During times of massive disruption, you need to plan for every possible outcome

A chatbot that can help seniors remember to take their medication or even request a home visit from a nurse seems like a pretty handy tool to have during a pandemic. Ring of Support wasn’t supposed to launch for several months, but the Futures team at SE Health, a 112-year-old healthcare organization focusing on seniors, had gone through months of testing, and based on the accelerated need for such a product, they decided to take the leap and launch it.

The Ring of Support chatbot is one example of how Zayna Khayat’s team at SE Health prepares the organization for the future — how foresight informs strategy and leads to actual products. SE Futures is driven by the ethos of the organization: to spread hope and happiness. While that may sound lofty, the team has a mission grounded in reframing aging from a lonely, sickly stage of life to “co-creating a future where Canadians age with health, vitality and dignity.” Khayat works outside the day-to-day operations of SE Health to focus on how to achieve this future, whether that’s playing with technology or new business models. Ring of Support deals with both — it’s a subscription model the organization has never tried before and it uses voice technology that wouldn’t have been possible to implement even two years ago.

Khayat is well-versed in the business of building the future of healthcare — she’s an adjunct professor of health sector strategy at Rotman School of Management at the University of Toronto, she also co-founded the Netherlands-based Health Innovation School and is the co-author of the book The Future of Aging. But even for her, forecasting during a global pandemic has proven to be a challenge. Khayat spoke with us about how innovation has become an empty word, how COVID-19 changed her method for forecasting, and the lessons she’s learned in planning for a cycle of shocks and recoveries.

You’re not a fan of the word innovation — why not? 

The word gets diluted — it’s used to describe anything different, especially in healthcare, where there is so much about the status quo that is not working. You wouldn’t call everything marketing — the marketing department has a skilled craft that requires a methodology and has KPIs. Your innovation unit or office has a skilled craft that has a clear methodology with clear impact goals. When most health organizations set these units up — the office of innovation, the design lab — anything new (usually in our world that involves anything digital) often gets sent to the innovation department. My view is, no, that’s just good old-fashioned business process optimization. That should be done in the core of the organization. That has little to do with innovation.

So that’s my problem with the word “innovation.” It too easily allows you to do the low-hanging fruit stuff with your precious, limited innovation resources, and never go for the real meat, which is true innovation — to rebase the business model because that’s healthcare’s unfinished business. Are we just going to spend our time setting up online appointment scheduling apps and call it an innovation?

What was your forecasting process like before COVID-19 hit? 

Applied strategic foresight is my job as the future strategist. For inputs we’re constantly reading, looking, sensing and mining signals from within and outside of our industry, globally.

I also get the luxury of being able to go out and speak quite a bit — I can test what we think we know by how the audience engages. We than translate the signals into new business model designs that we incubate, test, refine and (hopefully) scale for impact.

How has COVID-19 changed what you do?

In our mining and sensing of signals, we look at how so many industries are pivoting given the impact of COVID-19 on their business, and draw inspiration for our work from banks, automobile manufacturers, telcos, restaurants, grocers, retailers, entertainers, sports and public goods providers like libraries, schools and postal services. For instance, many banks around the world rolled out new products, policies and experiences for seniors, while also managing a blended physical (retail branches) and digital (everything else) infrastructure, frontline staff issues, and a customer population that is not as familiar with omni-channel experiences. I also find gems from Twitter scans, or from consulting firms who package case examples of pivots and share them in reports or webinars.

We also evolved our foresight methodology in the context of a crisis. Standard practice is to set up a crisis response council that convenes every day to deal with the immediate issues. We — like everyone else — built that. A leading practice I first heard about from the Danish Emergency Management Association is having a parallel cell to your crisis team that is keeping its eye on the future. When it’s all hands on deck to save the business, who’s going to create space to plan ahead? My CEO — because she’s always visionary — asked us to form a small team “to be looking out for how the world’s going to change when we come out of this, so we can leap forward and not just survive or go back.” We formed the cell, Project Fenix, a play on the metaphor about the phoenix rising from the ashes. Then we put a methodology together.

Our plan-ahead strategy is almost like an if/then logic tree because you can’t make a very firm bet in this much uncertainty. It’s a rolling strategy, where we do regular checks — did this possible future materialize or not? In this way, we have been refining a small set of “plausible” futures as soon as we get new intelligence. We then assess what impact the new futures have on our working strategy:

• Is it neutral?
• Will it make our strategy better? (should we move faster, or invest more?)
• Will it make our strategy worse off? (should we slow down, or experiment with very little investment?)
• Is it catastrophic to our strategy? (which means we stop and focus on something else.)

A combination of market events plus our own internal performance management leads to adjustments to the rolling plan. It’s an exciting approach to strategic foresight under extreme uncertainty.

For example, a market event was around wages for essential health workers. With no warning, the Ontario government rolled out a $4/hour wage increase that would affect almost all of our staff compensation. That changed the context for our work overnight. And then again, just as we were planning a new strategy for when the $4/hour increase would run out, it was extended by several months. Again, we had to change course given we are a labour-intensive health delivery organization.

Is there anything that’s landed on your plate that you didn’t think would ever be your job? For instance, PPE became a massive issue.

When the immediate crisis hit, we went through the same amount of PPE in one week that we normally would have had inventory for a year. And we had little purchasing power in the supply chain the way hospitals and government do. The rest of us — doctor offices, home care, dentistry — we were fending for ourselves. We loaned one of our team-mates to the PPE team — this fellow was hustling, finding supply wherever he could, driving to dentist offices picking up PPE, and distilleries to pick up hand sanitizer. Everyone’s got to have everyone’s back in a crisis response — there’s no saying “that’s not my job.” This attitude has really galvanized our organization.

How can we plan for healthcare providers to continue with non-COVID related care for seniors during this moment of crisis? 

An important part of our work is after care when a patient is discharged from hospital to their home. The fair share of usual healthcare for hospital-to-home patients with a severe chronic illness or recovering from surgery stopped. We’re now preparing for it being turned back on, and also the impact of what the deferred care — all those chemo treatments that didn’t happen, the management for arthritis that didn’t happen, and now the person got worse, that’s going to add an additional demand load in healthcare. Then add on the third pandemic that’s going to come, which is the mental health issues of citizens and health workers. We’re bracing ourselves for a tougher environment in which to do our work.

What are some of the lessons you’ve learned about planning for a continual cycle of shocks and recoveries over the last few months?

COVID-19 is hard for anybody in any business or any organization, but when you’re in healthcare it adds a whole other layer of challenges. If you look at the big waves, the first wave was PPE. Then the next wave was the hospital ICU and vent capacity. Then just as those two went away, it was the nursing home outbreaks. What is it now? Migrant farm workers, prisons and meat plant outbreaks. Who would have thought that would be the next thing that keeps our economy shut down? The next thing is going to be community transmission and schools. Each one of those waves is a massive shock. They’re not small things to contemplate. So now we’re like, how to shock-proof and future proof at the same time?

I think we are more ready than ever before. More innovation happened in 10 days than in 10 years. This has built resilience in the form of innovation “muscle memory” which will serve well in keeping momentum toward creating a new future of healthcare, instead of going back to the pre-pandemic past.

This interview has been condensed and edited for clarity.