Strategic foresight as a critical health leadership capability: Reflections on imagining and designing for alternative futures

A Course in Strategic Foresight

The current moment invites us to consider how we might anticipate and prepare for multiple futures in health care, especially those which may be plausible but come as a surprise to business-as-usual.  Over the past two years, the Michael G. DeGroote Health Leadership Academy (HLA) is exploring how strategic foresight is crucial for innovation and good leadership in the health sector.  If we want change, we need capabilities for building new systems that have not existed before.

One of our courses – HTHSCI 4LA3: Innovation by Design 2 – is offered to senior undergraduates from all faculties as an opportunity to use strategic foresight to examine an emerging health theme from the perspective of different stakeholders. Students generate plausible future scenarios to provoke critical conversations about present actions. 

During Winter 2020, students focused on the theme of Caregiving and Caregivers.  We wanted to explore plausible caregiving futures in context of digital and connected care.  At the outset we created teams of students organized around specific stakeholder groups that could contribute a range of perspectives on the past, present, and future of caregiving.  Each team had a McMaster-affiliated mentor to provide perspective, contacts, and guidance (Hsien Seow, Alex Drossos, Kim Blair-McKibbon, and Amanda Calzolaio). 

We had teams for:

• caregivers and patients
• clinicians
• technology-oriented entrepreneurs (techpreneurs)
• health administrators and policy makers
• community organizations

Experiential Futures

Using Candy and Kornet’s ethnographic experiential futures (EXF) model, students engaged in a process of:

Mapping – Students gained perspective on the past and present challenges around caregiving and connected care by conducting primary research (interviews) and secondary research data on emerging trends, drivers of change, and weak signals. Future strategist Zayna Khayat from SE Health Zoomed into our class to provide some context around the future of health care in a digital world.  Students produced stakeholder reports that synthesized their research into personas and storyboards that captured the hopes, dreams, and desires for the future of their stakeholder

Storyboard from Clinicians Team (Olamide Egbewumi, Katherine Tang, Alexey Mashentsev, Tamara Mohanavathanan, Arooj Irfan)

Multiplying – After synthesizing meaningful insights from the above research into questions, provocations, and personas, students then generated multiple high-level scenarios of the future based on metaphors and critical uncertainties that emerged from their research; utopias, dystopias and everything in between.  Futurist Sanjay Khanna joined us to share how organizations engage in scenario-building to respond to changes in the larger contextual environment.

Mediating – Students choose a scenario for their stakeholder persona and begin to imagine “situations and stuff from the future” that could make the scenario tangible and experiential. Stuart Candy and Situation Lab’s THING FROM THE FUTURE card game and a presentation on exhibits and visual design from McMaster museum educator and futurist Nicole Knibb helped to generate ideas including job ads, interactive art works, technologies, toolkits, and services from the future.

Caregivers team (Syeda Zaidi, Ruby Mann, and Olivia Wilson), playing with the theme ‘hanging by a thread’

Mounting and Mapping – A museum curriculum including a self-guided audio tour enabled students to visit museum in the local area and learn how artifacts and information are displayed to viewers. Pivoting from a public museum exhibit event due to COVID-19, students created a virtual museum exhibit on MURAL that offered a sketch of the 2030 scenario for the stakeholder as well as an artifact from the future.  Students then solicited and mapped responses from stakeholders, faculty, mentors, and other students about what the exhibits provoked.

Student Project

One project that exemplifies the process was produced by the Community Organizations team (Arsh Kanotra, Abhiti Kuhad, Vaithiegaa Mathanarajan and Yosi Ladipo). The team spent time speaking with retirement home directors and policy makers. Their exhibit Boom’n’B describes a dystopian future in which the economy has collapsed, and seniors find themselves in a desperate and resource scarce situation trying to access to retirement homes.

Riffing off both Tinder and Airbnb as platforms, the team imagined seniors applying for and seeking to match with local residents who have space in their homes. Their exhibit – constructed as a website with screenshots below – includes testimonials, an application process, and potential homes.

Reflections and comments on their virtual exhibit from viewers and the students centred on the value of:

• Dystopian futures – The discomfort raised by the exhibit disrupted the habit for some of thinking of the future solely in terms of solutions and positives.
• Reframing the familiar – The use of familiar technologies and services (such as AirBnB and Tinder) provided concrete mediums through which to reimagine alternative manifestations of the underlying ideas like resource sharing and matching platforms.

Student Reflections: Lessons for supporting emerging leaders

Returning to the question posed at the outset of this article -how do we better anticipate and prepare for the unexpected and the inevitable? – we asked students to provide an account of their creative process and their thinking throughout the course. Students from the health administration team (Karan Taghizadeh, Maddy Mulcahy, Stefan M Mladjenović and Caitlin Carrigan) provided some reflection on their learning process that speaks to the challenge, opportunity and benefit of futures work. A few themes emerged:

Navigating ambiguity – “One of the difficulties we first faced in this project was navigating ambiguity…Most of the time when you are assigned a problem to tackle, and the way you do so is by finding a solution, yet here we were not asked to do that. Instead we were asked to think about all the potential future scenarios encompassing the problem, and our stakeholder group, and find a way to showcase this idea in an engaging way.”

Moving between concrete and abstract – “Thinking about the future in a concrete way is quite challenging. It is easy to get lost in the fantastical and forget to ground your ideas in reality…While it is often beneficial to think up outlandish ideas, to then come to ideas more grounded in reality, you do need to eventually get to those grounded ideas.”

Generating depth in scenarios and artifacts – “Once we had decided upon the future scenario we were going to explore, then came the time to develop an artifact that could showcase this future scenario… Coming up with artifacts was not necessarily a challenge, however, it was difficult to come up with artifacts that told the story we wanted, caused individuals to question their own assumptions, and provoke emotion.”

The emerging lessons from our work with students indicates that we need to help leaders sustain curiosity and seek clarity about what is important when the path is not clear. Foresight is not about predicting outcomes or finding a solution to a problem, but about awakening our sense of what is plausible and making our stories and ideas concrete enough to inspire us to head, today, in the direction we want to go.