Scenario Planning, Healthcare, and the Humanities

Podcast with Matt Finch and Matthew Molineux

In this podcast, Brandy Schillace (EIC) and Cristina Hanganu-Bresch (Blog and Associate Editor) talk to Matt Finch and Matthew Molineux about how scenario planning can help inform decisions about healthcare and the role of narrative in building scenarios that teach and humanize the health professions. You can also read Matt Finch’s essay on this topic on our blog.

 

Matt FinchMatt Finch is an Associate Fellow of the Saíd Business School at the University of Oxford and consultant at mechanicaldolphin.com, specialising in strategic foresight and organizational development across the public, private, and not-for-profit sectors.

 

 

Matthew MolineuxMatthew Molineux is a Professor of Occupational Therapy and Deputy Head of School (Learning and Teaching) in the School of Health Sciences and Social Work at Griffith University, Australia. He is passionate about finding ways to enable students and practitioners to enact theory in practice, and to think creatively about the potential of the professions.

 

 

 

 

 

 

Further reading/viewing mentioned on the podcast:

Book: Ramírez and Wilkinson, Strategic Reframing
Chapter: Molineux, “Occupation in Occupational Therapy: A Labour in Vain?
Video: NIOSH Foresight Fridays with Rafael Ramírez
Video: NIOSH Foresight Fridays with Cho Khong

 

TRANSCRIPT

SCHILLACE: Hello and welcome back to the Medical Humanities Podcast. We’re so happy to have you with us today. And we have a couple of guests, but not just that, I also have with me Christina, Christina, who is our blog Editor and Associate Editor and who’s also been helping us out with the podcast. Thanks for being here, Christina. Why don’t you say hi to our audience?

HANGANU-BRESCH: My pleasure. Hi. [laughs] Perhaps I should introduce myself a little bit. I am an Associate Professor of Writing and Rhetoric at Saint Joseph’s University in Philadelphia. And my research background has been mostly in Rhetoric of Medicine and Psychiatry. And I’m very happy to be here and dip my, try my hand out at this podcasting business.

SCHILLACE: We’re gonna get your toes and your hands all involved in this podcast.

HANGANU-BRESCH: Yes, thank you.

SCHILLACE: [laughs] So, it’s really exciting. We’ve got a couple of folks here today, and, Christina, I know that you’ve been contacting them back and forth. We’re going to go talk to Matthew and Matt. We’re gonna try not to get super confused. But you’ve been in conversation with them and maybe let us know, how did all of this come about? Maybe they can introduce themselves.

HANGANU-BRESCH: Sure. So, we have here Matt Finch. I believe you go by Matt, right? And Matthew—let me let me know if I say this right—Molineux. Yeah?

MOLINEUX: Perfect.

HANGANU-BRESCH: All right. So, Matt wrote a very, very nice blog for us to start off the new year, entitled Stories of the Futures You Didn’t See Coming: Scenario Planning, Healthcare, and the Humanities. And it’s a very intriguing concept that I personally had not read about yet. And he proposed this blog, and here we are. We are in the US, Matt is in the UK, and then Matthew is in Australia. So, this is a very exciting meeting of the minds here. So, first of all, I would like to allow you an opportunity to introduce yourselves. So, Matt, will you go first?

FINCH: With pleasure. Thank you, Christina, and thank you, Brandy. It’s good to be with you both. My name’s Matt Finch. I’m an Associate Fellow at Saïd Business School at the University of Oxford, but I also have a PhD in Modern Intellectual History. I’ve been a kindergarten teacher and written for various publications. These days, I mostly help organizations make decisions under conditions of uncertainty, which involves scenario planning, the process we’re gonna talk about today. Thank you very much for having me.

HANGANU-BRESCH: Thank you. And Matthew?

MOLINEUX: Hi, everyone. Thanks very much for having me as well. My name is Matthew Molineux. I’m a Professor of Occupational Therapy at Griffith University. I’m currently working as Deputy Head of School Learning and Teaching for the school that I’m in. And I’ve worked in the UK and Australia as an occupational therapist in clinical practice, but also in health service management and in higher education for a long time, including setting up brand new occupational therapy programs, which is how I met Matt in some ways a few years ago.

HANGANU-BRESCH: Wonderful. I understand you’re gonna tell us a little bit about how you apply this scenario, scenarios in occupational therapy as well, so this is what this is about. We live in uncertain times, though some may argue that we have always lived in uncertain times. However, we have collectively all felt the weight of the pandemic trauma, planetary crisis, political and economic turmoil, and also more diffuse uncertainties such as AI, which may either save us or kill us, depending on who you listen to.

SCHILLACE: [chuckles]

HANGANU-BRESCH: And you met in the blog, arguing that under the so-called “TUNA” conditions—so, that stands for turbulence, uncertainty, novelty, and ambiguity—it becomes impossible to say what tomorrow will bring based on experiences and models drawn from the past. And that in, and I’m quoting you here, “in these circumstances, the humanities have a special gift to offer decision makers at all levels.” So, your thesis is that we can use the power of narrative in building plausible futures or scenarios in, I’m guessing, all sorts of settings, but also in healthcare settings, in order to prevent and mitigate health emergencies or disasters. So, let’s start there. Can you elaborate? Can you tell us more about scenarios?

FINCH: Yeah. With great pleasure. So, as you say, conditions of uncertainty have existed for a very long time, and the truth is, no one has ever gathered data or evidence from events which haven’t happened yet. And really, when we have evidence-based decision making, what we’re really doing is expressing our faith in a predictive model and our confidence that the environment is not going to be uncertain or destabilizing in a way that the model doesn’t work. So, when we find ourselves in that situation where we can’t make an analogy to the past, we actually need to manufacture visions of the future context and think about the future that our decisions, our policies, our practices are going to inhabit. And so, scenarios become a way of thinking through what environment we might occupy in times to come that lies beyond our assumptions, our expectations, our hopes, and our fears.

And to the extent that they are narrative contexts, it’s a way of exploring through collective storytelling what might be around us. What are the things that we choose not to look at in our day-to-day? What are the consequences? What are the dynamics that might play out that are not simply the ones we already expect, the ones we already see ripped from the headlines, but a chance to kind of reach towards the edge of things? And I think it’s particularly interesting, in the case of healthcare and medicine, the interplay of that dynamic, that attitude to the future, specifically with the traditions of medical but also allied health disciplines, and that wider question of the medical humanities and how health relates to society and culture. So, it’s a nice nexus, really, coming together on the common ground of the unwritten future.

HANGANU-BRESCH: Hmm. Wonderful.

SCHILLACE: That’s fascinating.

HANGANU-BRESCH: It is fascinating. And, Matthew, by the way, you can chime in at any moment here. So, you quote the novelist Carlos Fuentes to compare scenarios to literary texts, right? “What then is a novel other than telling that which cannot be told otherwise? A novel is a verbal search for that which awaits being written.” I love this quote. So, what is the takeaway for medical practitioners and/or decision makers? What are some of, and also, if you can elaborate, what are some of the novels or works of art that you turn to? So, not just novels, but you also talk about history and poetry here in building the scenarios.

FINCH: Yes, it’s a nice point. Well, what happens is that for institutions in health and care that recognize they face these kinds of uncertainty, it’s an opportunity to bring together people from within the profession, within institutions, but also the wider community, different areas of expertise, and talk together about what might transpire and have that creative conversation about the different ways in which our environment might play out. And although we’re talking about the future, that’s really just a way of coming to terms with uncertainties that are already in the environment. What we’re really talking about always is the here and now, and it’s anchored in a real, strategic decision that we face. So, it’s not simply speculation, it’s not just futurism, but it’s thinking about the uncertainties of today by playing them out through a kind of storytelling.

And this has happened in various contexts. The Global Outbreak Alert and Resource Network, looking at the future of infectious disease during the pandemic, and the United European Gastroenterologists, who said in 2014, if we have a student entering med school in 2014, what’s life gonna be like in 2040 when they’re midway through their career as a stomach doctor? What are people going to be eating? What will healthcare look like? And I guess that’s the point at which Matthew comes in as well, because we began working together on foresight in the context of role emerging placements and a particular way of training occupational therapists experientially. So, perhaps I should hand over to Matthew at that point.

MOLINEUX: Sure.

SCHILLACE: Yeah, some practical technique here.

MOLINEUX: Yes. So, I guess one of the things that’s interesting for me when thinking about the work that Matt and I have done and the stuff he’s exposed me to in terms of scenario planning, is this link personally, but also professionally with narrative and storytelling. It’s something I’ve been interested. Some of my research has taken narrative approaches, and occupational therapy has a narrative reasoning process that we teach students and talk about. Not surprising because humans like stories and make sense of stories and tell their lives in those ways. And so, there has been this nice fit. And then the medical humanities bit has been really interesting to me because I’ve used it previously with some others from different disciplines and backgrounds and have just really seen the power of not, of moving beyond the scientific, the academic ways of talking about people’s experiences to see somebody express and display their experience of a particular situation, condition. And so, it all seemed to come together really nicely because occupational therapy is a fantastic profession, and, but we have a long-standing issue with identity. We feel we’re not, well, we feel we’re not well understood. People think they don’t know what we do. And so, you mesh that with the uncertainty that Matt’s talked about in terms of healthcare, but also society more broadly. There are lots of tensions, but also, I think lots of opportunities.

And so, one of the things I try and do is really get students, but also practitioners, to think creatively about what could the profession offer to stop just being restricted by the current health and social care processes and models and funding and all those sorts of things, and get them to think very differently. And so, I’ve done that through medical humanities, for example, in the past. But then the scenario planning actually takes it to another level, I think, or a different level ‘cause they both have value, and provides a, I think one of the important things, a really fun way of doing some of this stuff that engages students really deeply, but really does take them out of the current situation they’re in or we’re in and give them an opportunity to think really differently. And so, we’ve found that—

SCHILLACE: That’s fascinating.

MOLINEUX: Yeah.

SCHILLACE: It’s fascinating, too, because a lot of medical humanities is very, we, history is a field that we publish a lot here. We do a lot of, historians do work for medical humanities. And so, of course, it’s funny to think how history plays into future planning, but it does, doesn’t it?

MOLINEUX: Mm, mm. Absolutely. And in fact it can be a real barrier for some people, for some professions, because they see it as limiting them, whereas scenario planning really does push things open again, I think.

FINCH: One—

HANGANU-BRESCH: And— Go ahead.

FINCH: One of the places where we have a great common ground at the outset, forgive me, Christina, Matthew had written a lovely chapter called A Labour in Vain, which describes the different identities that occupational therapy has had historically, going back even to this notion of “labour in vain,” which was actually a punishment for prisoners in the Australian penal colony, where people were just made to clean buckets that were already clean, and just pointing to the most demeaning form of occupational therapy there could be. But seeing that occupational therapy had this history and had a very different identity in different historical contexts raises precisely this notion that Brandy mentions that therefore one can imagine future historical contexts within which the discipline is practiced differently and has different identities. And particularly one of Matthew’s students ended up concocting a scenario that was very challenging for occupational therapists, where it seemed to be a kind of utopia. She deliberately contrived this far-future utopia in which there were apparently no occupational dysfunctions, but she gradually saw that she would become a kind of detective, checking if, beneath the surface of this apparent paradise, people truly had complete liberty to do the things they wanted, needed, and had to do, that they really had that occupational freedom and health. So, that notion of context is really powerful.

MOLINEUX: Mm.

HANGANU-BRESCH: Yeah, excellent. I was gonna ask how students respond to this and how practitioners respond to this. Are there any differences, or do you have any, let’s say, lessons on how we can incorporate the scenario work in academic practices like teaching and writing and research, but also beyond that, obviously, in the practice of the actual work?

MOLINEUX: If I say a bit about students, ‘cause that’s what I’ve focused on mainly with Matt, I think some of the things for me are to do it. And because I think people might be surprised that if you do it well, how quickly students get into it because it’s interesting, it’s different, it’s creative. So, I think absolutely do it, even though it can be very different to some of their other learning and teaching experiences. I think the other thing for me, going back to this idea of context, context, I think, would be, is really important in terms of the sort of program the students are in needs to support this creative, forward-thinking, problem-solving way of doing things because I think otherwise it could be quite jarring for students ‘cause it could be a very different perspective you’re asking them to take. And then I think the third thing for me would be ensuring that although you can’t give students, and don’t want to give students, all the tools and techniques, the program should enable students to have some things, some frameworks they could go back to. And that’s, in fact, been one of the strengths of doing the scenario-based stuff with Matt and the student occupational therapists is we create these fantastical scenarios, or place them in scenarios, but we use that as an opportunity for them to go back and say, okay, you’ve never met this person, you’ve never worked in this situation before, but you do have some frameworks and theories and approaches. Let’s just apply those in this particular context. And so, I think they’d be my three tips for students. But absolutely, it’s incredibly enjoyable as a staff member as well who’s doing it. [chuckles]

HANGANU-BRESCH: Yeah. Matt?

FINCH: I think there’s resonance there as well for the institutional context where scenario users are really scenario learners. One is not simply applying a methodology which an institution is meant to take from someone like me, for example. But one learns together what it means for any given community or institution to think in this way about the future collectively. And so, therefore, whether you’re heading a research network that’s attached to the World Health Organization or a meta organization like United European Gastroenterology, really, we are learning together, and there is always that quality of exploration. And I think, again, being able to look to the past and say we’ve experienced uncertainties in the past, we’ve been blindsided by things that our predictive model did not have us ready for, or things like the pandemic, where we had actually predicted and had some plans in place, but political and social and economic context didn’t allow us to respond in the way we might have, it’s a reminder that in the same way that the past has not necessarily played out according to someone’s plan, we might need to be ready to anticipate for something that wasn’t really what we had hoped for or what we had really predicted. And so, again, it’s always about that learning experience, which for me fits with that excitement of what the humanities brings to this field.

SCHILLACE: Mmhmm.

HANGANU-BRESCH: Yes, because I see you placing scenarios as a bridge between healthcare professions and humanities. And in a sense, that’s what, I see a lot of overlap here, obviously, with narrative medicine, right?

SCHILLACE: Mmhmm.

HANGANU-BRESCH: Except narrative medicine seems to be mostly oriented towards the past or present, the experience of the patient or the practitioner as it is in the moment of providing care or having received care. Whereas this is obviously future oriented. So, do you see this overlap? Do you see that you’re working sort of complementary to that sort of subfield of health humanities?

SCHILLACE: I would just add one addendum because I think that’s a good question. One addendum is that unlike narrative, narrative medicine is really what it says it is: narrative. [laughs] Whereas medical humanities also incorporates things like anthropology, autoethnography, history, you know. It’s quite broad: social justice issues. So, I feel like there’s definitely greater resonance with what you’re doing. Because of the contextual elements, I wonder if, yeah, it almost seems like though this has a real connection to narrative medicine, it almost kind of seems more on our side of it, a little bit on our side of the spectrum.

FINCH: I think there’s space for scenarios to serve as kind of boundary objects, where different practices can come together, and we can put them in dialogue with one another. So, definitely, you can take the techniques of narrative medicine and train them on future contexts. It also speaks to the wider medical humanities. But as we implied earlier on, it’s not solely about the techniques of history or even of writing prose fiction. In some ways, it’s more akin to poetry, because what’s the most elegant form of words that will get someone to see the future could be different? The famous poet and scenario planner Betty Sue Flowers, who’s very storied in the profession, she once said by saying the single word “jazz,” people understand we’re talking about loosely self-organized, improvised systems. I don’t always need a 50-page document. I say this scenario is like jazz. And this ties to the other aspect of Matthew’s work, I think, which is so exciting, is that Matthew is also a practicing artist and a fine art student and brings, really, things that are nothing to do with the verbal into this space. And I know there’s more to say on that as well.

MOLINEUX: I was just thinking about the narrative. I think one of the things that is interesting from occupational therapy is, as I agree and certainly think about some of the research I’ve done, narratives are retrospective. But in terms of narrative reasoning in occupational therapy, there are, there is the retrospective. But then one of the aspects of narrative reasoning in occupational therapy, and I’m just wondering if this helps the students think about using scenarios in this way, is that part of it is also thinking about and recognizing and potentially even talking with clients about future stories: What’s my future story for you as a client, and what’s your future story? And recognizing how similar or different those might be and using that similarity and difference as a point of then continuing with the therapy process. Yeah, ‘cause, I think, yeah, it’s definitely, from research there is that retrospective, but it’s interesting thinking about future stories as well in that very minute context.

SCHILLACE: Mmhmm.

HANGANU-BRESCH: Yeah, I mean, I think there are echoes from the business world, business scenarios. But you call scenarios as static objects, which I love, which have a special purchase on the mindset of decision makers. And if you could tell us just very briefly what other contexts, I mean, you mentioned United European Gastroenterology that use scenarios to examine education priorities. And can you give us more examples of how scenarios have helped healthcare practitioners, decision makers to plan for the future?

FINCH: Yeah. With pleasure. I mean, very specifically, that UEG example from 2014 is really interesting because it really forced that zooming out to say, actually, gastroenterology is about agriculture, it’s about food supply chains, it’s about our way of life. It’s also about where healthcare happens, who is a health professional, who has the expertise. And so, it took something that seemed to be a question about skills, education, and career paths, and made it a question about the future of European society. But also within that, to remember that UEG, this organization, is itself a meta organization bringing together different bodies, membership bodies, so it becomes a place where organizations with slightly different agendas or remits can also come together. Similarly, in the Global Outbreak Alert and Research Network, which is a response network, which is affiliated to the World Health Organization, you have UNICEF, Médecins Sans Frontières, CDC, all kinds of organizations coming over the world to mobilize expertise in response to infectious disease outbreaks, which are beyond the capacity of any one nation to handle. So, obviously, strategizing in this way is actually, is a very complex, multi-stakeholder process with all kinds of different players involved with different liberties, different capacities, and different agendas. So, it’s not even so much about here are the different futures and how do we configure ourselves to face them? It’s also just simply it creates a space for us to talk, where players with different priorities and different power levels in a hierarchy can come together and talk.

What happened at GOARN was that they were able to set a set of themes and objectives for their four-year plan, because they’d looked many more years ahead. And what was interesting is that the scenarios were structured around the potential scope of what was defined as a public health emergency, like, would climate change really be accepted as a public health emergency in the same way that there’s the debate in the US about can things around gun law be brought into public health? And within different jurisdictions around the world, different things can be considered within scope. So, they explored scope, and then they explored whether international cooperation was harmonized or discordant. So, it wasn’t simply saying which infectious disease will play out in which context? Will the permafrost melt and give us novel infectious diseases? It was also about how does the world work? And it becomes a place where we can talk differently about the things that are often only in the edge of our vision, as well as being a creative experience.

SCHILLACE: I think what’s amazing about this is how systemic it really is, because of course, we talk about this all the time in medical humanities, and I know Christina and I both, Christina, as an Associate Editor, sees papers about this as well, that health is systems and communities. It’s not a sort of singular separate thing. And so, I think that that’s really, I think, the power of something like this.

We’re starting to run close on our time, so—

HANGANU-BRESCH: I have one more, just one more.

SCHILLACE: Okay. One more question. Dive in. [laughs]

HANGANU-BRESCH: Which is, so our listeners can look at Matt’s blog for more ideas, and he has some links and a nice bibliography there. But if you guys have any last recommendations for our listeners and for Medical Humanities’ audience as to how to begin exploring this or maybe get involved in research or reading more about this, other than that, we would appreciate that.

SCHILLACE: Mmhmm.

MOLINEUX: I think one of the things for me, which I’ve realized over the years is just exposing yourself to different ways of understanding the human experience to be very broad and vague. And so, whether that’s movies or poetry or theater or whatever it is. But making a conscious effort to think about what that tells you, but perhaps in a different way about the thing you are interested, whether that is as a sociologist or whether that is as an occupational therapist. What can you see in Love Island or some of those crazy, Big Brother, for example? What are some of those things that you can learn and be deliberate in thinking about those things, but exposing yourself to a whole range of media approaches, experiences, to look out for them.

SCHILLACE: Mmhmm.

FINCH: And in that spirit, I guess most of the books are really referenced in the bibliography of the blog associated with this podcast. But NIOSH, the occupational health and safety institute, which is part of CDC, has an excellent YouTube series called Foresight Fridays, where they had a series of one-hour lectures from practitioners. So, people can find great books like Strategic Reframing, The Art of Strategic Conversation. I think they’re name checked in the blog. But also if you look on NIOSH’s YouTube channel, there’s some really good Foresight material from people like Rafael Ramírez, Cho Khong, some of the big names of the profession thinking very specifically about public health.

SCHILLACE: Foresight Fridays, is that what you said it was called?

FINCH: Yeah, I believe that was the name of the [inaudible].

SCHILLACE: Great. That’s fantastic.

HANGANU-BRESCH: Excellent. Thank you.

SCHILLACE: Thank you, guys, so much for being here and for being part of our conversations. It is just a joy to have these experiences and to have these chats, which again, is another means of meeting at the intersections, which is exactly what your blog and what all of this is about. Christina, thank you so much for bringing this to our public on our podcast. I think it’s been wonderful to have you leading it. And I just wanna say thanks to you all.

FINCH: Thank you for having me.

MOLINEUX: Thank you.

HANGANU-BRESCH: Mmhmm, bye.

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