health futures - spaces places - introduction

the futures of healthspaces + places of care

/2the futures of health

SPACES + PLACES OF CARE

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the futures of health

SPACES + PLACES OF CARE


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05 Preface09 Introduction

13 About this Publication

16 The Goals17 The Process23 Design Principles25 Themes

191 Embracing the Futures of Health

193 Delphi Study201 Applying the Futures of Health

205 IC Health + Foresight Practice

208 Appendix

Reframing Health + Disease

124 Overview129 Shifts135 Tension /

Uncertainties Matrix137 World-Views 137 quad a 141 quad b 145 quad c 149 quad d

153 Conclusion154 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

AuthorsFiona HughesMathew Lincez

ContributorsPaul HartleyElizabeth KelleyMelanie LevitinShane SaundersonJulia SchaeperVurain TabvumaBraeden Watts

DesignersJemuel DatilesJason LukSophie Qi

Production DesignerAnna Pateras

Editors/CopywritersKiley BellMorgan GerardPatrick GlinskiCaroline LeungEsther Rogers

Special Thanks toIdris Mootee

Content

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01 02

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New Approaches to Treatment




Caring Technologies




Health Delivery + Community Care




Economic + Human Values in Healthcare





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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.

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If the path before you is clear, you’re probably on someone else’s.

— Joseph Campbell

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There is absolutely no inevitability as long as there is a willingness to contemplate what is happening.

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Introduction

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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.

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—Marshall McLuhan

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introduction


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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.

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introduction


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Spaces + Places of Care

the futures of health

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About this Publication

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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


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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

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illustrate different types of change taking place within the health and wellness context.

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bring to life big shifts taking place and explore questions and uncertainties that are emerging as a result.

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highlight principles that can be applied to the design of better healthcare experiences.

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The Process

OverviewThe 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.

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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.

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the process/17


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Synthesis + Context MappingThroughout 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.

ShiftsOne 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.

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Scope SettingTo 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 ScanningWe 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.

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the process


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ScenariosScenarios 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.

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World-Views / Meta-NarrativesMeta-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 TensionsSeveral 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).

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the process


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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.

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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.”

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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.

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05 Economic + Human Values in Healthcare

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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.

In New Approaches to Treatment, we recognize that while modern medicine is about the quest for newer, better, and more precise treatments, we explore what constitutes a treatment, with what intent treatments are given, and what the expectations of those receiving a treatment are.

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


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.

health futures - spaces places - introduction

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