futures literacy in health care: the managed outcomes project paul forte 1, riel miller 2, tom bowen...

Futures Literacy in Health Care:The Managed Outcomes Project

Paul Forte1, Riel Miller2, Tom Bowen1

1The Balance of Care Groupwww.balanceofcare.com

2UNESCO1st International Conference on Anticipation, Trento 5-7 November 2015

http://www.balanceofcare.com/

2

The FP-7 ‘Managed Outcomes’ Project www.managedoutcomes.eu

• Effect of organisation and management of care processes on patient health outcomes for:• type 2 diabetes• acute stroke care• dementia• hip osteoarthritis

• Case study comparison of health networks and patient outcomes (EQ-5D)

• Finland, Netherlands, Spain, Greece, Germany, England

• Scenarios to address existing and future health needs

1st International Conference on Anticipation, Trento 5-7 November 2015

http://www.managedoutcomes.eu/

3

‘Futures Literacy’ methodology

• Aims to deepen understanding of current procedures and how these might be affected by assumptions about the future

• Level 1 – Catalytic Awareness– Where are the trends going?

• Level 2 – Imaginative Discovery– Breaking out of current assumptions– Unconstrained futures

• Level 3 – Strategic Choice– What changes can be made now given the above?


1st International Conference on Anticipation. Trento 5-7 November 2015

4

Why scenarios?

• Highlight important relationships between process and outcomes

• Combinations which optimise various elements and perspectives including delivery channels

• Insights from model elements and FL perspectives

• Stories about the future; insights for the present

5

Futures Literacy and Managed Outcomes

• Why use it?– Better suited to our timescales, resources and

available expertise than a ‘Delphi’ process– Advantages of an ‘action research’ approach

• Who was it for?– Participants from the case instance location

working in the same clinical domain, but across different organisations

– Clinical and non-clinical backgrounds


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Scenario workshop format

• Systematic• Facilitated by Managed Outcome researchers• Involved wide-ranging local expertise• Time and resource constrained• Format:

– Relevant Managed Outcomes case study introduction

– Level 1: Catalytic Awareness (group discussion)– Level 2: Imaginative Discovery (group discussion)– Level 3: Strategic Choice (plenary)


Futures workshops: the challenge

Stroke Hips Diabetes Dementia

England Yes Yes Yes Yes

Finland Yes Yes No Yes

Greece Yes Yes Yes Yes

Netherlands Yes Yes Yes No

Spain Yes Yes Yes Yes

In some case studies workshops were held separately; at locations wheremore than one case study took place there were some joint workshops with case-specific streams.

Most workshops ran for half or full days depending on availability of participants.

Training, development of materials and delivery – 6 month timescale.


Stroke scenarios

• Rapid access to specialist stroke team- prioritise this over thrombolysis and related

processes- distance issue becomes less important

• High prevention/awareness strategy (minimise stroke)- reduced incidence- increased thrombolysis


Some follow-up data

10

Time from admission to CT Scan

0

50

100

150

200

250

<=1 1-3 3-24 >24 NK

Hours from admission to CT Scan

No

of p

atie

nts

adm

itted

2010-11

2011-12


Type 2 diabetes scenarios

– Low cost• maintain patients as long as possible in

early stage of the condition– Prevention

• active management of patients at all stages including pre-diagnosis

– ‘Zero complications’ • no ‘excess risk’ for stroke, amputation,

sight problems


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Useful experience gained

• Clarity of the workshop objectives: – pre-workshop meetings to clearly define

workshop objectives and outcomes?• Importance of relating the FL approach to

participants who have a predominantly operational rather than policy focus

• Increased importance of facilitation in ‘short workshops’


13

Conclusions

• Valid and useful methodology which was easy to apply and enthusiastically received by participants

• Had an ‘instant’ effect for those taking part as well as providing material for enriching the development of the Managed Outcomes scenarios

• Efficient of project time and resources available


14

The views of participants

• ‘We rarely have time as a group to sit down and do this kind of thinking – very helpful to know what colleagues think of these issues’

• ‘Good to meet other people working on the same field but with different approach – an opportunity to develop links for future collaboration’

• ‘We are all looking forward to meeting in a few months to review the final figures (never seen my team so animated with facts and figures!)’

• ‘A useful day and good to take a breather from the front-line’


futures literacy in health care: the managed outcomes project paul forte 1, riel miller 2, tom bowen...

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