In the first of our series of articles on Scenario Planning, we explore what we understand by the term, and the purpose of this approach.
One of the challenges that continues to vex healthcare systems is how to translate strategy into tactically-based, local planning which delivers high quality and effective services allied to value for money for the taxpayer. Whilst there is no ‘silver bullet’ or toolkit to guide organisations through this journey, the development of scenario planning tools can act as an effective means of exploring the impact of alternative approaches to service delivery with the aim of securing a balanced health and care system.
“Transitioning from siloed approaches to whole system planning in healthcare is essential to meet the evolving needs of populations, improve health outcomes, and ensure the sustainability of healthcare systems in the long-term.”
Target-driven, acute hospital-focussed models place too much emphasis on operational dashboards and too little on strategic planning tools which allow us to develop and model alternative scenarios in relation to what the future landscape may look like and how we best respond. Understanding historic trends provides context, and an element of directional trend, but only enables us to understand how an organisation came to be where it is.
However, this is of very limited use in moving an organisation forward, improving performance and positioning it to weather the inevitable challenges it will face in coming years. It provides no basis for evaluating the relative merits of proposed innovative changes in models of care, nor any true prediction of the impact of known or potential changes in the system in the short, medium and longer term.
As we operate within increasingly integrated health and care systems, it is critical that we look beyond traditional organisational boundaries in planning how services best respond to the changing needs of patients and users.
As such, scenario planning needs to reflect the dynamics of the wider system, recognising the inter-dependency between acute care, community services, primary care and social services.
Digital developments and enablers are moving at rapid pace which positively disrupt traditional interactions between patients and staff. This was accelerated in responding to the Covid-19 challenge and becomes a key component of the approach to scenario planning by embedding the impact and benefits of digital working into the system wide service models.
What happens in one part of the system can have a positive or negative impact on some or all of the other components, making it critical that we are able to predict this in advance, and plan accordingly.
Effective scenario planning cannot, of course, be undertaken in a darkened room, remote from service and the workforce that support its delivery. We must use the skills and expertise of a wider staff base to help develop the assumptions that underpin the service scenarios and then test the outputs as a means of validation. In addition, by engaging staff from across organisational boundaries who have a shared challenge in delivering effective services within a set level of resources, there is an opportunity to ‘get them on the same page’ by demonstrating the impact of change across the entire patient pathway, irrespective of who has responsibility for delivery.
Scenario planning must be a fluid, rather than static, exercise with the ability to refine assumptions in light of changes in system dynamics, including factors such as changes in patterns of demand, evolving models of service delivery and increasing application of digital technology. Whilst there is no universal remedy, the scenario planning outputs should be used to inform decision making and align capacity planning to workforce, estate, digital and financial strategies of organisations and wider systems.