In 2019, I was preparing to attend a WHO summit on patient safety in Switzerland: a gathering of policymakers, government representatives, and practitioners. Then came the email notifying participants that the conference was no longer taking place, due to some delegates having to tackle a new virus in their region. Few could have imagined that this was a foretelling of a large-scale global event that would soon shape and disrupt life as it was known.

A few months later, the virus had spread globally, with measures such as mandatory masking, lockdowns, and school closures becoming the new norm. For me, a physician involved in my local organization’s COVID-response task force, the pandemic highlighted several aspects of leadership and raised pressing questions about what leadership truly meant, especially in the health domain.

It became clear that the concept of leadership transcends the C-suite and clinical department heads. Hospital housekeeping and janitorial staff who had rarely been regarded as leaders became central to the conversation and innovation on keeping hospitals safe through rigorous infection control measures (1). Additionally, in various organizations, sick days due to infection or isolation meant that subordinates often stepped up to act as heads, expanding the notion of leadership beyond traditional structures.

The pandemic revealed just how urgently the world needs stronger collaboration in healthcare, collaboration that crosses borders, languages, and cultures. Countries like Italy, among the first hit hard in the early days, shared their knowledge and experiences with others. That willingness to exchange ideas highlighted a powerful lesson that true leadership in healthcare requires humility and openness to learning in both directions.

As I watched the challenges brought by the pandemic unfold, I wondered if we could have been better prepared. While no one can ever predict exactly when or how such events will happen, we can design healthcare systems resilient enough to adapt and withstand shocks of any kind. That question, “What does it take to build resilient healthcare systems in the face of uncertainty?” sparked my deeper exploration into strategic foresight. It led me into doctoral studies on strategic leadership and inspired me to design a curriculum that helps healthcare professionals apply foresight in their own leadership journeys.

Foresight has already proven useful in areas like AI development and workforce planning, but one striking gap remains. Most doctors and medical trainees receive little to no exposure to foresight during medical school or residency. Embedding this way of thinking earlier, whether in career planning or system-level leadership, has clear value for the future of healthcare.

Key Foresight Concepts

Foresight is not about predicting the future. It is about examining possible futures and preparing for them. Some key concepts include the following.

• Signals are early signs of change, such as wearable health technology that supports aging populations.
• Trends are long-term shifts, like the move toward outpatient care.
• Drivers are broad forces, such as demographic change in aging societies.
• Uncertainties are unpredictable variables, like the speed at which virtual care will be adopted.
• Plausible futures are scenarios grounded in evidence and current dynamics.
• Alternative futures represent a range of possible outcomes, not all of which are equally likely.
• Scenarios are narratives that bring together signals, trends, drivers, and uncertainties to help leaders plan across multiple futures.

These tools strengthen healthcare leaders’ ability to think strategically and make better decisions in unpredictable conditions.

Understanding VUCA

VUCA (2) is an acronym that reflects the realities of healthcare delivery today.

Volatility is the rapid and unpredictable change experienced during events such as the COVID-19 pandemic.
Uncertainty is the lack of clarity about present or future developments, for example the evolving role of AI in diagnostics.
Complexity refers to the many interwoven factors that defy simple solutions, as illustrated by the opioid epidemic.
Ambiguity arises when situations can be interpreted in multiple ways, such as the ongoing debates over medical assistance in dying (MAID).

In this environment, strategic foresight is not optional. It is a core leadership skill that cultivates creativity, adaptability, and the ability to anticipate change rather than merely react to it.

Conclusion

Strategic foresight equips healthcare professionals with the mindset and skills to navigate a world where complexity and change are constants. By learning to read signals, understand trends, and anticipate multiple possible futures, physicians and leaders can act with greater agility and help shape systems that are both resilient and equitable.

The pandemic reminded us that leadership is not only about clinical expertise. It is also about perspective, adaptability, and the courage to rethink what leadership looks like. Bringing foresight into medical education ensures that future healthcare leaders are not only skilled in diagnosis and patient care but also prepared to guide their systems through uncertainty.

Tomorrow’s physicians must be clinicians and visionaries, able to anticipate challenges, bring together diverse perspectives, and lead healthcare into a future that is stronger, fairer, and better prepared for whatever comes next.

References

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2. Nandram SS, Bindlish PK. Introduction to vuca. In: Nandram SS, Bindlish PK, editors. Managing VUCA Through Integrative Self-Management [Internet]. Cham: Springer International Publishing; 2017 [cited 2025 Aug 21]. p. 3–14. Available from: http://link.springer.com/10.1007/978-3-319-52231-9_1
3. Chermack TJ. Using scenarios: scenario planning for improving organizations. First edition. Oakland, CA: Berrett-Koehler Publishers, Inc; 2022. 221 p. (A publication in the Berrett-Koehler organizational performance series).
4. Fargason CA, Evans HH, Ashworth CS, Capper SA. The importance of preparing medical students to manage different types of uncertainty: Academic Medicine [Internet]. 1997 Aug [cited 2025 Aug 21];72(8):688–92. Available from: http://journals.lww.com/00001888-199708000-00013
5. Berwick DM, Finkelstein JA. Preparing medical students for the continual improvement of health and health care: abraham flexner and the new “public interest”: Academic Medicine [Internet]. 2010 Sep [cited 2025 Aug 21];85:S56–65. Available from: http://journals.lww.com/00001888-201009001-00007

Author

Dr. Lind Grant-Oyeye

Lind is a medical practitioner currently working in Canada. She holds a doctorate in strategic leadership with a concentration in foresight from the Oral Roberts University.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none