Unleash Health Future Thinking Skills To Counter The Tectonic Shifts With These 16 Easy To Apply “Pair-A-Dime” Health Futures Thinking Tools

Blip-Zip Executive Summary and Takeaways

Healthcare faces tectonic shifts, dubbed “Pair-A-Dime,” demanding a paradigm change. This article explores these shifts, from personalization to sustainability, and offers tools like scenario planning and backcasting to navigate them. It is a follow-up post to a previous article: Embrace the Future of Health: Unleash Innovation Through Strategic Foresight With 7 Must Do, Can’t Fail and Become a GROUND 0 Champion in Health Futuring. Embrace the future of health by moving from disease models to wellness, fostering collaboration, and prioritizing time over money.

1. Healthcare is erupting: Witness paradigm shifts like personalization and sustainability.
2. Tools for the future: Scenario planning, backcasting, and more guide your healthcare journey.
3. Beyond disease, embrace wellness: Prioritize collaboration, time, and patient partnerships.

Introduction to Health Futures and Futuring

Remember Joel Barker’s, Paradigm Shift? Since the early 1990s following the Military Health System (MHS) 2020 Kick off Conference on Health Futuring I heard the term so many times, I coined and used the term “Pair-A-Dime” Sh@#t so I could get through the messaging behind it. The term created a chuckle as a facilitator in our seminars on Total Quality Management (TQM) at the Air Force Academy hospital. 

Today, I am begging for a Paradigm Shift in healthcare. Many of you are too.  There’s a lot right and wrong with healthcare delivery today. The average physician spends 2 hours on paperwork for every hour spent with patients.¹ Yet, from 2000 to 2012, deaths from heart failure have declined 30 percent.²  Reliability is questioned: one in twenty patients is misdiagnosed daily. Only 34% of Americans have “great confidence” in the leaders of the medical profession.¹

The same number of patients die from preventable errors in 2017 compared to 2001 when first reported.¹ Sadly, billions of dollars are spent on preventable chronic diseases. However, the chances of dying immediately after a heart attack has declined for 30-40 percent to 6 percent.²  Maybe it is time form a Paradigm Shift—Health as a National Strategic Imperative. WDYT?   

Pair-A-Dimes Are Tectonic Plates Being Rubbed Together

Maybe, Pair-A-Dimes are the equivalent of two “tectonic plates” being rubbed together to create much shaking followed by an eruption. When I heard senior health leaders in the late 1990s talk about the tectonic plates and eruptions, I was not quite sure what they wanted a COO like me of a clinic in the middle of New Mexico to do. I tried to translate. 

Today, some believe there’s a shift back to more balance in healthcare. The fundamental problem is that the art (how we care), science (how we treat), and business (how we pay) of medicine has fallen out of balance.³

As a result, the healthcare sector has lost focus producing healthier patients, happier doctors, and better outcomes such as healthy relationships between patients and physicians, informed by smart science, enabled by good business, and public health system integration.^1,3

To me Paradigms Shifts can be thought of as Senge’s Mental Models or patterns of thinking about or valuing a new or future situation. It could be a framework such as Senge’s Archetypes to identify a set of rules to live or decide by.^4,5 When these “paradigms” change, we have a paradigm shift. When 9/11 happened (an eruption) we had mega paradigm shifts in security, travel, surveillance, and disaster response.  Shifts represent changes in rules.

Knowing a shift is occurring and in what direction is very useful. For example, some believe genomics represents a paradigm shift or slow-moving lava of disruption followed by innovation.⁶ Being prepared positions the organizations to adapt and be agile in their thinking toward opportunities.^7,8

Understand the 7 Large-Scale Patterns Paradigms

Some experts consider a large number of paradigms are in force at any time, and others look only at the few significant or ubiquitous ones. When you understand the big or small pictures, major paradigm shifts are underway:

1. Collaboration (e.g. leading laterally across organization boundaries)
2. Personalization (e.g. patient-centered care)
3. Customization (e.g. 3D printing)
4. Sustainability (e.g. go green)
5. Reliability (e.g. zero harm)
6. Lifestyles (e.g. healthier choices)
7. Interdependence (e.g. community health system integration)

You have a better chance of making the appropriate decisions even in absence of sufficient data. 

The critical factor is to recognize when shifts occur between the significant paradigms so you can operate in the context of future changes or patterns rather than the past.⁹ For example, we are part of a paradigm shift moving from hospital buildings and physician offices into the homes and BYOD mobile devices of patients (another slow-moving eruption). This eruption has resulted in disruption of the status quo. 

The driving force behind the shift began with economics followed by personalization in the form of convenience, transparency, and differentiation. Use of sensors, apps, and clouds create opportunities for customization and interdependence between providers, patients, and insurers.¹⁰  

Such patterns, when changed to another pattern, can be called paradigm shifts, and form the underlying structure for talking about the future. They are pervasive and would be included in the driving forces as well as scenarios. They are the “unwritten rules” of how the emerging society might function.⁹

16 Futuring Techniques You Can Apply Today

When thinking about paradigms in the context of health futuring, many individuals jump of the “let’s do scenarios” to create the future we want. While appropriate, resist, seek first to understand, then align the best futuring technique with the issue or shift at hand. While scenarios are popular, they represent one of many health futuring techniques.  Here are a few to consider.

1. Backcasting
2. Looking from the Bottom-up
3. Delphi Analysis or Questionnaire
4. Focus Groups
5. Technological Forecasting
6. Personal Interviews
7. Models or Simulations
8. Scenarios
9. Search Conference
10. Science Fiction
11. Surveys
12. Modified Trend Analysis
13. Concept Mapping
14. Cross Impact Analysis
15. Futuring Wheel
16. Separating Foresight from Data Collection

When anomalies or inconsistencies arise within a given paradigm and present problems we are unable to solve within a given paradigm, our view of reality must change, as must the way we perceive, think, and value the world.⁹ Paradigms should be reviewed in relation to driving forces (and don’t be confused by the two).

Events and patterns are no longer local. They are global with 2^nd, and 3^rd order effects or slow-moving shifts ultimately headed for an eruption.  The model of disease is giving way to the health, wellness, and resilience model followed by several eruptions or large-scale patterns. Act quickly and know transparency, diversity, and inclusion are the best policies in a “leak-happy” and “all lives and brains” matter world. 

We must take on new assumptions and expectations that will transform our theories, traditions, rules, and standards of practice.⁹

The Strategic Health Leader’s (SHELDR) Imperative

If we are to create the healthiest nation in the world, the conversation on making health a national strategic imperative is required.  We must create a new paradigm in which we can solve the unsolvable problems of the old paradigms.⁹ Health futurists such as Dr. Halee Fischer-Wright are calling for bringing healthcare back into balance and make a several paradigm shifts. In her book, Back to Balance: The Art, Science, and Business of Medicine these changes will pave the way for the innovative solutions necessary in healthcare today.³ Here are three of her suggested paradigm shifts.

1. From Money as an Incentive to Time as an Incentive: Today, the stimulant to encourage “good physician behavior” is money in the form of incentives.  Rather than starting with the question “How do we use the money to reward good behavior?” we should ask, “How do we use the time to encourage good outcomes?”³ Encourage upstream collaboration!
2. From More Complexity to More Simplicity: Many well-intentioned healthcare laws have morphed into something much bigger. Medicare laws grew from 1,000 pages in 1965 to more than 130,000 pages today. Healthcare is now second only to nuclear energy as the most complex and regulated industry in America.³ Stop the insanity!
3. From More Metrics to Better Relationships: What looks good on paper and what drives the best medical outcomes can be two very different things.  Tracking and reporting metrics cost $8 billion per year.³ Knock it off! 

These shifts are just the beginning. These shifts, and others, are the starting points for new conversations about how to move American healthcare past the mediocrity we are settling for today to reach for–and achieve–excellence once again. The future has moved beyond any individual’s or any organization’s walls. We must let go to grow as a leader! Command and control are out, collaboration and coordination are in. Leveraging the social determinants of health or swimming upstream is in. 

The new healthcare landscape contains new partnering opportunities given today’s economic incentives such as value-based payment schemes.  This also includes partnering with patients.  The average patient visits the provider 2-3 times per year for about 24 hours. What about the other 364 days?  How do we engage patients to create healthier lifestyles? 

Agile and adaptive leadership must be applied and continuously fueled by lifelong learning. Leaders must place exceptional value on disruptive innovation and distributed everything as an “era” in health systems transformation.⁷ Being comfortable with YES AND or BOTH AND as ways to inspire innovative solutions in young leaders such as those in the 1990s is the way forward.⁸  Stay confident and optimistic about the future. Your future will follow.

Summary

In 2012, I had the honor of developing a presentation for a senior health leader in the military health system.  His guidance, “build a presentation with a set of messages designed to reframe the conversation from healthcare to health.” While I struggled at first, I reached back to my health futuring experiences over the years and did some exploring on past healthcare paradigms. It clicked. The biomedical model of disease is crumbling while health, wellness, and resilience or culture of health paradigm are emerging. 

Researching the “pair-a-dimes” of the past, present, and future enable development of the presentation to help the senior health leader challenge the mental “paradigms” of the audience and think about the next tectonic shifts.  

Remember, health futuring is not about assessing scenarios, but a mindset to create the future using a wide array of techniques. Look backward from the future.  More importantly, health futuring is about personal change, leader development, and leading across boundaries by swimming upstream (leveraging the social determinants of health) to create better health for the nation.

Embrace your fears to create the right incentives, increase simplicity, and enable meaningful relationships.

Go for it!

Deep Dive Questions For Discussion

1. What “Pair-A-Dime” shifts are impacting your healthcare experience?
2. How can health futuring tools like backcasting shape your strategic planning?
3. Which “pair-a-dimes” are shaking your corner of healthcare? How can you leverage them for positive change?
4. What outdated paradigms hinder your organization’s progress toward a thriving healthcare future?
5. Beyond metrics and incentives, what fosters meaningful patient-provider relationships and healthier lifestyles?
6. What innovative solutions can bridge the gap between healthcare and wellness?

Professional Development and Learning Activities:

1. Host a “Pair-A-Dime” Brainstorming Session: Identify future healthcare trends and develop action plans.
2. Map Your Healthcare Future: Use a futures wheel to visualize opportunities and threats in different scenarios.
3. Conduct a Backcasting Exercise: Define your desired healthcare future and work backwards to identify actionable steps.
4. Build Your Personal Health Futuring Toolkit: Explore various health futuring techniques like backcasting, scenarios, and concept mapping to envision your ideal future.
5. Champion Upstream Collaboration: Partner with community organizations and social service agencies to address the social determinants of health impacting your patients.

Resources

1. Strategic Foresight: Learning from the Future, Patricia Lustig
2. “Back to Balance: The Art, Science, and Business of Medicine” by Halee Fischer-Wright (2018): This book proposes three paradigm shifts to rebalance healthcare: time as an incentive, simplicity, and better relationships. https://www.amazon.com/Back-Balance-Science-Business-Medicine/dp/1633310140
3. “The Healthcare Foresight Toolkit” by The Healthcare Foresight Center: This online resource provides tools and templates for scenario planning, backcasting, and other health futuring techniques. https://www.foresightforhealth.org/
4. “The Futures of Health in 2040: Ten Trends Shaping Our Future World” by Institute for Alternative Futures: This report explores ten key trends that will impact healthcare in the coming decades. https://www.linkedin.com/posts/the-future-of-health-in-2040-will-be-radically-activity-7088676593719468032-cf3q?trk=public_profile_like_view
5. “Health Futuring: Creating the Health System of Tomorrow” by World Health Organization: This website provides an overview of health futuring and its applications in healthcare planning. https://www.who.int/podcasts/series/science-in-5/episode–84—future-of-health
6. Bradley E, Fineberg, Harvey B., The American Health Care Paradox: Why Spending More is getting Us Less. New York City, NY: PublicAffairs; 2013.
7. Dowling M. Healthcare Reboot: Megatrends Energizing American Medicine. 65 Gadsden St, Charleston, SC 29401: Forbesbooks; 2018.
8. Fischer-Wright H. Back to Balance: The Art, Science, and Business of Medicine. Austin, TX: Disruption Books; 2017.
9. Senge PM. The Fifth Discipline: The Art and Practice of the Learning Organization. New York City Doubleday/Currency.; 2006.
10. Schimpf S. The Future of Medicine: Megatrends in Healthcare that Will Change Your Quality of Life. Nashville, TN: Thomas Nelson, Inc.; 2007.
11. Johansen B. The New Leadership Literacies: Thriving in a Future of Extreme Disruption and Distributed Everything Oakland, CA: Berrett-Khoeler Publishers, Inc.; 2017.
12. Johansen B. Leaders make the Future: Ten New Leadership Skills for an Uncertain World. San Francisco, CA: Berrett_Koehler Publishers, Inc.; 2012.

About the Author

I am passionate about making health a national strategic imperative, transforming and integrating health and human services sectors to be more responsive, and leveraging the social drivers and determinants of health (SDOH) to create healthier, wealthier, and resilient individuals, families, and communities. I specialize in coaching managers and leaders on initial development, continuously improving, or sustaining their Strategic Health Leadership (SHELDR) competencies to thrive in an era to solve wicked health problems and artificial intelligence (AI).

Visit https://SHELDR.COM or contact me for more BLIP-ZIP SHELDR advice, coaching, and consulting. Check out my publications: Health Systems Thinking:  A Primer and Systems Thinking for Health Organizations, Leadership, and Policy: Think Globally, Act Locally. You can follow his thoughts on LinkedIn and X Twitter: @Doug_Anderson57 and Flipboard E-Mag: Strategic Health Leadership (SHELDR)

Disclosure and Disclaimer:  Douglas E. Anderson have no relevant financial relationships with commercial interests to disclose.  The author’s opinions are his own and do not represent an official position of any organization including those he consulted.  Any publications, commercial products or services mentioned in his publications are for recommendations only and do not indicate an endorsement. All non-disclosure agreements (NDA) apply.

References: All references or citations will be provided upon request.  Not responsible for broken or outdated links, however, report broken links to [email protected]

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