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					The Foresight Process in Practice



            Authors: Dr. David Stewart
                  Brandi Green

  Vector Aerospace Chair of Irish Business Studies
               Memorial University




                                                     July 23, 2004
                                                   Table of Contents



WHAT IS FORESIGHT? ................................................................................................... 3
THE FORESIGHT PROCESS ............................................................................................ 4
WHO DOES THE SCOPING? ........................................................................................... 5
       Table of Critical Aspects of Foresight .................................................................................. 6

1. THE STARTING POINT ............................................................................................... 6
2. POLICY MILIEU AND SOCIO-ECONOMIC CULTURE ............................................ 6
3. TARGET AUDIENCE ..................................................................................................... 6
4. DESIRED OUTCOMES ................................................................................................. 7
5. RESOURCES.................................................................................................................. 7
6. COVERAGE .................................................................................................................... 8
7. TIME HORIZON ........................................................................................................... 8
8. FORESIGHT METHODS ............................................................................................... 8
   ENVIRONMENTAL SCANNING ..................................................................................................... 8
   THE DELPHI SURVEY TECHNIQUE ............................................................................................... 9
   CROSS-IMPACT ANALYSIS ........................................................................................................ 9
   TREND ANALYSIS ................................................................................................................. 10
   SCENARIO ANALYSIS............................................................................................................. 10
9. PARTICIPATION........................................................................................................ 11
10. ORGANISATION AND MANAGEMENT ................................................................. 11
   10.1 THE STEERING COMMITTEE: ........................................................................................... 11
   10.2 THE MANAGEMENT TEAM: .............................................................................................. 11
   10.3 EXPERT PANELS: .......................................................................................................... 12
11. OUTPUTS .................................................................................................................. 12
12. POLICY INTERVENTION........................................................................................ 12
REFERENCES .................................................................................................................. 13
APPENDIX 1: SCENARIO BUILDING ......................................................................... 14
APPENDIX 2: UNIDO FISHERIES FORESIGHT ........................................................ 20
APPENDIX 3. MALTESE EXPERIENCE WITH FORESIGHT ..................................... 23
What is Foresight?

Foresight is a unique approach to devising policy, either in the public or private arenas. It
probably originated in Asia, and was used extensively by the Japanese in the seventies. Since
then, it has become the methodology of choice in the EU, and in many other areas of the world.
For example, it has been used by Ireland, the UK, the Czech Republic, Malta, Venezuela,
Columbia, New Zealand to name a few disciples of the approach.

Foresight is extremely flexible and can be used by:
     Developed or developing countries;
     nations or regions within nations;
     cities;
     public or private organisations.

While many Foresight studies concern technology and innovation, it can also be used for social
issues, such as how to deal with ageing populations, or how to coordinate the distribution
strategies for the fisheries of neighbouring countries. In fact, even Foresight studies concerning
technology have focused more and more upon the impact of technology upon Society.

As Foresight can be used in many contexts, it is not surprising to learn that it has many uses. It
can be used by policy makers to:

       set priorities;
       re-design/create a Science and Innovation System for a nation or a region;
       bring new stakeholders into a discussion;
       create enduring networks that last beyond the life of the Foresight exercise;
       create supranational networks amongst nations;
       plan for the future.

Before describing the process of Foresight, it is appropriate to examine how Foresight exercises
have evolved over the last few decades.

Why have so many governments initiated Foresight exercises since the middle of the nineties?
There are undoubtedly many contributing factors. However, the following two reasons are
derived from the needs of policy makers. Firstly, many issues if left to themselves will not get
resolved in a favourable manner. In some situations, a laissez-faire attitude on the part of
government, or leaving the problem for the market to solve, will only make the situation worse.
For example, most firms will not fund basic research and yet many innovations flow from this. So
there is a need for some form of government initiative to ensure that basic research is
conducted. Similarly, leaving a growing crime problem to resolve itself through the actions of
individuals, is not desirable. Again, there is a need for government intervention to devise a
strategy for dealing with either the current or a future situation with respect to crime.

The second reason that has contributed to the growth of Foresight is that many systems simply
do not work properly or efficiently. This can happen because of inadequate linkages amongst
people/organisations in the system; or because the system simply has outlived its usefulness and
needs to be updated. Many nations see this type of situation erupting in their Health systems.

In summary, Foresight exercises can deal with these situations. It is a useful way for government
to intervene but still collaborate with other stakeholders. Similarly, Foresight provides a forum for
bringing together the various participants in a system, and assisting them to understand how the
whole should operate.
Since Foresight arose out of concerns over technology and innovation, its history is defined by
changes in how to deal with these issues. Some Foresight experts have suggested that there
have been three generations of Foresight. The first generation of Foresight projects were purely
concerned with technology, as in the case of energy. The short-sightedness of these projects led
to a failure to predict the energy crises of the 70’s and 80’s. The second generation of Foresight
broadened the scope to include aspects of relevant markets, so that commercial feasibility and
future energy needs could be drawn into the exercises. The third generation again broadens the
scope of Foresight to include social aspects such as the impact of certain technologies upon
Society or portions of Society. As Foresight has evolved through these phases, the nature of the
participants has changed. First generation projects tended to be rather exclusive, concerning
experts, usually of a technical variety. In the second generation, the participant list was
broadened to include different types of expert—academe and industry. The third generation
studies broadened once again to include various stakeholder groups representing aspects of
Society. Amongst these third stage studies we see examples of Foresight exercises performed on
Crime Prevention, and upon the effects of Ageing Populations.

The Foresight Process

In this section we are concerned with determining how a particular Foresight exercise is
organised and administered. There are many ways that Foresight can be structured. The
following is one of the more common structures. Issues such as :

       What are feasible objectives for the Foresight exercise?
       Who should be included in the exercise?
       What methods shall we use?
       What are our expected outputs and outcomes?

are discussed. Keenan and Miles (2004) have called this phase Scoping the Foresight exercise.
During scoping the Foresight exercise is designed and its implementation organised. During this
phase several different Foresight options will be considered. This can be eased by researching
what others have done. For example, should scenarios be used, or should a Delphi survey be
used? Shall we invite wider participation by designing a web site for the Foresight exercise and
inviting various parties to respond via the site?
We may even decide to pilot a Foresight study during scoping, just to see what problems could
arise. The end result of scoping is that a plan or blueprint for the Foresight exercise is produced.

K and M (2004) indicate that there are three main tasks in scoping. Firstly, the Foresight
champion should research the various approaches that are available, and whether anyone else
has conducted similar exercises. This may involve investigating the activities of other countries
because Foresight has become a truly international exercise. In many instances this can be
handled through desk research. Secondly, the Foresight champion needs to consult widely with
others who have implemented/been involved in Foresight exercises. Essentially, one is trying to
tap into previous experience with Foresight. In addition, during this second task, the consultation
should be broadened to include the types of individuals who are likely to be involved in your
Foresight exercise. Here one is trying to gauge interest and buy-in to the Foresight exercise.
Thirdly, and finally, a report of the scoping activity has to be prepared. A typical structure of this
report is:

    1. Background to the Problem/Issues
    2. Rationale for using Foresight
    3. Present a list of options for conducting Foresight (or a preferred structure if one can be
       determined at this stage)1

Who Does the Scoping?

Normally scoping is led by the Foresight champion, or by consultants who are commissioned by
the main sponsor of the Foresight exercise. So, if a government department wished to run a
foresight exercise, it may hire a consulting firm, or an academic to scope out the project.

Keenan and Miles (2004) suggest that there are 12 elements that influence the scoping plan. The
twelve elements are listed in the table below. Most of the elements on the left hand side of the
table represent factors that are normally pre-determined, whereas those on the right can be
influenced by those designing the Foresight exercise. Each of the 12 elements is discussed below.




1
 Keenan and Miles recommend that 3 – 4 Foresight options should be presented for consideration so that
participants feel that they have had a say in the structure of the project.
Table of Critical Aspects of Foresight

Conditioners                                         Modulators
Starting Point                                       Methods
Desired outcomes                                     Outputs
Target Audience                                      Coverage
Policy Milieu                                        Organisation & Management
Resources                                            Time Horizon
                                                     Participation
                                                     Policy Intervention
(Abstracted from Keenan and Miles (2004))


1. The Starting Point


The Starting Point of a Foresight exercise refers to the level of the exercise, often this is national.
However, more recently sub-national exercises have been conducted in, for example, the BMW
areas of Ireland, and in Catalonia, Spain. The sponsor of the Foresight exercise usually
determines the Starting Point. Consequently, if a department of the provincial government
sponsored a study---the Starting Point would be the Province. Similarly, if a trade or professional
association such as NATI sponsored a Foresight project the Starting Point might be the ICT
industry.

2. Policy Milieu and Socio-Economic Culture


As mentioned earlier, through time, Foresight exercises have become broader, encompassing
different types of stakeholder. The prevailing political and/or economic situation can influence the
design of a Foresight exercise. For example, in the case of Ireland, policy makers observed that
their future ability to attract inward FDI would likely be affected by a variety of factors, largely
outside their control. These included increasing costs of doing business in Ireland (particularly
Dublin), and the competitive terms offered by some of the 10 accession countries which wished
to join the EU. These environmental factors, together with others, not only inspired the Irish
government to initiate a national Foresight exercise, but also shaped the nature of the exercise
by focusing it upon the impact of future trends in technology within particular economic sectors,
such as biotechnology and IT. In the Irish case, the Foresight process was probably made easier
by the embedded culture of cooperation in Ireland, through its history of Social Partnerships. The
danger of a cooperative culture like this is complacency. In such instances Foresight should
attempt to shock stakeholders out of their comfortable milieu. The use of scenarios can be
effective in these circumstances, and this was one of the methodologies used in the Irish project.

3. Target Audience


Experience with Foresight exercises has shown that the involvement of prominent individuals
from various stakeholder groups is likely to produce outputs that have greater impact upon policy
making. Similarly, the more widely publicised the exercise the greater the likely impact upon
future policy. Two additional aspects are related to this point. While it may be difficult to get
prominent individuals to contribute regularly to the Foresight process, say in the panels, it may
be feasible to involve such individuals in a Steering Committee for the project. The Steering
Committee can be used to generate a profile for the activity. Secondly, Foresight panels require a
Chair and a Technical Secretary(TS). The function of the former is obvious, while the latter’s task
is to organise meetings, set agendas, and ensure that appropriate materials are available for
meetings. The TS is often a full-time position, while the Chair is part-time. The choice of the
Chair is critical and is usually an individual with experience and credibility in the subject matter.

Apart from the actual Foresight panel or group, web sites and conferences may be used to
attract input from wider audiences. Related to this, some Foresight exercises involve the Media
at various stages in order to ensure exposure. In some cases, members of the Media have been
included in a Foresight panel. More recently, and pioneered in Latin America, on-line tools have
been used for Foresight activities to bring together individuals from distant areas, and those that
cannot afford to travel to central locations.

4. Desired Outcomes


As might be imaged, there can be a broad range of desired outcomes from a Foresight exercise.
Some of these are listed below:

        Developing a regional supply chain for fisheries in four South American countries;
        Generating an image for region;
        Isolating key technologies within particular industries and developing policies to ensure
         their development;
        Guiding the transition of the economies of several Eastern European countries to meet
         EU membership requirements;
        Tackling issues related to an ageing population.


In addition, Foresight exercises often have objectives beyond the immediate concern, such as
those listed above. There may be intent to diffuse Foresight thinking within the organisations of
the panel members.

5. Resources

The nature of a Foresight exercise is shaped by available resources. From a financial perspective
the direct costs are borne by the Sponsor, which may be a government department, or a trade
union or trade association. Sources of cost include:

    1.   The management team;
    2.   Organisation of meetings, conferences etc
    3.   The production of necessary materials and the distribution of it
    4.   Any required surveys
    5.   Use of consultants and facilitators.

Consulting costs include the use of facilitators to promote discussion within panels; the use of
specialists to frame scenarios. Finally, specialists in the use of Delphi surveys of experts may be
needed.

Normally participants in the Foresight panels give their time freely, which can be a substantial
commitment. For example, the Irish Foresight exercise lasted for a year and involved around 5-7
meetings per panel over that time.

A resource that is often ignored but is, in fact crucial, is the level of political support given to the
exercise. Upon occasion, rivalry amongst government departments can derail a Foresight
exercise. Positioning the exercise near the centre of government is one method of ameliorating
this. In the Irish exercise, Foresight was organised through Forfas, the policy advisory board to
government.

6. Coverage

While Foresight has been embraced enthusiastically by many countries, there is a danger that
expectations will be set too high for the outcomes of the exercise. Foresight delivers less than
useful results, or even breaks down entirely if the panels are set too ambitious an agenda.
Setting realistic objectives for a Foresight project is usually the subject of discussion between the
various stakeholders that will be represented in the exercise. The intensity of coverage is
associated with the number of panels created. It may be politic to give each say two or three
main issues to tackle, even at the expense of generating a higher number of panels. Typical
structures that have been used are:

       Limiting panels to covering a particular economic sector;
       Limiting panels by the tasks that they complete, e.g. one panel may identify the key
        driving forces, and future trends for an industry. Another panel may use this information
        to develop scenarios of the future.
       Sectoral panels may be used to feed results into a Super-panel that looks for
        commonality across all sectors.

7. Time Horizon

One of the virtues of Foresight is that it takes a very long term view of a situation. In Foresight,
the future is not just 5 years away, it is far more distant than that ---- typically 10, 15, 20 years
hence. This has the advantage of freeing individuals from pursuing a personal agenda. It also
shakes business people out of their strategic planning mode (based upon a 5 year cycle). This
long term perspective is both an advantage and a disadvantage for Foresight exercises.
Advantages have already been cited --- it lessens conflict because individuals are freed from their
own agendas. In addition, structural change often comes incrementally, rather than in a single
act. Hence, planning long term incremental change is facilitated through Foresight.

Some participants may see the long time horizon as indicative that the exercise is meaningless,
since they wish to act now rather than in 10, 15 or 20 years time. However, the Foresight
champion should be able to overcome this obstacle by indicating that Foresight is used to think
about possible futures, so that we can devise strategies TODAY to move towards desirable
futures.

8. Foresight Methods

There are many methods used within Foresight panels. These range from quantitative to
qualitative methods. Some of the more common ones are described briefly in the next section of
this report.




Environmental Scanning

Environmental Scanning is usually conducted at the beginning of a foresight study and is
considered to be a pre-requisite to any foresight studies. Environmental scanning involves
analysing major trends, issues, innovations, events and ideas in the general environment. The
purpose of environmental scanning is to gather information that will aid decision makers in
situations where uncertainty is high.
Policymakers and planners use environmental scanning to gather information on the general
environment inside and outside their area of interest. Proficient scanning ―has the value of
sharpening observation and analytical skills while providing opportunities to hone discrimination,
judgement and expression.‖

The Delphi Survey Technique

The Delphi Survey Technique is a popular method used in foresight and other futures studies. It
involves a panel of experts that judge the timing, probability, importance and implications of
factors, trends, and events regarding the problem in question. There are eight steps to the Delphi
method:2

    1. The specification of some topic or subject whose possible, probable, and preferable
       futures are to be investigated.
    2. The construction of a questionnaire as an instrument of data collection.
    3. The selection of some individuals (respondents) whose opinions are to be studied,
       usually experts on the topic.
    4. The initial measurement of the opinions of the respondents by means of a questionnaire.
    5. The preliminary organisation and summary of the data resulting from the initial
       measurement.
    6. The communication of the results of the initial measurement of opinions as feedback to
       all the respondents.
    7. A re-measurement of the opinions of the respondents as they have been informed and
       may have been changed by their knowledge of earlier results including those of other
       respondents supporting comments for their opinions.
    8. An analysis, interpretation and presentation of the data and the writing of the final
       report.

A common mistake is to use Delphi to come up with answers; Delphi does not generate answers
but simply responses. It produces judgements or estimates of probabilities, rather than objective
or factual information. Hence, the Delphi Technique is best used as an input to a larger
forecasting and futures process. Countries like Germany and the UK used the Delphi technique
when they conducted their Foresight exercises.

Cross-impact Analysis

Cross-impact analysis is often thought of as an extension of the Delphi technique. Like its name
entails, it involves identifying and evaluating the impact of trends or events upon each other.
Cross-impact analysis is commonly used as part of an expert-opinion study, which is why it can
be considered part of the Delphi technique. It is useful in exploring a hypothesis and in finding
points of agreement and divergence.

Cross-impact analysis involves constructing a matrix to show the interdependencies of different
events. A matrix lists the set of events or trends that may occur along the rows, and the events
or trends that would possibly be affected by the row events along the columns. Respondents are
then required to assess how the occurrences in each of the rows affects the probability of the
event in the corresponding column. The person analysing the results can average the responses
to generate a summary; this summary is known as a cross-impact analysis.


2
 Ratcliffe, John. “The Creation of a Built Environment Futures Academy: A Scoping Study.” Dublin Institute of
Technology.
Trend Analysis

Trend analysis, also known as trend extrapolation, is another method used in forecasting. Trends
can be measured quantitatively or qualitatively. Quantitative trend analysis deals mostly with
data as opposed to information. Statistics pertaining to the subject are gathered and plotted
along a time axis to produce a curve, which can be extrapolated into the future. Of course, the
further in time the extrapolation, the greater the uncertainty of the event happening. This kind of
trend analysis is normally used to draw attention to the forces that could change the extrapolated
pattern. More sophisticated analysis (eg. time series analysis) can be used to try to reveal
different patterns.

Qualitative trend analysis is one of the most challenging and creative aspects of futures research.
Identifying and characterising a trend involves observing the trend to some extent and involves
some creativity. The point of qualitative trend analysis is to identify the trend early.

It is worth noting that no matter how long is spent analysing and projecting trends, there is no
guarantee that the trend, or variable, will continue the way it was in the past.

Scenario Analysis

Scenario analysis is perhaps the most popular and widely used method in futures studies and
foresighting. Policymakers, corporate strategists and military analysts have long used scenarios to
assist in decision making. Scenario analysis is a process of analysing possible future events by
considering alternative possible outcomes or scenarios. Scenarios are like sets of stories built
around carefully constructed plots, but they follow systematic and recognisable phases. The Irish
used scenarios in their foresight exercise and in Canada, the Ontario Hospital Association used
scenarios to determine hospital planning. Please see appendix ? for an example of the scenario
planning process in Ontario.

The following diagram illustrates the scenario process:


                                     Set the Strategic Question




                                 Identify Driving Forces of Change




                               Determine the Main Issues and Trends




                                  Clarify their Level of Impact and
                                        Degree of Uncertainty



                                     Create Different Scenarios
                                 Test Policy Options Against Scenarios
                                         and visions of Future



                                 Test Policy Options Against Scenarios
                                         and Visions of Future



                                             Agree Priorities




9. Participation

Participation is conditioned by the scale of the Foresight exercise---i.e. whether it is national,
regional, sectoral, theme oriented, or a company exercise (see the Daimler-Chrysler example in
the Appendix).

Selecting participants is a fine balancing act between ensuring representative and avoiding
unmanageable conflicts. In practical terms, some form of stakeholder analysis should be
performed3. A simple rule of thumb is to use a filtering process to determine participants—
starting broad by listing organisations that have some level of interest in the issue, and then
identifying individuals within those organisations. Progressively, organisations and individuals can
be eliminated after consideration of each organisation’s interest in the issue, and personal
characteristics of individuals. In the ideal, we are trying to identify individuals who are open-
minded, and able to think beyond the perspective of their own organisation.

10. Organisation and Management

Suggested organisational structures for Foresight exercises are presented in the case studies in
the appendices. Typical entities that are involved in a Foresight exercise include:

10.1 The Steering Committee:
       Acts like a board of directors for the project, approving goals, methodology and
        reviewing interim and final reports.
       Often a figurehead, performing promotional activities for the exercise.
       Comprised of ―high profile‖ individuals.

10.2 The Management Team:

This group look after the day-to-day operation of the project. Their duties include:

       organising meetings/workshops;
       supplying materials to participants for meetings;
       hiring that reports are prepared and fed back to the Steering Committee.

3
 An excellent overview of Stakeholder analysis is available from the webpage of Dr R. Sexty’s, Faculty of
Business, Memorial University at : http://www.ucs.mun.ca/~rsexty/business8107/StakeholderRelations.htm
10.3 Expert Panels:

These are the working groups of the Foresight exercise, consisting of representatives from the
various types of stakeholder.

11. Outputs

Foresight practitioners now generally agree that the output from a Foresight exercise can be
divided into two categories: products and processes.

An exercise may produce both types of output. ―Products‖ are tangible outputs, such as reports,
scenarios, a list of priorities, or a report on a Delphi survey.

―Process‖ output, on the other hand, is more intangible and includes the networks established by
the Foresight exercise. Some participants in Foresight see value in maintaining a network after
the exercise is over. These intangible outputs have led to the creation of Foresight units within
government. The EU has established the DG Research Unit which specialises in Foresight studies
and promoting the use of this methodology.

Similarly, participants may return to their organisations and initiate Foresight studies there.

12. Policy Intervention

Since much of the output from Foresight studies involves information about the future, it is
difficult to judge the success of policies derived, at least in part, from these exercises. Certainly,
panel members become increasingly concerned about what will become of their findings as the
Foresight exercise unfolds. Creating a Foresight culture depends upon participants seeing that at
least some of the output from an exercise leads to action on the part of the project sponsor. It
needs to be established at the outset of a Foresight project which aspects will be impacted by the
exercise. For example, during the second phase of the UK Foresight exercise, 11 sectoral panels
and three thematic panels were formed. All panels were asked to consider the implications of
their findings in the areas of:
      education
      skills and training
      sustainable development

Presumably, the UK government expected the Foresight process to yield information that would
impact policy in each of these areas.

Another example of the impact of Foresight on policy development can be seen with the Irish
Technology Foresight exercise of the late nineties. Here eight sectoral panels were formed and
asked to deliver the following outputs:

       a list of recommendations;
       strategic technologies relevant to the sector, and
       policies to be implemented in order to achieve these recommendations.

Some aspects of the policy recommendations for each sector were implemented over a period of
time, however more critically was the influence that all eight reports had on government policy.
The Science Foundation of Ireland was established as a result of the Foresight exercise and
considerable sums of funding was made available for targeted developments in ICT and
Biotechnology.
References

Ratcliffe, John. ―The Creation of a Built Environment Futures Academy: A Scoping
        Study.” Faculty of the Built Environment, Dublin Institute of Technology.
Appendix 1: Scenario Building
Alternative Paths for Ontario Hospitals



Background

Over the past 100 years, Ontario hospitals have been, and are perceived by the public to be
amongst the most important of Ontario's social institutions. Spending on hospitals is one of the
largest items in the Ontario budget, and it is also the largest item of the Ontario public health
expenditure. Given the importance of hospitals, the Ontario Hospital Association (OHA) decided
to focus on the long term and begin to address the question of whether the current hospital
restructuring would adequately position the hospital sector for the future.

In 1999, the OHA commissioned a review of the existing hospital restructuring plan in order to
determine if this restructuring would put Ontario hospitals in a position for future success. Two
reports were produced - one of which presented a current analysis of progress and outcomes
while the other report covered restructuring from a future perspective using scenario planning.
The first report found that government focused too much on short-term solutions for hospital
restructuring and that there was no long-term plan. As a result of this, the second report
aforementioned was presented, entitled Alternative Paths for Ontario Hospitals. This study was a
Foresight exercise based upon scenario planning designed to identify alternative options for
hospital development.

Objective

The primary objective of the study was to ensure that money invested in restructuring today
would contribute to the success of the hospital sector in the next 25 years (the period of time it
would take for the funds to amortize).

What Scenario Planning Can Accomplish

Scenario planning is useful in determining which courses of action to take today in order to be
prepared for the future. It can assist in key strategic decisions such as:

       Whether to invest or pull back;
       Whether to engage or disengage in particular businesses or services;
       Understanding how today’s decisions impact on the future.

The scenario method enables organisations to consider the future environment based upon what
we know of current trends in macro-forces; changing attitudes and other influences. At the core
of scenario planning is the idea that the larger forces of society will ultimately determine a
society’s organisations and systems. Consideration of scenarios also permits a determination of
the actions and influences that must happen today in order for the scenario to become a reality
in the future.



Who is Involved

In the case of the Ontario Hospitals, the Change Foundation, commissioned by the OHA, was
responsible for the overall organisation and direction of the study. The Change Foundation acted
as the Steering Committee in this case (see Figure 1 for Organisational Structure). The Change
Foundation enlisted a specialist to create the framework of variables for consideration in each of
the scenarios.

Two expert panels were involved in the scenario building process. The first group of experts,
including health care providers, policy analysts and academics, determined the most important
drivers of change to health, health care, and hospitals. The second panel, consisting of four
experts, was then asked to use the framework developed by the scenario specialist to create four
specific scenarios. Once the scenarios were developed, the research team and the first group of
experts developed five strategies based on the future scenarios. Senior staff and board members
from ten hospitals participated in the workshops. The workshops were facilitated by the research
team and by two consultants, one of whom had sat on the expert panel and had also participated
with the research team in the first workshops.

                                Figure 1: Organisational Structure

                                       Ontario Hospital
                                        Association




                                    The Change Foundation
                                   (The Steering Committee)




                                       Research Team




            Expert          Expert                        10 Ontario Hospitals
            Panel 1         Panel 2



Scenario Building

Identifying Drivers of Change

Nine drivers of change were identified by the research team (at the Change Foundation) and
each driver was evaluated on the basis of its (1) importance to health, health care and hospitals,
and (2) the level of uncertainty. If a particular event is certain to happen, then there would be
no need to conduct a scenario about the possibility of it happening; the more uncertain and
important an outcome is, the greater its impact will be on developing strategies. Therefore, only
those drivers that are more important and about which we are uncertain about their influence
were used in setting up the scenarios. These are known as the key drivers of change or scenario
logics. In the Hospital study, these included: (1) consumer attitudes and behaviours, (2) science
and technology, (3) information technology, and (4) the environment.

Because consumer attitudes and behaviours are susceptible to change, the range and types of
services and products made available in the healthcare system is also subject to change.
According to research conducted by the Change Foundation, health was ranked by Ontarians as
their first or second issue of importance. Consequently, it was concluded that consumers were
both highly interested in healthcare and were concerned about it.

Science and technology can be a direct driver of change within healthcare. Hospitals are early
adopters of research and technology given their link to academic health science centres.

Information technology was seen to be accelerating consumers’ interest in health and healthcare
and to also increasing their overall sense of control in these areas. Consumers can find a plethora
of information on the Internet about disease, wellness and other health issues. Consequently, IT
was seen as a key driver in shaping health and health care.

Environmental factors (eg. lifestyle, state of the economy) are an area of extreme uncertainty.
Further, it was expected that the environment will greatly affect health and healthcare in the
future.

After identifying the key drivers of change, each of the four factors were analysed from both
sides of the spectrum, as can be seen below:

                Consumers’ Attitudes: Free market – Protected public sector
                Science and Technology : Scientific orientation – Subjective orientation
                Information Technology: Health – Healthcare
                Environmental: Stable environment – Environmental breakdown

Four scenarios for 25 years in the future were constructed based on the dichotomies of the axes.
Typically, three to four scenarios are the norm.

Please refer to Figure 2 for an overview of Ontario Hospital’s Scenario Building Process.

Brief Summary of Future Scenarios

Each expert in the four-expert panel developed a scenario based on the scenario logics from the
previous section. The titles and descriptions of the scenarios are listed below. The scenario
descriptions in this paper are rather brief; typically, scenarios are several pages in length.

Healthy Communities in 2025
In this scenario, variables such as health, a strong public sector, incremental innovation and a
stable environment are used to create a possible future. There are fewer hospitals and hospital
beds because the family and the community have assumed responsibility for the care of children,
the aged and the ill. There is collaboration between general practitioners and nutritionists,
exercise coaches, alternative therapists, and others in publicly funded clinics

The Market Rules in 2025
Variables such as healthcare, a free market orientation, a high rate of scientific invention and an
unstable environment are developed in this scenario. Consumer choice and control expand along
with increased markets for healthcare services and products. As the market for healthcare has
become global, hospitals often sell their services to American insurers and individuals. Wealth is
increased overall, but the distribution of wealth is quite concentrated. Government does not have
much control over the environment and consequently environmentally related disease and
disability grow in importance.

Science Rules in 2025
In this scenario the variables of health and healthcare, public orientation, scientific values,
continuous improvements through scientific breakthrough and an improved and stable
environment are investigated. Science has become an important, respected part of everyone’s
life. Basic scientific research has become a top spending priority for government. Healthcare
products and services are narrowed down to only those that are scientifically effective. Air and
water quality is greatly improved. People are healthier and living longer.

Blade Runner – Economic Decline and/or Environmental Catastrophe
The main variables in this scenario are healthcare, central control, science and environmental
decline. In this scenario the healthcare focus is on emergency care. Energy costs are high and
supply is becoming more difficult because of lack of political will and the deterioration of
infrastructure. Many crops and businesses are failing. Basic and essential healthcare to save lives
has become the priority. Services and products are provided at the minimum level.

Strategies

From the scenarios, the expert panel and research team developed five ideas for future hospital
enterprises: ―Reformed Cathedral‖, ―Focus Factory‖, ―Health Mall‖, ―Broker‖, and ―Fire Station‖.
Each of these enterprises has a strong focus on the key drivers of change, these being consumer
attitudes and beliefs, science and technology, information technology and the environment.

―Reformed Cathedral‖
This system sees the hospital at the centre of the health care system with satellite facilities such
as clinics, home health care facilities, long-term care facilities, long-term care facilities and
mental health care facilities placed around the hospital. The hospital would be the keeper of
knowledge, skill and ability, sending out its expertise into the community through its satellite
facilities.

This type of organisation works well under the Healthy Communities Scenario, Science Rules
Scenario and Blade Runner (Economic Decline) Scenario.

―Focus Factory‖
This option transforms the current generalist hospital structure to a speciality enterprise. The
organisation’s main advantage is its leading edge R&D for continuous improvement of its
products and services. Like a factory, the focus is on product line and production. Volume is a
driving force because the more cases performed the more efficient the factory is in terms of
expertise, experience, and cost.

The Focus Factory could respond to the Healthy Communities Scenario, Market Rules Scenario,
and Science Rules Scenario.

―Health Mall‖
The Health Mall provides ―one-stop shopping‖ for health and health care services. These include
both publicly insured programs as well as those funded through private insurance or payment.
Hospitals act as the anchor (similar to a department store in a retail mall), attracting customers
and offering a variety of services and products.

The Health Mall is a viable option for the Healthy Communities Scenario and Market Rules
Scenario

―Broker‖
The Broker is a referral network of service providers and consumers, with knowledge and
connectivity as its main products. It is a virtual mall of e-health services. The goal of this
enterprise is to connect consumers with the best health care service for their needs and with a
provider of this service.

This enterprise works well with the Market Rules Scenario, the Science Rules Scenario and the
Blade Runner Scenario.

―Fire Station‖
This enterprise is a model whose main focus is response to urgent or emergency need for care.
Response teams within the organization are always prepared and waiting for the emergency or
urgent cases. Consumers in this model are not proactive or focused on prevention and they have
less control over the health care provided.

This organisation fits with the Blade Runner Scenario and is also compatible with the Science
Rules Scenario.

Results

Each of the ten hospitals reviewed the key drivers of change from their perspective and
considered how they would respond to each of the four scenarios. They selected what they
would continue to do, what they would discontinue and then considered the opportunities and
the implications for infrastructure, services, and human resources (eg. the type of physicians
required). In addition, the hospitals reviewed the strategies to see what opportunities and risks
each would pose for the hospital. The most desired strategy was believed to be the one that
could succeed for as many scenarios as possible.

Strategies emerged from the workshop that would have been previously inconceivable such as
partnering with a perceived rival, closing emergency services, and building a health mall in
tandem with a focus factory. The Reformed Cathedral and the Health Mall were avenues that
hospitals felt they could explore for additional hospital revenue and to supplement their insured
services. Hospital participants rated the scenarios as an extremely effective tool for setting
hospital directions for the future.

The Change Foundation is continuing to monitor the impact of the report and workshops for the
next three to five years.

Sources

Murray, Gale. 2002. Alternative Future Paths for Ontario Hospitals: An Exercise in
        Scenario Planning. Conference paper on Organisational Behaviour in Health Care at Said
        Business School, Oxford, UK. 4




4
 This paper can be viewed at:
http://www.changefoundation.com/tcf/TCFBul.nsf/e0f92439bd3e9bb6852565e500033ec6/30fe8bc2191f88
a085256ebc005441db/$FILE/Oxford.pdf.
  Figure 2: Process Overview


                                          Trends

Consumer Attitudes                                                     Environment
 and Behaviours
                                 Drivers of Change                       Government

Socio Demographic
                                                                          Economy


                   Values       Science &       Work and the     Information
                               Technology        Nature of       Technology
                                                   Work


                            Key Drivers for Health Care


   Consumer Attitudes        Science &             Information           Environment
    and Behaviours          Technology             Technology




                                         Scenarios



                Healthy         Market            Science           Blade
              Communities       Rules              Rules           Runner




  Reformed                                                                        Fire
  Cathedral                              Strategies                              Station



              Broker                     Focus Factory                    Mall
Appendix 2: UNIDO Fisheries Foresight
Foresight Study on the Productive Chain of the Fishing Industry in the Region of the
South American Pacific Coast


May 2004 saw the beginning of a supranational Foresight initiative in the fishing industry for four
South American countries: Chile, Columbia, Ecuador and Peru. These countries, in cooperation
with UNIDO and the Spanish government, are conducting a year long Foresight exercise to:

             Develop a basic framework and identify linkages for their fisheries productive chain;

            Analyse the respective value chains in the target countries, including the extraction of
         resources, food processing, markets, etc.; and

               Design scenarios for the productive chain in the South American fishing industry

Once scenarios have been developed, panels of experts in each country will use them to identify
the technological and economic challenges faced by the country, and, through consultation, will
identify the critical issues for the development of the fisheries sector. Once the scenarios are
completed, each country will conduct their own foresight exercise using these scenarios to
develop their own strategies.



                                                               Background
                                                               Three of the countries have limited
      Columbia
                                                               local demand for seafood products and
                                                               all four rely heavily on exporting, which
 Ecuador                                                       is similar to the situation in the Atlantic
                                                               Provinces.

                                                               Chile, Ecuador and Peru would like to
        Peru
                                                               upgrade the quality and value of their
                                                               respective exported fish products, but
                                                               they face serious economic constraints.
                                                               Columbia on the other hand would like
             Chile
                                                               to develop its fishing industry but lacks
                                                               the capital to properly develop an
                                                               attractive aquaculture sector.




Source: http://www.yourchildlearns.com/south_america_map.htm



Currently, these countries are in competition with each other for the lucrative seafood export
market. However, by combining their efforts, costs such as marketing, distribution, and resource
management can be shared amongst the group, hopefully resulting in greater demand for fish
products from the group. The Foresight study will look at the possibility of collaboration between
the four South American countries to align their production facilities and enter into a consortium
to export their seafood.
Project Schedule (2004 – 2005)

May (first two weeks)         Assessment of the National Situations
                              This first phase involves assessing the current status of the
                              countries’ sector development. The production chain;
                              sustainability of the ecosystem; resources; market; food
                              processing, and value chain functions are all areas that will be
                              analysed. A SWOT analysis of the environment will also be
                              conducted.

June                          National Panel Meeting
                              The four national panels review the information based on the
                              assessment. The design of the future scenarios will take place
                              here, but they will be further developed at a Regional
                              Conference. The scenarios will take into consideration a variety
                              of different factors, such as economic, social, market,
                              technological, policy, enterprises, environmental etc.

July – October          Management Survey


September                     Regional Conference
                              This conference will include two intensive workshops on (i)
                              foresight methodology for regional productive chains and (ii)
                              scenario building. Participants will include the four national
                              coordinators, international experts from Spain and Brazil, and
                              representatives from UNIDO and foresight institute.
                              Identification of the possible future scenarios for the fisheries
                              sector in each region will be completed. A review of the
                              assessment of the national situation (completed in May) will be
                              presented to the audience.

November                      National Panel Meeting

January (2005)          National Reports

February                      Regional Panel Meeting

April                         Final Report
                              The final report will identify the strengths and weaknesses in the
                              region, critical issues for development, future technologies,
                              industrial development trends, markets, strategies, and decision-
                              making processes that will enhance the fishing industry for all
                              four countries.
     Figure 1: The Process of the South American Foresight Exercise


                           Analysis of the Basic
                            Productive Chain




SWOT analysis                     National                  National productive
    of the                      Diagnostics                    chains: fleets,
 environment                                                 industry, markets




                            Regional Situation




                     Regional Future Scenarios Panel




                          Regional Conference




                       National Foresight Studies




National             National                   National              National
Panel 1              Panel 2                    Panel 3               Panel 4




                                Consultations



                           Regional Panel and
                                Report
Appendix 3. Maltese Experience with Foresight

Overview
The following example illustrates that Foresight can be used effectively by a small country. While
Malta is involved in Foresight exercises at the EU level, it is its efforts at the national level that
are described here.

eFORESEE is a two-year project developed by the EU for smaller regions and countries to assist
policy makers who are involved in Foresight activities. The intent of eFORESEE is to examine the
strategic role of Foresight during the accession process (i.e. accession to the EU). Six pilot
projects have been agreed for three countries (Malta, Cyprus, Estonia) covering the following
themes:

         Knowledge Management Issues for Foresight and Related Policy Tools;
         Foresight in the development of Research and Technology Development Policy for the
          Applied Biosciences;
         Foresight as a Policy Development Tool for EU accession States.

As can be seen, Malta is one country that is taking part in the eFORESEE program. eFORESEE
activities in Malta are organized through the Malta Council for Science and Technology (MCST),
which hopes to create a national foresight culture. More specifically, the eFORESEE project has
the aim of developing sustainable public-private sector partnerships. It is anticipated that new
foresight methods and approaches will need to be developed to achieve this goal.

The following quote from the eForesee web site illustrates the intent of the program:

―The eForesee will create an open participative process of thinking, debating, consulting and
networking on alternative futures……A more ambitious aspect of this project is the launch of a
high level dialogue with other national strategic players. The aim is to provide a sounding board
for the development of common methodologies for national strategic planning and the
embedding of a national foresight culture.‖ 5

From this we can see that Malta intends to use Foresight as an important building block in
developing a national strategic plan. The country appears to have embraced Foresight
wholeheartedly. Apart from carrying out pilot studies in the following areas:

      1. Knowledge Futures and ICT in Education.
      2. Towards enhancing the Marine sector's contribution to the Maltese Economy in 2020,

it is intended to embed the Foresight approach in future planning.

The following is a summary of the Marine sector Foresight exercise.

Foresight in the Marine Sector

Objectives

The Maltese Foresight exercise in the Marine sector has the following broad aim:


5
    See eFORESEE in Malta, http://www.eforesee.info/malta/?s=86991192-7D4709170237-3CF
          To examine the future contribution that the Marine sector can make to the Maltese
           economy.

This aim will be achieved through examination of the following :

          The current contribution of the marine-related industries and services to the Maltese
           economy.
          How the various marine areas can be optimally and sustainably exploited through
           emerging science and technology by 2020.

The study is intended to provide the basis for establishing, both management and development
strategies in marine sectors, through the use of public-private partnerships and industry-
academia linkages.

The output of the project will feed into the development of a national Marine Science and
Technology strategy to identify the policy approaches and research investments that need to be
made. While the study will be overseen by the Malta Council for Science and Technology, it is
also endorsed by the Ministry for Rural Affairs and the Environment.

Methodology

 The Foresight exercise will be built around an expert Group. This group, together with other
stakeholders, will complete a survey to provide information on the following:

          the nature and extent of R&D initiatives that are conducted within local marine-related
           entities,
          the manpower and funding dedicated to such efforts,
          the relevance to current activities and potential for the future.

The survey will be broadly distributed amongst the following types of stakeholders: i) Academic
institutions; (ii) Marine-based industries/enterprises; (iii) Organisations/agencies/authorities with
marine-related responsibilities/activities6.

In addition to the main survey, information will be collected via two other sources. Firstly, a web
site has been designed to permit individuals to state their opinions/views on the key issues.
Secondly, an online form is available for individuals to complete and submit by either email or
fax, indicating any reports or studies that they are aware of that are relevant to the exercise.

Launching the Exercise

The Marine Foresight project was launched in May, 2003 by means of a one-day seminar
organized by the MCST. The seminar had the following objectives:

          to   describe the Foresight exercise;
          to   provide overviews of key marine sectors in the Maltese Economy;
          to   start consultation with key stakeholders;
          to   promote the project amongst the public.



6
    The questionnaire can be viewed at http://www.eforesee.info/malta/marine-research.doc.
The seminar was attended by representatives from key stakeholders in the marine sector,
particularly individuals holding key positions in public and private
organisations/agencies/institutions/departments with marine-related activities. This included:

          Representatives from Ministries relevant to marine affairs;
          Governmental agencies, and authorities;
          Leading marine scientists;
          Representatives of the marine research management community;
          Representatives of the marine industries and services sector;
          National Representatives to the EC related to the marine sector.

The Maltese Marine Foresight project is continuing throughout 2004.

Concluding Remarks

Malta has embraced Foresight and is moving rapidly to embed it in both the public and private
sectors. It is encouraging its use in the private sector for both large and small enterprises.
Specifically, it is intended to use Foresight in the following areas:

          To   prioritise research and technology development spending;
          To   improve the operation of the innovation system;
          To   improve the competitiveness of the Maltese Economy, generally;
          To   assist in social issues such as career development, and gender issues.

MCST is developing in-house Foresight methodological skills and is promoting it in the higher
education curriculum. An MCST Foresight Methodologies Team has been created to assist in the
launch of an MA course on Creativity and Innovation at the University of Malta to commence in
October 2004. The MA will include 4 credits on Foresight7.




7
    Details of the MA can be found at http://www.um.edu.mt/courses/ma_cr_inn.pdf

				
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