By Jonathan Peck
The Wing of Zock symbolizes hope for the future, so consider what your hopes are for the future of primary care. The Institute for Alternative Futures (IAF) prompted this consideration when we posted Primary Care 2025 scenarios that include two alternatives readers should like, one you should be dissatisfied with, and another you should be downright disturbed by. Why this approach?
There are so many variables interacting unpredictably inside and outside health care in ways that will shape primary care. We have to go beyond deterministic thinking that relies on cause-and-effect reasoning alone to predict the future, and instead adopt probabilistic thinking to assess the likelihood of different futures. Simply predicting one scenario makes us more vulnerable to being wrong and that also narrows our view of possibilities. So we presented national leaders who came together to explore the futures of primary care with the four very different futures. Then we asked them to assess their likelihood. The “expectable” future which should dissatisfy any Wing of Zock reader was assessed most likely of the four: 48 percent. The really disturbing scenario? Second most likely: 46 percent. The two scenarios for primary care that the national leaders really like appear less likely by their assessments: 30 percent and 25 percent.
Providing preferred scenarios along with an alternative “expectable future” and a “desperate scenario” creates a real tension in our minds. When we objectively assess what is likely, and subjectively assess what we like, the tension creates a spur to act. What we do should create a future we want rather than one we think we will get, so we link potential futures to behaviors through the creative tension. The psychology behind this dynamic tension was partially described by Jonathan Haidt in his book The Happiness Hypothesis, which notes, “Bad is stronger than good.”
Haidt argues that, if you were a fish, it would be important to make the stimulus for “bad predator” stronger than for “good food,” because you can skip a meal, but ignore that moray eel and you’re out of the gene pool. Similarly, when working with alternative scenarios, the “bad futures” are more readily engaged and are generally seen as more likely than aspirational futures. When we consider the differences in likelihood objectively and the likability subjectively, then a creative tension between the two forms of judgment fosters new strategies.
The public may have an even more jaundiced view on the prospects for health care than our experts. The PBS NewsHour website invited the public to explore Primary Care 2025 and Pick Your Future Health Care Adventure by watching videos describing a woman living through each scenario and then answering a survey. PBS respondents see the most desperate future for primary care as far more likely — 71 percent versus 46 percent — than our national experts. Bad really is stronger than good when people look at our future health care adventure over the coming decade.
Yet like the Wing of Zock, the hopeful future we can build from strategies from change agents could make the difference between seemingly likely futures that are pretty crummy and our really good scenarios for primary care. The most ambitious strategic recommendation came from a team assigned the most desperate future and told to devise a strategy. They proposed to create a broader social movement for health that includes “leaders in sports, business, religion, education and medicine, as well as senior statespeople, women and families, local health leaders (both federal and civilian), and others such as popular talk show hosts and respected public school teachers.” Maybe it’s hard to imagine such a social movement arising today. Yet just last week one of the leaders who came to our national meeting told me he has a proposal to fund the consortia called for by this recommendation. Maybe this Wing of Zock is in the early construction phase for those working in primary care today.
—Jonathan Peck is president and senior futurist of the Institute for Alternative Futures, where he provides a wide range of research, consulting, speaking, meeting design and facilitation services. He guides futures research used by government leaders, foundations, and non-profits as well as by corporations. Peck has integrated psychological theory, patterns, and insights into his facilitation of vision, mission, and strategic processes. His research spans health topics, social, technological, economic, ecological and governance futures. He has led IAF projects that sketch out visionary outcomes for US health care reform, addressed biomedical research futures, and brought multiple disciplines to bear in his futures work. He can be reached at firstname.lastname@example.org.