Scenario Planning, by Helen Blanchard

So how do we predict the future? (spoiler alert, we can’t!)

In these very uncertain times, it feels as though we could all benefit from a crystal ball to get a glimpse into what happens next. I’ve been reflecting on my own experience of anticipating what the future holds and am happy to share one heroic failure and a couple of modest successes.

So, first is that heroic failure. It was a ‘hospital of the future’ we were designing back in 2004 to be a completely paperless service. By the time we realised that paper would be very much with us, we had to literally go back to the drawing board and spend time and money updating the designs and retro-fitting medical records storage across umpteen clinics, offices and wards, so that the hospital actually worked. On the plus side, I believe that 16 years later they still have enough capacity in the IT hub rooms (which may be something to do with cloud storage now being a thing).

I do have some good news prediction stories though, including the following:

• Accurately anticipating the future in getting the capacity and demand modelling right and planning in significant additional capacity for endoscopy and theatres on that same 2004 project
• Supporting a group of General Practices to move towards a shared operating model, shared premises and some joint back office support posts ahead of the Government’s development of Primary Care Networks

The Theory Bit: Scenario Planning

So, is it possible to predict the future? Well, no, not really but it is possible to visualise what a number of possible futures might look like and to test your plans and strategies to see how robust they might be in this range of possible futures.

One tool for doing this is Scenario Planning and a good description of is this from Harries:

‘Scenarios are stories about the way the world might turn out tomorrow, stories that can help us recognize and adapt to changing aspects of our present environment…Scenario planning is about making choices today with an understanding of how they might turn out’ 

As with many management approaches, there are various conflicting approaches to scenario planning and a lot of academic argument about which approach is the best. I use the approach developed by Dr F.O’Brien and colleagues at Warwick University, which is summarised in the diagram below:

During the scenario development process, the most significant (driving) factors are identified and then combined to create different scenarios. Typically, two to four scenarios are developed in a reasonable amount of detail, so that they can be used to help test and develop strategy.

How does this work in practice?

The scenario process doesn’t have to be labour intensive or time consuming. In fact, it can usually be run over two or three facilitated workshops that draw on a mix of staff from across the organisation.

Several years ago, I completed a scenario planning exercise with a large Ambulance Trust. They considered a number of potential factors, including the requirements of their funding bodies and the level of competition. We produced two scenarios, the BMW and the Ford, summarised below.

The Trust developed and tested its strategy using these scenarios and subsequently invested in significant quality improvements, including staff training and development and new IT systems. It is also seeking to expand some elements of its service offer to help achieve economies of scale. The team involved felt that the scenario planning really helped in testing their strategy against a range of possible futures, and to make changes as a result.

So, would scenario planning have helped me to avoid planning a paperless hospital? Well, I’d like to think that the scale and pace of digital development (or ‘IT’ as we called it back in the day) would have been one of the factors we considered as we developed the strategy underpinning the building programme.

I certainly believe that a day or two thinking through the possible scenarios would have been time well spent. And it’s probably something that needs to be considered and employed as part of moving out and on from the current crisis.

Helen Blanchard