Key Points - PAHO/WHO

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Policy Analysis and Decision MakingPolicy Analysis and Decision Makingwith Emphasis on Chronic Nonwith Emphasis on Chronic Non--communicable Diseasescommunicable Diseases

Bridgetown, BarbadosBridgetown, BarbadosOctober 15October 15--17, 200717, 2007

Strategic Thinking and Anticipatory ApproachesStrategic Thinking and Anticipatory Approaches

Focus on Scenarios as Tools for Learning about the FutureFocus on Scenarios as Tools for Learning about the Future

Cristina Puentes-MarkidesHealth Policies and Systems

PAHO/WHO

CPM HSS HP 2007 2

Key PointsKey PointsUnderstanding and creating the future.Understanding and creating the future.

Strategic Approach: Core Concepts. Foresight, Strategic Approach: Core Concepts. Foresight,

strategic thinking and strategystrategic thinking and strategy--making. making.

Scenarios: Origins, Uses, MatricesScenarios: Origins, Uses, Matrices

Scenarios for PAHO.Scenarios for PAHO.

Relevance of futures approaches.Relevance of futures approaches.

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‘‘The contribution of the futurist approach is to understand The contribution of the futurist approach is to understand

probable developments, and probable developments, and ““illuminate the choices of the illuminate the choices of the

present with the light of the possible futures.present with the light of the possible futures.””

Michel Michel GodetGodet

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KEY CONCEPTSKEY CONCEPTSKEY CONCEPTS

UNDERSTANDUNDERSTANDTHE FUTURETHE FUTURE

TrendsTrendsWildcardsWildcardsScenariosScenarios

CHOOSE AND CHOOSE AND CREATE THE FUTURECREATE THE FUTURE

VisionsVisionsProphetic futuresProphetic futuresPreferred futuresPreferred futures

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Source: Institute for Alternative Futures 5

TodayToday TomorrowTomorrow

Plausible futuresPlausible futures

Possible FuturesPossible Futures

Alternative FuturesAlternative Futures

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33

44

55

66

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ProbableProbableFuturesFutures

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Using scenarios is rehearsing the future. One Using scenarios is rehearsing the future. One goes through simulated events as if one was goes through simulated events as if one was living them. We are trained to recognize what living them. We are trained to recognize what is the drama unfolding. This helps to avoid is the drama unfolding. This helps to avoid nasty surprises and know how to act. nasty surprises and know how to act.

Peter Schwarz "The Art of the Long ViewPeter Schwarz "The Art of the Long View""

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Trends are patterns or directions of change of one Trends are patterns or directions of change of one or more variables during a period of timeor more variables during a period of time……(+ (+ --))

Wildcards are sudden system ruptures, high impact Wildcards are sudden system ruptures, high impact but low probability events. (e.g. 9/11)but low probability events. (e.g. 9/11)

SCENARIOS ILLUSTRATE IMAGES OR HISTORIES OF SCENARIOS ILLUSTRATE IMAGES OR HISTORIES OF THE FUTURE THAT ASK THE FUTURE THAT ASK ““what would happen ifwhat would happen if…”…”

Forecasts are statements about how trends or Forecasts are statements about how trends or conditions will evolve in the future with respect conditions will evolve in the future with respect

to a specific topic.to a specific topic.

Some useful concepts

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The future is like a theater where you haveThe future is like a theater where you have

Actors (who)Actors (who)

Events (what)Events (what)

Time when the action takes place (where)Time when the action takes place (where)

Scenario (where and how)Scenario (where and how)

Motives for the actions (why)Motives for the actions (why)

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Adapted from the Institute for Alternative Futures 9

Life cycle of a strategic issue: Life cycle of a strategic issue: the relevance of anticipationthe relevance of anticipation

Social Social ExpectationsExpectations Policy Policy

AgendaAgenda

FormalizationFormalization ControlControl

Mag

nit

ud

e o

f si

gn

sM

agn

itu

de

of

sig

ns

TIMETIMEMore options to choose strategies, more More options to choose strategies, more difficult to convince decision makersdifficult to convince decision makers

Decision-makers are now convinced, but options are fewer and risks have increased

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Strategic approach: Core conceptsStrategic approach: Core concepts

ForesightForesight

Strategic ThinkingStrategic Thinking

StrategyStrategy

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What is foresight?What is foresight?

Web DefinitionsWeb Definitions: : Having a forward view, seeing ahead, prudence, anticipation, preparation, caution, sagacity, intelligence, long-term vision, anticipatory knowledge, prospective, look into the future, sense-making, etc.

…”the ability to create and maintain a quality, coherent and functional future vision, and to use the information that it gathers in a useful way for the organization, to detect adverse conditions, guide policies, design strategies, explore new markets, products and services.” (Slaughter, 2002)

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What is foresight?What is foresight?

It is our individual and social capacity for probing the future, to understand and interpret complexity and how these forces and trends may shape uncertain and unpredictable futures.Foresight is characterized by being outward looking, future oriented, participative, creative.In complex and uncertain environments (social or organizational)“medium and long term ‘predictions’ become less reliable.”Making sense of changing, complex and uncertain environments anddevising strategic responses requires foresight processes.Strategic foresight is anticipation for action. It seeks not only to look far but also broadly and deeply, recognizing turbulences, uncertainties and weighing alternative futures systematically.

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Foresight and Strategic Planning in OrganizationsForesight and Strategic Planning in Organizations

Although related, foresight is not equivalent or replaces strategic thinking or strategic planning. Rather, it strengthens both by improving sensitivity to external and emerging relevant factors/trends.

Strategic planning makes sense only when it involves strategic thinking and it leads to strategic management.

In the context of an organizationForesight is a strategic competency that creates value for stakeholders and clients, and as a practice, it expands the limits of perception.It focuses work more in terms of goals rather than on the routine, and it is nourished by the existing and relevant organizational talents.

“Foresight is more than methods, it is the way in which an organization learns about the future and is able to see its present under the light of the future." (Fuller y Larue, 2001)

Voros, Joseph. A generic foresight process framework. Foresight 5(3):10-21. 2003. 14

Generic Foresight ModelGeneric Foresight Model

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Voros, J. A generic foresight process framework. Foresight 5(3):10-21.2003. 15

Generic Foresight Model: Corresponding MethodsGeneric Foresight Model: Corresponding Methods

Jones, J. (1997) Thinking in the Future Tense. Free Press. 16

Skills to think in future tenseSkills to think in future tense

PerspectivePerspectivePattern recognitionPattern recognitionCultural knowledgeCultural knowledge

FlexibilityFlexibilityVisionVisionEnergyEnergy

Intelligence (s)Intelligence (s)Global ValuesGlobal Values

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ScenariosScenarios

Delineate the boundaries of what could Delineate the boundaries of what could conceivably occur in the future (GBN)conceivably occur in the future (GBN) Products of collective Products of collective

mental constructionsmental constructions

Increase the understanding of Increase the understanding of issues, challenges and issues, challenges and

opportunities in the opportunities in the environment.environment.

Stories told that simplify complexity Stories told that simplify complexity and illustrate images of the futureand illustrate images of the future

Stimulate strategicStimulate strategicthinking, dialogthinking, dialogueue

and learningand learning

One of several tools to explore the futureOne of several tools to explore the future

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Scenarios are useful because today there is...Scenarios are useful because today there is...

Environmental complexity, uncertainty and interdependence

Greater permeability and vulnerability of society and institutions to external factors

Variety and velocity of scientific and technological changes.

Increasing questions about governance vis a vis the changes.

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So, what is the role of scenarios?So, what is the role of scenarios?

Identify trends, clarify themes and critical areasIdentify trends, clarify themes and critical areas

Test the robustness of strategiesTest the robustness of strategies

Consider alternatives in safe contexts.Consider alternatives in safe contexts.

Design alternative approaches that would be more resilient Design alternative approaches that would be more resilient

against future shocks. (GBN)against future shocks. (GBN)

Warn about weak signals that may be early warnings.Warn about weak signals that may be early warnings.

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……and their valueand their value--added?added?

Change mental maps and assumptionsChange mental maps and assumptions

Reduce uncertaintiesReduce uncertainties

Promote organizational flexibilityPromote organizational flexibility

Enhance creative thinkingEnhance creative thinking

Improve dealing with Improve dealing with ““moving targetsmoving targets””

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Origin of scenariosOrigin of scenarios§ In the United States, their origin linked to military and strategic studies. In Europe,

linked to social policy§ Term derives from the arts, a script.

§ Herman Khan introduces it in planning linked to military and strategic studies of the Rand Corporation in the ‘50s.

§ Khan and Weiner describe possible challenges for the US security (Toward the Year 2000)

§ Experience of Pierre Wack at Shell, use of scenarios before the oil crisis of 1973.§ Project Independence (FAA, 1974) and Energy Policy Project, Ford Foundation

(1974)§ Use in public sector, agricultural and environmental policy§ Extended use in the private sector

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Decision making

Collaborative learning

Setting strategic directions

Catalyzing bold actions

Try policy alternatives in safe contexts

Identification of critical emerging areas

Change the mental map of decision makers

Improve the internal flexibility of organizational responses

Alert about weak signals, “early warning” systems

Alignment and visioning

During the past decades, the use of scenarios has extended to:

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Adapted from Kairos Futures. Scenario Learning. Sweden. 23

Improve thinking Improve thinking process and address process and address

uncertaintiesuncertainties

Organizational Organizational development and development and

learninglearning

PolicyPolicy--making, making, planning and planning and managementmanagement

WHY USE SCENARIOS

Contribute to understand the “logic” of developments in the external environment (key forces, events, actors, our own possibilities) Recognition and assessment of drastic discontinuities in the external environment.Identify uncertainties.Develop strategies to anticipate and address unexpected &/or rapid changes in driving forces, trends, position, interests of relevant social actors, etc.

Change mental models, stimulate strategic thinking at all levels.Increase flexibility, contributes to conflict resolution.Forces decision-makers to question their basic assumptions and/or orthodoxies.Generate a shared vocabulary to communicate complex and/or paradoxical conditions.

§ Contribute to reduce the high cost or inefficiency of taking the wrong decisions.§ Address the investment needs

of human and financial resources.§ Improve planning processes

and products by refining strategies, prepare for the unexpected and keep our focus on the direction in which we want to proceed. § Contribute to consider risky

alternatives in safe contexts.

Decision Strategies International 24

Example of Scenario Based Strategic PlanningExample of Scenario Based Strategic Planning

Key Phases of the Process• Self-diagnosis regarding approaches to

strategic management • Challenging of conventional wisdom via

scenario thinking • Reframing of strategic segments and

competitive position • Completion of a core capabilities matrix • Generation and valuation of strategic

options • Action plan and implementation

strategies

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nn A scenario is A scenario is NOTNOT a prediction or a projectiona prediction or a projection

nn Perfection is not a measure of a good scenarioPerfection is not a measure of a good scenario

nn Good scenarios are not necessarily those that happenGood scenarios are not necessarily those that happen

nn Scenarios are not plans or policies but they support Scenarios are not plans or policies but they support

planning and policy developmentplanning and policy development

A few words of caution

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§§ Scenario thinking and planning require new looks at Scenario thinking and planning require new looks at planning, strategy making and resource allocations. planning, strategy making and resource allocations.

§§ Managerial competence is generally defined in terms of Managerial competence is generally defined in terms of ““knowingknowing””. .

§§ ““Good managers are those that know where they are, Good managers are those that know where they are, where they are going and how they will get there.where they are going and how they will get there.””

§§ Scenarios force us to recognize a certain degree of Scenarios force us to recognize a certain degree of ““incompetence.incompetence.””

A few words of caution… continued

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Adapted from NHS Scenarios, T. Ling 27

Learning with scenario thinkingLearning with scenario thinking

ACTIONSACTIONS

Implications for Implications for (PAHO?)(PAHO?)

What will 2020 look like?What will 2020 look like?

SCENARIO LEARNINGSCENARIO LEARNINGENHANCESENHANCESDECISIONSDECISIONS

WIDER RANGE OF OPTIONSWIDER RANGE OF OPTIONSRobust ideasRobust ideas

Risks to manageRisks to manageSkills to developSkills to developThings to monitorThings to monitor

Things to influenceThings to influence

DecisionDecisionDemandsDemands

EFFECT ON STRATEGIES:EFFECT ON STRATEGIES:EARLY WARNING SIGNSEARLY WARNING SIGNS

OF DIFFERENT SCENARIOSOF DIFFERENT SCENARIOS

Source: J. Medina Vásquez 28

SCENARIOSSCENARIOS

Social SystemSocial System

PasPasttPresentPresent

TiTimeme

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Garrett, M. and C. Puentes-Markides. Application of Futures. 29

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Scenario AnalysisScenario Analysis

““A logically rigorous, participatory tool to help stakeholders anA logically rigorous, participatory tool to help stakeholders and d decisiondecision--makers look at key strategic uncertainties in the long makers look at key strategic uncertainties in the long term through:term through:

A discussion of key trends relevant to a particular issue, policy, program, intervention, reform, etc. (e.g. driving social, economic, political and technological forces)

Identification of major relevant discontinuities (e.g. political instability, wars)

Creation of plausible future scenarios based on those discontinuities

Assessing the robustness of the particular policy, program, reform or intervention by testing it in each of the scenarios.

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Higher UncertaintyHigher Uncertainty

IndirectIndirect

ImpactImpactDirect Direct

ImpactImpact

Lower UncertaintyLower Uncertainty

PotentialPotential

JokersJokers

Pivotal Pivotal

UncertaintiesUncertainties

Context Context

ShapersShapers

SignificantSignificant

TrendsTrends

Impact and UncertaintyImpact and Uncertainty

CPM HSS HP 2007 32

High Impact

Low Uncertainty

High Impact

High Uncertainty

Low Impact Low Uncertainty

Low Impact

High Uncertainty

Impa

ctIm

pact

HIGHHIGH

MediumMedium

LOW

UncertaintyUncertainty

Example: You may want to focus on the degree of impact (or risk) and degree of uncertainty .

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CPM HSS HP 2007 33

Scenario Analysis: Impact/Uncertainty MatrixScenario Analysis: Impact/Uncertainty Matrix

Examples of Scenario Logics/MatrixExamples of Scenario Logics/Matrix

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Tom Cronin, TM 325. 35

Blazing videoBlazing video

EE--mail onlymail only

WorldWorld--wide wide StandardStandard

Custom BuiltCustom Built

On the outside On the outside looking inlooking in

Time to go to Time to go to battlebattle

WeWe’’re left holding re left holding the bagthe bag

Solution without Solution without a problema problem

APON Equipment APON Equipment AvailabilityAvailability

Con

sum

er

Con

sum

er

Ban

dwid

th N

eeds

Ban

dwid

th N

eeds

Focal question: Should SBC use APON to replace copper in the loFocal question: Should SBC use APON to replace copper in the lo op?op?

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ECONOMYECONOMY

DATA

IN

DUST

RYDA

TA

INDU

STRY

NATIONALNATIONALDEPRESSIONDEPRESSION BOOMINGBOOMING

HIGHLYHIGHLYCOMPETITIVECOMPETITIVE

MONOPOLYMONOPOLY

$$$$$$KINGKING$$$$$$

OF THEOF THEMOUNTAINMOUNTAIN

$$THE BATTLE RAGES$$THE BATTLE RAGES$$$$C C ONLY THEONLY THE

STRONG SURVIVE STRONG SURVIVE CC

$$KINGKING$$

OF THEOF THEHILLHILL

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Four Futures Four Futures --Different Patterns of use of new ISTDifferent Patterns of use of new IST

Competitive and Dynamic Knowledge Society:

• rapid growth in IST use• economy -driven innovations

• uneven development

Cohesive and Integrated Knowledge Society:• rapid growth in IST use

• economy -driven innovations• much reduction in disparities across EU

Challenged Knowledge Society:• slow and very uneven growth in IST use

• innovations in specific areas• major concerns about technology and

market

Sustainable and Inclusive Knowledge Society:• new paradigms of IST use

• social & community -driven innovations• environmental and other objectives

Scenario 1Scenario 1




Progress and

polarization

Challenged and

contested Doing things

differently

Catch Up and Creative

WS1

WS1

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Example of a Scenario MatrixExample of a Scenario Matrix

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CPM HSS HP 2007 40

Example of the Scenario Framework LogicExample of the Scenario Framework LogicMont Fleur Scenarios (South Africa)Mont Fleur Scenarios (South Africa)

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GLOBAL BUSINESS NETWORK 41

The decision tree can be used to determine whether scenario thinThe decision tree can be used to determine whether scenario thinking is an king is an appropriate tool for addressing your challenge or problem.appropriate tool for addressing your challenge or problem.

CPM HSS HP 2007 42

Additional ChecklistAdditional Checklist

DO NOT USE SCENARIO THINKING WHENDO NOT USE SCENARIO THINKING WHEN……The problem you are dealing with is not central to your organizational strategy and/or your problem and solution are clear.The outcome is largely predetermined due to internal or external forces.The leadership wants to maintain the status quo.There is too much urgency to step back for a reflective and creative conversation.Your desired outcomes are poorly aligned with your dedicated resources.

YOUR SITUATION IS IDEAL FOR SCENARIO THINKING IFYOUR SITUATION IS IDEAL FOR SCENARIO THINKING IF……You are dealing with a strategic issue and the solution is unclear.You are working in a highly uncertain environment.There is leadership support for the scenario thinking process.our organization is open to change and dialogue.You can attract the resources necessary for a successful initiative.

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CPM HSS HP 2007 43


ForesightForesightStrategic ThinkingStrategic Thinking

StrategyStrategy

CPM HSS HP 2007 44


Emphasizes intuition, creativity, sensitivity to discontinuitiesEmphasizes intuition, creativity, sensitivity to discontinuities and and an open attitude towards alternative options.an open attitude towards alternative options.Enables participation, unstructured processes, stimulates new Enables participation, unstructured processes, stimulates new ideas that challenge the managerial orthodoxy (remember the ideas that challenge the managerial orthodoxy (remember the political model of policymaking?) political model of policymaking?) Strategic planning is analytic, convergent, conventional while Strategic planning is analytic, convergent, conventional while strategic thinking is synthetic, divergent and creative.strategic thinking is synthetic, divergent and creative.It makes explicit a future intentionality, yet the past is the lIt makes explicit a future intentionality, yet the past is the link to ink to the future, nourished by multiple perspectives.the future, nourished by multiple perspectives.In organizational contexts, it should be linked to strategic In organizational contexts, it should be linked to strategic planning. planning.

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45

... May be defined colloquially as “acting in the present with a clear sense of the future” – a perception of what the future environment can be, and a vision of what you want the future (of your organization, community, etc) to be. Therefore, no aspect of cultural change is more important than to “futurize” the values and the organizational behavior.”

Adapted from Wilson, Ian. Futurizing our Institutions: Turning Intelligence into Action. Wolf Enterprises, 1998.


Liedka, JM. Strategy and Leadership. 26(4) pp. 30. 1998. 46

LiedtkaLiedtka’’ss Strategic Thinking ModelStrategic Thinking Model

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Source: Clem Bezold, IAF 47

Vision, Strategy and TacticsVision, Strategy and Tactics

Tactics Tactics ---- OperationOperation

StrategyStrategy

VISIONVISION

Definition of Definition of ValueValue--addedadded

How?How?

How? What?How? What?

CPM HSS HP 2007 48


ForesightForesightStrategic ThinkingStrategic Thinking

StrategyStrategy

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CPM HSS HP 2007 49

CPM HSS HP 2007 50

A way to get from here to there?

A pattern of actions during a period of time?

A position that reflects decisions to offer particular types of products or services to certain groups?

A long term change perspective, an orientation/direction towards a shared vision.

Strategy has to do with understanding the choices we make, how they relate to one another and link to the performance of an organization, a system, an enterprise, etc.YET, A STRATEGY IS NOT PLANNING OR BUDGET!!YET, A STRATEGY IS NOT PLANNING OR BUDGET!!

WWhat is a strategyhat is a strategy??

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CPM HSS HP 2007 51

Some useful questions to guide the process of strategySome useful questions to guide the process of strategy--makingmaking

Ø What are we trying to achieve?

Ø What do we want that we don’t have?

Ø What are we trying to preserve?

Ø What do we want that we already have?

Ø What are we trying to avoid?

Ø What do we don’t have that we don’t want?

Ø What are we trying to eliminate?

Ø What do we have now that we don’t want?

For each strategy, answer:• Why do we want to do this?

• What would we achieve by implementing this strategy? (the goals, objectives)

• What decisions should we make if we adopted this strategy? (managerial actions)

• What would be timeline of the actions involved in the strategy? (timeline, agendas)

• What would be the cost of implementing the strategy? (tangible and intangible/prestige, reputation, human, financial, etc.)

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Qualities of a Good StrategyQualities of a Good StrategyGenerates responses that are sensitive to the needs of the clients and stakeholders.

Takes advantage of existing strengths.Gives priority to activities that ensure success.

Centers on building capacity and learning.

Creates unique areas of excellence and innovation.

Generates abilities to identify risks (and avoid them), and to take advantage of unexpected opportunities.

Assigns human and material resources to increase quality per unit of investment.

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53http://www.emergence.net.au/articles/generic_strategic_foresight _process.pdf

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Not all decisions are strategicNot all decisions are strategic

…… and neither are the problemsand neither are the problems

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Visions: Creating the FutureVisions: Creating the Future

PAHO-CPM/HSS/HP 56

VisionsVisions♥ A vision is an image of the future based on the shared values that a group (community,

organization, etc.) commits to achieve.♥ A vision is not a plan; it does not tell us how to get there, but rather what this future is like.♥ Visions:

♥ touch people’s hearts, they are inspiring, they set the “north star ”.

♥ make values explicit, and sustain leadership.

♥ require imagination, commitment and sacrifice.

♥ establish a creative tension between present and future

♥ “Visions enrich productivity by connecting values with the most noble goals of the daily work.”

♥ “Scenarios are futures for the head and visions are futures for the heart.” (Clem Bezold)

♥ Visions must be linked to strategies and actions, otherwise they are only wishes.

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Examples of visionsExamples of visions

u The Republic of Platou The City of God, St. Augustineu Utopia, Thomas Mooreu Health for Allu The European Unionu Martin Luther King’s “I have a dream” speechu Health as a bridge for peaceu Etc.

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Visions in a Nutshell: ExamplesVisions in a Nutshell: Examples

GE: We bring good things to life.Nokia: Connecting people.AVIS: We try harder.Nestle: Good Food, Good LifeCoca-Cola: The Coca-Cola company exists to benefit and refresh everyone it touchesBoundless Technologies: Sharper Business ThinkingATT: The World’s Networking Company.

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Differences between strategic plans and visionsDifferences between strategic plans and visions

Language is warm, spiritual, poetic, publicLanguage is warm, spiritual, poetic, publicLanguage is cold, rational, secret, Language is cold, rational, secret, bureaucraticbureaucratic

A vision is dynamically incompleteA vision is dynamically incompleteThe plan is completeThe plan is complete

It is not clear how to get thereIt is not clear how to get thereYou need to know how to get thereYou need to know how to get there

Work from the future towards the pastWork from the future towards the pastWorks from the present towards the Works from the present towards the futurefuture

AnticipatoryAnticipatoryOriented towards the outcomeOriented towards the outcome

HolisticHolisticReacts to trendsReacts to trends

DireccionalDireccionalLinearLinear

VisionsVisionsStrategic PlansStrategic Plans

Another type of vision: peripheralAnother type of vision: peripheral

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61

In a changing and uncertain world, peripheral vision is In a changing and uncertain world, peripheral vision is particularly importantparticularly important

“To expand the number and types of signals we are able to sense with a view to transform new signals into meaning, rather than dismiss them as meaningless noise.

To enable role-specific managing-by-wire support, which makes possible order of magnitude decreases in sense-and-respond cycle time by key decision-makers.

To develop competencies of “knowing earlier” improves the organizational understanding of and ability to act upon changes in the periphery, thus increasing the degree of organizational adaptability and chances of success.

Haeckel, Stephan H. Peripheral Vision: Sensing and Acting on Weak Signals Making Meaning out of Apparent Noise: The Need for a New Managerial Framework. Long Range Planning 37 (2004) 181–189. www.lrpjournal.com

Haeckel, Stephan. 62

Developing Peripheral VisionDeveloping Peripheral Vision

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Source: Decision Strategies International 63

Peripheral Vision: Detecting Weak Signals SoonerPeripheral Vision: Detecting Weak Signals Sooner

What limits success for most organizations?What limits success for most organizations?Trapped in yesterday’s business models

Lack of vision and risk-taking

Biases of internal decision processes

Corporate arrogance and overconfidence

Insufficient attention to weak signals

Short-term metrics-driven versus long -term focus

Need a disciplined strategic framework to overcome these challenges

Haeckel, Stephen 64

Peripheral Vision: Asking The Right QuestionsPeripheral Vision: Asking The Right Questions

Learning from the pastLearning from the past§ What have been our past blind spots? What is happening there now?§ Is there an instructive analogy from another industry/sector?§ Who in your sector/industry is skilled at picking up weak signals and acting on

them ahead of competition?

Examining the presentExamining the present§ What important signals are you “rationalizing away”?§ What are your mavericks, mutants and outliers saying?§ What are peripheral customers and competitors (clients/stakeholders, etc.) really

thinking?

Envisioning new futuresEnvisioning new futures§ What future surprises could hurt or help us?§ What emerging technologies could change the game?§ Is there an unthinkable scenario?

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Decision Strategies International 65

Peripheral Vision and Strategy DevelopmentPeripheral Vision and Strategy Development

66

Alternative Scenarios for PAHOAlternative Scenarios for PAHO

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67

How clear is your crystal ball?How clear is your crystal ball?

CPM HSS HP 2007 68

Key Drivers... What we can expectKey Drivers... What we can expect

GlobalizationGlobalizationHIGHHIGH

HIGHHIGHLOWLOW UncertaintyUncertainty

Impo

rtanc

eIm

porta

nce

Environmental Environmental ChangeChange

Science & Science & TechnologyTechnology

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CPM HSS HP 2007 69

... Other trends... Other trends

DemocracyDemocracyHIGHHIGH

HIGHHIGHLOWLOW UncertaintyUncertainty

Impo

rtanc

eIm

porta

nce

Population Population GrowthGrowth

GovernmentsGovernments’’PerformancePerformance

IncomeIncomeDistributionDistributionEconomicEconomic

GrowthGrowth

Status Status of womenof women

Role of the State to Role of the State to guarantee equityguarantee equity

Disease Disease patternspatterns

PH PH InfrastructureInfrastructure

DiversityDiversity

IC IC TechnologiesTechnologies

EquityEquityEnvironmental Environmental DegradationDegradation

CPM HSS HP 2007 70

Scenario Table: what could PAHO be like in the future (2015)?Scenario Table: what could PAHO be like in the future (2015)?

SCENARIOS

ELEMENTS

BUSINESS ASUSUAL

RENAISSANCE HARD TIMES SUSTAINABLESOCIETY

B IG PICTURE

Population

Society

Politics

Economics

Science and Technology

HEALTH, HEALTH CARE ,ENVIRONMENT

Health sector reform

Health services

Wellbeing

Innovations in health andmedicine

DEVELOPMENT COOPERATION

Cooperation agencies

United Nations

THE FUTURE OF PAHO OBSOLESCENCE TRANSFORMATION CAPITULATION TRANSCENDENCE

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CPM HSS HP 2007 71

SUST

AINA

BLE

SOCI

ETY

SUST

AINA

BLE

SOCI

ETY

RENAISSANCE

RENAISSANCE

PRESENTPRESENT

BUSINESS AS USUAL

BUSINESS AS USUAL

HARD TIMES

HARD TIMES

ProblemsProblems

SuccessSuccess

SCENARIOSSCENARIOS

HIGH ASPIRATIONHIGH ASPIRATION

CONVENTIONALCONVENTIONALEXPECTATIONSEXPECTATIONS

INCREASEDINCREASEDDESPAIRDESPAIR

Adapted from IAFAdapted from IAF

EquityDemocracyPeaceEthics in S & T useEnvinment valued

InequityTotalitarismWarsS& T unmanageableEnvironment devalued

CPM HSS HP 2007 72

PAHO unprepared to cope with new game related to emerging roles PAHO unprepared to cope with new game related to emerging roles of of government: more and varied demands, different stakeholdersgovernment: more and varied demands, different stakeholders’’ base, new base, new problems and areas of knowledge.problems and areas of knowledge.

Advantages of the past no longer work.Advantages of the past no longer work.

Cooperation scatters as PAHO spreads itself too thin: demands exCooperation scatters as PAHO spreads itself too thin: demands exceeds capacity.ceeds capacity.

Difficult to maintain and to develop an adequate workforce, unabDifficult to maintain and to develop an adequate workforce, unable to eliminate le to eliminate unproductive staff who also lag on competencies and commitment. unproductive staff who also lag on competencies and commitment.

Priority setting laced with internal politics and pettiness. ManPriority setting laced with internal politics and pettiness. Many good professionals y good professionals have moved on to other organizations, others are unhappy and feehave moved on to other organizations, others are unhappy and feel helpless.l helpless.

Inability to translate emerging trends in medicine and public heInability to translate emerging trends in medicine and public health into meaningful alth into meaningful cooperation programs.cooperation programs.

Scenario 1: Business as Usual Scenario 1: Business as Usual (but going downhill)(but going downhill)

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Scenario 2: RenaissanceScenario 2: Renaissance

uu PAHO anticipated, it changed accordingly and responded appropriaPAHO anticipated, it changed accordingly and responded appropriately: true tely: true understanding of the understanding of the ““big picture,big picture,”” longlong-- term thinking about issues and solutions.term thinking about issues and solutions.

uu Cooperation products are customized and delivered in a variety oCooperation products are customized and delivered in a variety of ways (real f ways (real and virtual), extensive use of ICT, strong role in producing norand virtual), extensive use of ICT, strong role in producing norms and standards, ms and standards, pioneered pioneered ““realreal--timetime”” epidemiological surveillance.epidemiological surveillance.

uu A flat organization encourages trust, communication, ownership A flat organization encourages trust, communication, ownership and empowered and empowered employees who are now lifeemployees who are now life--long learners with appropriate skills.long learners with appropriate skills.

uu PAHO has recognized prestige, a relevant role in coordination ofPAHO has recognized prestige, a relevant role in coordination of international international public health in Latin America and the Caribbean. It is a brokerpublic health in Latin America and the Caribbean. It is a broker and a sensible and a sensible social agitator for health. social agitator for health.

uu The Governing Bodies reflect regional diversity and sectors.The Governing Bodies reflect regional diversity and sectors.

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Scenario 3: Hard Times Scenario 3: Hard Times

tt PAHO and WHO broke up. Global ground and some resources are lostPAHO and WHO broke up. Global ground and some resources are lost, and its work , and its work now centers mostly on humanitarian aid to help in crises with vonow centers mostly on humanitarian aid to help in crises with voluntary and religious luntary and religious organizations.organizations.

tt Sluggish to adapt, centralized and intolerant management, inabilSluggish to adapt, centralized and intolerant management, inability to identify ity to identify solutions to institutional problems and to design the correct orsolutions to institutional problems and to design the correct organizational structure, ganizational structure, unable to address needs and demands of staff, clients and key stunable to address needs and demands of staff, clients and key stakeholders.akeholders.

tt Failure to see the value of partnerships and alliances with Failure to see the value of partnerships and alliances with ““nonnon-- traditionaltraditional””partners/stakeholders, and to participate in international healtpartners/stakeholders, and to participate in international health fora. h fora.

tt Unable to influence policy development with equity criteria. WeaUnable to influence policy development with equity criteria. Weakened governance kened governance affected meaning, values and technical cooperation.affected meaning, values and technical cooperation.

tt Neglected need to develop/upgrade staff skills, staff is unhappyNeglected need to develop/upgrade staff skills, staff is unhappy (and many have (and many have developed a variety of stress related illnesses).developed a variety of stress related illnesses).

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Scenario 4: Sustainable SocietyScenario 4: Sustainable Society

§§ PAHO functions well in a global interconnected world, creative wPAHO functions well in a global interconnected world, creative ways to generate, ays to generate, fund and develop shared health objectives.fund and develop shared health objectives.

§§ Small but meaningful, rich in talents, outcome driven, technicalSmall but meaningful, rich in talents, outcome driven, technical ly sound, a leading ly sound, a leading visionary highvisionary high--performance organization, effective accountability and quality performance organization, effective accountability and quality control of technical cooperation products.control of technical cooperation products.

§§ Recognized leadership in global networks and fora. Recognized leadership in global networks and fora.

§§ Generates, transfers and manages knowledge on the cutting edge, Generates, transfers and manages knowledge on the cutting edge, permanent permanent forum for discussions about health and wellbeing.forum for discussions about health and wellbeing.

§§ Led by an ecological approach to health, vehicle for utilizing sLed by an ecological approach to health, vehicle for utilizing science and cience and technology to enhance humanity.technology to enhance humanity.

§§ Staff, clients and key stakeholders express satisfaction.Staff, clients and key stakeholders express satisfaction.

§§ Governance structures reflect regional mosaic. Governance structures reflect regional mosaic.

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ll Which do you think is the Which do you think is the most probable future?most probable future?

ll Which would you like to Which would you like to avoid?avoid?

ll Which would you like to Which would you like to happen?happen?

ll Which is the most unlikely?Which is the most unlikely?

1 2 3 41 2 3 4

1 2 3 41 2 3 4

1 2 3 41 2 3 4

1 2 3 41 2 3 4

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Suggested Reading(s)Suggested Reading(s)Garrett, M. and C. Puentes-Markides. Application of “ futures” in community health promotion with special reference to Latin America. International Journal of Health Planning and Management. (1996). 1: 317-338.GBN. Overview of Scenario Thinking Concepts. (Excerpted from GBN’s publication, What If? The Art of Scenario Thinking for Nonprofits. www.gbn.com/whatif.Lawrence, E. (April 1999) Strategic Thinking. Public Service Commission of Canada. http://www. psc-cfp. gc. ca/research/knowledge/strathink_e. pdfUnited Kingdom, Cabinet Office. (2001) A Futurist ’s Toolbox. Methodologies in Futures Work. UK Cabinet Office. Performance and Innovation Unit. http://www. number-10. gov. uk/su/toolbox. pdf.Voros, Joseph. (2003) A generic foresight process framework, Foresight, 5 (3): 10-21).World Health Organization (2000). Regional Office for Africa. Health Futures. www.afro.who.int/des/hsd/pub/healthfutures.pdf.

Key Points - PAHO/WHO

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