By David Somekh
Ten years ago a group of us spent three days at a yacht haven, Nya Varvet, outside Gothenburg discussing the possibility of health, education and business in Europe working together to improve quality in healthcare.
A striking outcome of the discussions was our discovery of similar processes going on in all three sectors. In essence it was about a trend towards the abandonment of traditional values. In healthcare the notion of caring and compassion had been largely replaced by a preoccupation with risk management. In education, the Aristotelean principles of ‘liberal education’ and the love of knowledge have been side-lined by the notion of education as training for a career. Finally, in business, the concept of business adding value to society has been more or less abandoned in favour of a culture of triumphalism (‘greed is good’ plus machismo).
These conclusions left us with a dilemma; if the problem is society-wide, where do you start if you want to improve healthcare?
During the next two or three years, our thinking developed, influenced by the importing of scenarios thinking that looked at both the contextual and transactional spaces in which organisations operate. Some of us also had experience of studying long-term trends in thinking about transformational change in organisations, and we were also curious about the applicability of complexity science to social issues.
In 2012, prior to formally establishing the European Health Futures Forum(EHFF) we stated ‘It is widely recognized that financial pressures, shifting demographics and unsustainable delivery systems all dictate that there must be a substantial change in society’s adoption of health and healthcare in the very near future. What is also clear is that no-one is very sure how to do this. Following conversations with DG SANCO, the Oxford Futures Forum and numerous other private and governmental health concerns, it was felt that the development of a European Health Futures Forum (EHFF) could contribute to tackling this dilemma.’
At that time our Statement of purpose was ‘to create an open interactive forum, the philosophy of which is to seek out, process and exchange knowledge and information in real time that may either influence the future of health and healthcare in Europe and/or provide a better understanding of future possibilities in this area, including identifying likely threats to the viability of health systems.’
When we launched the organisation in March 2013 there were several strands to the philosophy and direction that underpinned our purpose which remain very much our position today. That knowledge sharing should always be on an open-source basis., with the potential to cross disciplinary boundaries and ultimately to engage citizens. Secondly, that we intended to promote a holistic view of health, as part of societal well-being and to focus on the potential for transformational change through health, education and business working together. Thirdly, that we would actively employ methods, techniques and expertise related to futures work, in harmony with the Foresight model, of horizon-scanning, debating and shaping the future of society.
After establishing the EHFF brand via setting up an active (although not yet interactive) website and participation in several large-scale European projects in the health sector EHFF had established a working model of potential influence, looking at four overlapping levers for change in healthcare: patient empowerment, meaningful implementation of eHealth, disruptive innovation and reform of healthcare professionals’ education.
As far as ‘walking the talk’ i.e. applying our principles to our own organisation, at the beginning of 2016 in the annual work-plan there was a section on ‘innovation’ which in retrospect looks to be quite prescient, given where our current thinking seems to be heading. We identified three strands:
a) changing the shape of the model – continued iteration of the growth process
b) working on the forum concept – we need a new communications programme (progress the ‘pull’ element – are we ready to progress beyond being a network of experts?) and;
c) working on the society interfaces – getting to health from outside of health (how might we do this?).
By the beginning of 2018, these ideas had morphed only slightly. The main planks of our strategy were seen as (1) repositioning EHFF to be less rooted in healthcare delivery and more ‘outward-looking’ or holistic; (2) further refining our ‘elevator pitch’, to help us communicate more effectively and to persuade potential sponsors, but as a sub-set of this theme, the need to enlarge and make more effective a diverse communication strategy and (3) to continue to be involved in a certain number of relevant projects, as ‘bread and butter’ activity to establish that we are not just a think-tank.
All well and good, but the purpose of this thought piece was in part to critically examine where we started and where we’ve gone without getting too bogged down in operational considerations. The key question to be addressed is – does our original purpose, as we defined it back in 2012, still apply?
Sean Conlan and I recently took the EHFF story to a weekend meeting of innovative thinkers (the Metaphorum conference – systems experts who use the ideas and techniques developed by the cyberneticist and systems expert Stafford Beer). We asked a group of them for their advice/reflections. We feel that we came away with three valuable ‘take-home’ messages. First, if you want to grow further, don’t think simply about aggregation. Put much more resource into forming links with like-minded organisations that are already out there. Second, following on from this, give thought to the purpose of the larger body that you would then help create. Third, focus down on your purpose, spell it out, make it more accessible.
Taking this as good advice, it allows us to return to the question, ‘if the problem is society-wide, where do you start if you want to improve healthcare?’. With the benefit of the last few years’ experience, I’d rephrase that now. ‘As the problem is society-wide, starting from healthcare, how can we start to change society?’
We’ve clearly recognised that for the approach we’ve adopted thus far, one size can’t fit all. What might interest and motivate professionals to work with us, can’t be the same as what would motivate the man or woman in the street. Rather than re-invent the wheel, finding proxy representation that we could negotiate on a win-win basis might well lead to a more sustainable form of operating. It still leaves open the question of the purpose and form of the larger body, but no doubt that would emerge.
At this moment, our purpose could be identified in terms of three corners of a triangle – empowerment – education – the environment. This is the virtuous triangle of societal change. You read it first here!
Another time, I’ll aim to spell out how these three vertices incorporate the different themes we’ve struggled with, wellness, innovation, ethics and social responsibility, community and relationships, quality, effective communication etc. For now, I’m out of space.