framework was not fully devel-
oped. 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 de-
scribe the signals, preliminary implications,
extrapolations and countertrends in the
health care space. The trend deck that fol-
lows mainly highlights trends in the social,
technological and economic space.

8
Technology
Trend
In-home robot assisted patient care.
Robot Assisted/
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:
• 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.
Patients can stay home longer before needing
long term care facilities.
Implications for Providers:
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.
5

9
Technology
Trend
Access to health information at anytime.
Ubiquitous Health/
Overview:
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:
• 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
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
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.
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.
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.
5

10
Technology
Trend
Wireless internal monitoring of the human body.
In Vivo surveillance/
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:
• 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
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.
5

11
Technology
Trend
Mobile sensing devices that assess patient health.
Mobile Diagnostics/
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
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.
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.
5

12
Economic
Trend
Everyone and anyone is providing health services.
New Kids on the Block/
Overview:
There is a growing number of new provid-
ers 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
How will patients navigate through the clutter?
There are more options for patients to chose
from, but it is difficult to know which alterna-
tives are effective and trustworthy.
How will specialist providers compete with
these new and different health service op-
tions? Care models will be forced to change to
compete with low cost models. There is a de-
professionalization of services occurring where
tasks that were once performed by physicians
are being provided by nurses, personal sup-
port workers, devices, caregivers or patients
themselves.
Extrapolations:
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 tradi-
tional institutions and physicians that they can
be confident will provide the best care. There
is also a counter trend toward increased regu-
lation and restriction of health care products
and devices.
5

13
Economic
Trend
The rise of the Economic East brings a new global centre
Made in China/
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
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.
How will providers differentiate themselves
among global competitors?
Providers must compete for pricing and ser-
vice options on a global scale and cater to an
international market.
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 ef-
fective, proven approach to providing health
care.
5
for health care progress.

14
Economic
Trend
The rise in demand for seniors’services results in broken
Granny Breaks the Bank/
Overview:
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.
Signals:
• 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
Patients experience troubles accessing a full
system. There is increasing dependence on
family members as caregivers with major financial
restraints.
There are not enough providers in the market
to meet demand so existing providers are
overwhelmed with users, often collapsing their
systems.
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.
5
health systems and insufficient funds.

15
Economic
Trend
Get health care services anytime, anywhere.
Health Care On-Demand/
Overview:
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
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.
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.
Extrapolations:
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.
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.
5

16
Social
Trend
Increased social entrepreneurship and advocacy for
Health care for All/
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:
• 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
More patients will receive access to health care
but treatments may not always align with their
beliefs. Their influence will further challenge the
concept of health care to be viewed in terms of
the social, emotional and spiritual well being of
people across cultures.
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.
5
those without access to proper health care.

17
Social
Trend
Individuals actively seeking out information and
Patient Empowerment/
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
Patients are torn between having access to health
information and feeling overwhelmed by it. They
will increasingly have power over their physicians
in demanding treatment types. Their updated
personal health records become tools for
further patient empowerment.
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.
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.
5
asserting control over factors affecting their health.

18
Social
Trend
Measuring oneself in various situations in everyday life
Quantify Oneself/
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:
• 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
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
also question what data they own and what
they allow others to access.
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
Countertrends:
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.
5
to improve mind and body health and performance.

19
Environmental
Trend
Increasing adverse effects on society’s health related to
Weathering Health/
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 vector-
borne 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
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.
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.
Extrapolations:
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.
5
climate change and environmental degradation.

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:
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 advance-
ment of illnesses and the number of
conditions people have.
4. Personal Health Metrics – Collection of
health data from individuals.
5. Patient/Physician Interaction – The re-
lationship between patients and physi-
cians and their cooresponding actions.
20

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 pa-
tients look like in 2030 in Canada?
The purpose of developing the scenarios
was to think creatively about what special-
ist 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, incorpo-
rated 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 plan-
ning technique that uses a series of drivers
and key assumptions of the drivers to de-
velop 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 generat-
ed 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 special-
ist providers want not simply to react to the
future, but also create it.
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 broth-
ers, the founders of one of the first collab-
orative specialist medical clinics.
21
Creating Future
Scenarios/
What will the future inter-
action between traditional
health care specialists and
patients look like in 2030
in Canada?

22
Interconnected/
Preferred Scenario
In this world . . .
When visiting the specialist provider, pa-
tients enjoy a seamless experience with per-
sonalized, 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 effec-
tively managed at the clinic and that they
understand all aspects of their treatment
options.
Specialist providers are able to treat pa-
tients within a robust medical network.
Specialists strive for effectiveness in their
practice using a high degree of collabora-
tion with primary care providers and care-
givers 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 informa-
tion and it is automatically fed into a central
database within the health care system. For
the chronically ill, the social worker be-
comes critical in providing interim commu-
nication 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 two-
tierred health care system in Canada is
prominent. Typically, only the upper middle
class can afford timely specialist care.
Engaged patients have personal,
high-touch interaction with con-
nected providers.
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
Do It Ourselves/
Plausible Scenario
In this world . . .
With increased access to health informa-
tion, patients are highly engaged in manag-
ing 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.
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
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 net-
works 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 dis-
agreements as both have very strong views
on what treatment is required. Specialist
providers are caught between doing what
patients think is best and growing malprac-
tice liabilities.
The Canadian government now penalizes
citizens that chose unhealthy consump-
tion and behaviour by imposing taxes on
unhealthy goods and services.
• Pharmacists who now have greater
influence
• Engaged patients who demand treat-
ments
• Patients that face barriers to engage-
ment in their own care or have low
social support
• Specialist providers who face pressure
from patients and insurance companies
Patients take on a leadership role
in defining and administering
their own treatment.
•

24
Calculated
Possible Scenario
Craziness/
In this world . . .
It seems like technology has taken over.
Genome mapping is the same cost as get-
ting blood work done is today and on-going
personal biologic surveillance through ac-
cessory 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 infor-
mation allows for immediate, completely
individualized treatment for prevention of
disease and timely reactions to condition
changes. The high availability of informa-
tion due to advances in technology allows
for data mining of information. This en-
ables the Canadian government to improve
policy around promoting population health
and promptly respond to emerging health
issues.
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 con-
tinual feedback from their health devices.
There has been a significant rise in the num-
bers 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 ge-
netic information and genetic engineering
of new life come to the forefront. Debates
abound but there is no real direction or
resolution.
• Insurance companies have better infor-
mation on“risky individuals”
• In-house genetic data analysts who as-
sist patients
• Patients who have“bad”genes
Patients are bombarded with
health metrics and measures.

25
Healthy Immortal/
Extreme Scenario
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 physi-
cians 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.
New developments mean people
can live to at least 150 years of
age.
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

The intention of the graphic novel was to help interested
parties understand the world within each scenario and bet-
ter determine potential implications for stakeholders.
26
Back to the Future/
T
he following graphic novel tells the story
of going back to the future with the Mayo
Brothers, the founders of the first integrated group
practice in Rochester, MN.
Bringing Scenarios to Life
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.
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 . . .

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-
viders. These strategies were then tested
against each of the scenarios for strategic
fit.
First, informal conversations about potential
strategies took place for the purpose of sur-
facing 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 process of options surfacing, eliciting existing orga-
nizational and industry strategies, and option generation,
developing new strategy options were utilized to develop a
relatively comprehensive list of strategic options
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 clus-
tered into a more manageable set of four
possible strategic directions by grouping
options that required consideration of each
other in implementation.
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 evalu-
ated against the range of possible futures
outlined in the scenarios.

Wind-Tunnelling/
This wind tunneling matrix outlines the twenty five strategic
options and four overarching strategic directions. . Each op-
tion is tested for strategic fit within each scenario and rated
high (solid circle), medium (thick circle), or low (light circle).
34
Using a wind-tunnelling matrix, the stra-
tegic fit of each option within the environ-
ment 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 sce-
narios) were highlighted. The fourth scenar-
io, 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
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 ‘see-
ing more patients, more efficiently’ was
rather uncertain when tested against each
scenario.
The three robust strategic directions identi-
fied offer important long-term approaches
for specialist providers moving forward, but
still the process of acting on these direc-
tions remains unknown. And rather than
simply be reactive to the changing environ-
ment, 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 strate-
gies.

The Three Horizons/
35
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“pock-
ets of the future”embedded in the present
that represent both Horizon 2 and Hori-
zon 3. These weak signals of the patient-
centred model of care include changes in
reimbursement models toward bundling in
other countries and signals of the decentral-
ized mess include incidents of leakage of
health information and growing numbers
of people getting their health questions
answered online.

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 innova-
tions that would help a specialist
health care provider, not only
survive, but lead in the develop-
ment of the desired future.
In the short-term, Horizon 1
requires strategies that improve
current operations or incremen-
tal innovations to help keep the
system relevant longer. Horizon
2 requires strategies that ex-
tend current competencies and
address the growing tensions
within this space. Horizon 3 de-
mands radical innovations that
change the nature of the indus-
try and bring to life the vision for
an integrated, patient-centred
system.

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 find-
ing strategic ways to navigate
these tensions that will allow
providers to successfully transi-
tion to a patient centric system.
There is a tension between the
traditional physician power and
the growing patient empower-
ment. 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 envi-
sioned 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 part-
nerships with primary care pro-
viders and other practicioners
within the community.
The tension between standard treatement
and individualized care requires new mod-
els of assessment and deeper understand-
ing a patient profiles.
The transition from complex processes
within the health care space to easy to use
systems suggests the need for appropriate
technologies and systems changes.
The shift from valuing quantity of service to
patient wellness will require new reimburse-
ment models, ongoing health management
and truly collaborative practices.
As specialized health care providers transi-
tion toward Horizon 3 navigating the ten-
sions within Horison 2 will be critical.

Strategic Directions/
38
Bringing forward the robust
strategic directions from the
wind tunneling exercise, the fol-
lowing pages outline how these
three directions can be thought-
fully 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.

39
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 in-
formation 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 de-
sired end state will not happen overnight.
While the basics of this strategy is not a new
aspiration for specialist providers in
Strategic Direction One

40
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 technol-
ogy, and the complexity of many systems
currently on the marketplace.
The three horizons framework offers guid-
ance on a stratified approach to implemen-
tation 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 pre-
pare for the transition. These strategies
include identifying the electronic needs of
practitioners, patients and organizational
operations and establishing design guide-
lines to share with technology developers.
These steps will help to encourage the de-
velopment 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 ser-
vices 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 under-
standing of what is needed from a patient
perspective as well as establish trust in the
space as the organization moves forward.
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
• Identify system needs
• Utilize existing tools
• Establish design guidelines
New Related Activities
• Prototype new tools/systems
• Partner in technology
development
• Position as think tank
• Accredit technology
System Changes
• Shared e-health record
• Standard platform and interface
• Aggregate information
• Algorithms for prevention
• Collaboration in system
• Security safeguards

41
Actions appropriate for Horizon 2 and
surviving the chaos are those that posi-
tion specialist providers as relevant and
trusted experts amid the clutter of other
offerings. Activities include partnering with
technology companies to assist in develop-
ment of appropriate technology, openning
up network to test out different points of
interaction within the system, and provid-
ing 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 dif-
ferentiate specialist providers and attract
the right partners for moving toward the
desired electronic system.
Furthermore, to emphasize specialist pro-
viders 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.
In working toward the end goal of develop-
ing a smart electronic health system, several
fundamental developments are needed
including establishing a standard elec-
tronic health record early on and adopting
a standard platform for connecting, sup-
ported by cloud computing technology for
point of care communication. The common
system should then be utilized by aggregat-
ing 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 practi-
tioners to collaboration among all patients,
providers, communities, and beyond.
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.

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 barri-
ers to progress in this area.
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 be-
tween a specialist and a primary care physi-
cian to provide an update on patient status,
can improve the overall health manage-
ment 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 commu-
nity support organizations); and establish-
ing 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‘decen-
tralized 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 manage-
ment and care coordination do not change
the overall integration of the system itself,
but they help coordinate care, manage
patients’health, connect patients to ap-
propriate resources, and improve resource
The Three Horizons method offers a frame-
work for organizing the continuum of strat-
egies related to integration and indicates
how a specialist provider can move from
the current state toward complete integra-
tion. The figure to the left identifies areas of
strategic innovation that are appropriate for
each horizon and can be adapted based on
organizational readiness.

43
monitor, manage and share health informa-
tion instantly between providers57
. Pooled
or bundled funding is another critical ele-
ment which provides incentives for provid-
ers to collectively ensure patient health.
Using this reimbursement model, there is a
set amount of funding, regardless of ser-
vices provided and a network of providers is
collectively responsible for their wellness58
.
Co-location strategies, collective gover-
nance between providers, and team-based
care have also proven effective in achieving
system integration.
For specialist providers in Canada to con-
tinue to be leaders in their field, they must
invest in strategic innovations to help them
survive and thrive in the future across all
three horizons as they transition toward
integration. As illustrated in the Three Ho-
rizons Diagram, remnants of each horizon
exist in the present and specialist provid-
ers 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 ef-
forts 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.
Horizon 1:
Linkage Within The Current
System
Horizon 2:
Coordinate Care
Amid The Mess
Horizon 3:
Establish A Truly Integrated
Delivery System
• Informalcommunication
• Shared patient artifacts
• Practitioners act as navigators
• Collaboration protocol
• Casemanagement
• Carecoordination
• Single points of entry
• Service partnerships
• Careplans
System Changes
• Shared e-health records
• Co-location
• Collective governance
• Team-based care
• Pooled funding
efficiency.56
These tools are appropriate for
specialist providers seeking to remaining
relevant in a highly chaotic and decentral-
ized system. These tools also lay the ground
work and develop relationships critical for
Horizon 3.
The innovations directed at Horizon 1 and
2 fall short of establishing a completely
integrated system for the future. These ho-
rizons are the testing and building ground
for Horizon 3, the preferred state, which
requires radical system changes.
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

44
I
mproving the patient experience is at the
core of the transition toward a system that
is truly patient-centred.
Improving the patient experience is at the
core of the transition toward a system that
is truly patient-centred. Being patient-
centred 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 cur-
rently have organizational missions that ref-
erence 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-
Improve
the Patient
Strategic Direction Three
Experience/
ent patient experience enabled by patient-
centred 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 pa-
tients already are. Patient-centred care goes
beyond expanded patient consultation to
seeing patients as partners, key decision-
makers, and collaborators. It encourages
and enables self-care and self-management.
Patient-centered care for 2030 requires indi-
vidualized, 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 improve-
ments, such as training for practitioners on
improved patient-service and relationship
management, can significantly enhance the
patient experience in the existing system.

Horizon 1:
Improve Existing Services
Horizon 2:
Extend Service and
Delivery Options
Horizon 3:
Offer Services that are Truly
Patient-Centred
• Train practitioners
• Enhancecommunication
• Expandconsultation
• Family involvement
• Pilot new wellness services
• Test new supporting roles
• Improve scheduling flexibility
• Increasecommunication options
System Changes
• Patient collaboration
• Individualized medicine
• On-going health management
• Coreservices online
• Holistic, preventative offerings
• Transparencyand access of
information
Increased informal communication with
patients can improve the connection be-
tween patients and providers and is proven
to impact patients’perception of quality
of care. However, the shift toward patient-
centred 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 patient-
centred 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 coordi-
nators, or wellness coaches, will help serve
patients more holistically within an organi-
zational environment that is still somewhat
fragmented and an external environment
that is increasingly cluttered. In addition to
the types of services offered and roles, im-
proving ways in which services are provided
is also critical to competing in Horizon 2.
Actions like implementing same day sched-
uling, 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 chang-
ing demands of future patients.
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 patient-
centred. Horizon 3 requires a complete
paradigm shift that supports patient col-
laboration and integrates holistic thinking
and palliative care in all interactions – a
proactive approach to care. Building capac-
ity 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 get-
ting 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, personal-
ized service for each individual will create
a very different interaction and experience

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 appro-
priate 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 respon-
sibility around patient wellness may need to
be explored and developed.
The organizational milestones offer a
general targets for organizational decision-
makers, but an individual timeline for each
provider is needed. These milestones are
important check-ins along the journey for
providers.
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.
The timeline above outlines key organiza-
tional milestones and environmental indica-
tors 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 mile-
stones outlined offer general indications of
the progress necessary to lead the transi-
tion 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 alter-
native strategies may be necessary.
46

A Call for
New Thinking/
47
T
his foresight project challenges specialized health care pro-
viders 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.

48
Appendix/
STRATEGIC
DIRECTIONS STRATEGIC OPTIONS
INTER-
CONNECTED
POWER
TO
THE
PEOPLE
CALCULATED
CRAZINESS
HEALTHY
IMMORTAL
Integrate
service
delivery
1 Integrate with local community providers* H H M L
2 Partner other specialist providers L H L L
3 Integrate internal health care practitioners H M L L
4 Provide ongoing health care
management*
H H H L
Improve
the patient
experience
5 Increase front-end consultation* M H M L
6 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 Increase offerings for genomics based
individualized medicine*
H M H H
10 Increase alternative medicine options L M L M
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
follow-up consultation*
H H M L
14 Offer in-home services direct to patient
and caregiver
L H H H
Develop
a smart,
electronic
system
15 Develop capabilities for data analytics* M M H M
16 Partner with technology providers* M H H L
17 Ensure strong security governance* H H H L
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
Serve more
patients,
more
efficiently
21 Reduce hospital stay-time* H M M H
22 Increase patient through-put L M M L
23 Focus on more complex patients H L H L
24 Further centralize specialty care H L L L
25 Stay comprehensive and treat everyone
well
L M L L
This matrix details the results of the wind-
tunnelling excercise. Those strategic op-
tions that were recognized as“robust”(had
a medium or high rating in the first three
scenarios) were highlighted (identified in
the chart with *).

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52

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