Transcript Document
Creating a Centennial Vision
:
Four Possible Scenarios
The American Occupational Therapy Association
A VISIONARY EXAMPLE
Apple’s Vision of the “Knowledge Navigator” in 1987
Apple’s Vision Fostered the Development of:
Portable, wireless flat screen computers Multiple input devices (voice, touch) Simultaneous applications Agents (AI) Integrated IT (phone, data, network) Personal data managers (calendar, tasks) Videoconferencing Data mining and retrieval (Sculley, 1989)
When we imagine future worlds and create visions, by acting on those visions we set in motion circumstances that enable our imagination to become reality.
Mahatma Gandhi (1869–1948)
“Be the change you want to see in the world .
” 1
1 ThinkExist.com, 2005a.
Imagine a world different than the one you now inhabit...
© Sonia Coleman. Used with permission.
Shaping the Centennial Vision
What must the profession of occupational therapy do during the next twelve years to best position itself for the world of 2017 and beyond?
© Sonia Coleman. Used with permission.
Looking to the Future: Some Common Mistakes
Making predictions rather than attaching probabilities to possibilities Simply extrapolating current trends Overestimating the influence of short term change Underestimating the influence of long term change Thinking of only one future
Planning for Change
Change is constant In the present age, change is not incremental, it is exponential No one can exactly predict the future, but we can anticipate the course of known trends Unexpected or “wildcard” events are key reasons why known trends are not foolproof in predicting the future
Examples of Wildcards
The stock market crash of 1929 The attack on Pearl Harbor Shooting of Martin Luther King, Jr.
The advent of HIV AIDS The fall of the Soviet Union The 9-11 attacks
Therapeutic Positioning in the Strategic Sense
Consider where the profession is now Anticipate what the public’s needs are likely to be as the country moves into the third decade of this century and beyond Identify the services that must be provided at that point to meet those needs Take steps to prepare the profession to provide those services
“Skate to where the puck is going to be.”
—
Wayne Gretzky
1 • Identify and understand important trends • Take steps to shape events 1 ThinkExist.com, 2005b.
The point is not to predict the future, but to prepare for it and to shape it.
© Health Canada, www.hc-sc.gc.ca. Used with permission of the Minister of Public Works and Government Services, Canada, 2005.
Occupational Therapy
Current profile and emerging areas of practice © Health Canada, www.hc-sc.gc.ca. Used with permission of the Minister of Public Works and Government Services, Canada, 2005.
Occupational Therapy Workforce
OTAs 19,990 Total Practitioners: 112,653 OTs 82,990 ( AOTA , 2005)
Workforce Trends 1968–2003
120,000 100,000 80,000 60,000 40,000 20,000 OTAs OTs 1968 1978 1988 Year 1998 2003 ( AOTA , 2005)
Practice Settings
(AOTA, 2005)
Today’s Emerging Areas of Occupational Therapy Practice
Ergonomics consulting Design and accessibility consulting and home modification Older driver assessment and training Consulting to assisted-living facilities Technology and assistive-device development and consulting Health and wellness consulting Low vision rehabilitation Addressing Alzheimer's disease and caregiver training Addressing the needs of children and youth Community services
Important Drivers of Change
Aging and longevity Universal design Internet and the Information Age Prospective and preventive medicine Changing world of work Information access
Drivers of Change (cont.)
Diversity of population Stress and depression Developments in assistive technologies Changes in lifestyle values and choices Health care costs, reimbursement issues, and the efficacy of care
Change in Population 2000 – 2020
75% 54% 10% 14% (9%) 5%
Total U.S. Population Growth: 18%
Under 15 15 – 34 35 – 44 45 – 54 55 – 64
Age (years)
65+
(U.S. Census Bureau, 2002)
UNIVERSAL DESIGN
Recognizes that people are different
Equitable use Flexibility in use Simple and intuitive use Perceptible information Tolerance for error Low physical effort Size and space for approach and use
Copyright © 1997 NC State University, The Center for Universal Design
Information Age
• Rise of the personal computer • The Internet • Wireless connectivity • Personalization • Privacy/identity concerns
Changing World of Work
• Growth in the service sector, more specific risks • New forms of work (e.g., telework, job sharing, contracting) • Growing interest in autonomous work (entrepreneurism) • Changing management structures (flatter, smaller, leaner) • Increasing work pace and workload
Cultural Diversity in 2020
About 25 million (10%) of current U.S. residents were not born in the U.S.
The Hispanic population will increase from 37 million today to 55 million by 2020 (49% increase).
By 2020, the median age of Hispanics will be 28.8 versus 37.6 for the total population.
Stress-Related Disorders
There is growing evidence of a clear connection between stress and chronic disease through the immune system.
The term “allostasis” refers to the body’s response to the stress of life over time.
Chronic Stress
“Provides a hormonal milieu conducive to the development” of
Visceral obesity Insulin resistance/dyslipidemia syndrome Hypertension Atherosclerosis Osteoporosis Immune dysfunction Depression Irritable colon Peptic ulcer Substance abuse (VanItallie, 2002, pp. 40 – 45)
Specific Measures: Allostatic Load
Blood pressure Cortisol excretion C-reactive protein LDL, HDL Total cholesterol
Body mass index Waist-to-hip ratio Noradrenalin
Epinephrine
DHEA
Why Zebras Don’t Get Ulcers Robert M. Sapolsky
A readable and useful overview of the relationship among stress, disease, and coping
Depression
The inability to cope with the demands of everyday life can lead to depression.
About 26% of Americans had a mental health disorder in 2002.
Two thirds (66%) of these cases were moderate or severe.
Only 52% of the severe cases, 34% of the moderate cases, and 23% of the mild cases were treated by professionals.
(Narrow, 1999)
Assistive Technologies
Smart home monitoring Robotics Programmed electrical stimulation of muscles to enable movement Cochlear implants Biosensors and biomonitoring New uses of telemetry
Technological Advances
Nanotechnology: Molecular-scale machines to deliver drugs, repair cells, or produce needed proteins or enzymes Use of genetic markers Regenerative medicine/stem cell breakthroughs Wearable diagnostics/monitoring/ imaging
Lifestyle Values & Choices
Continued debate on the meaning of family Greater emphasis on balancing work and family Less interest in lifelong careers Growing acceptance of end-of-life options Growing recognition of the importance of social factors influencing health (e.g., ICF) Greater appreciation for quality-of-life issues
DALYS*
DALYs (thousands) Percent of total All causes
1. Ischaemic heart disease 2. Unipolar major depression 3. Cerebrovascular disease 4. Road traffic accidents 5. Alcohol use 160,944 15,950 9,780 9,425 7,064 6,446 100.0
9.9
6.1
5.9
4.4
4.0
6. Osteoarthritis 7. Trachea, bronchus, and lung cancers 8. Dementia & other degenerative CNS disorders 9. Self-inflicted injuries 4,681 4,587 3,816 3,768 2.9
2.9
2.4
2.3
10. Congenital abnormalities 3,480 *Disability Adjusted Life Years (a measure of disease burden) 2.3
(Murray & Lopez, 1996)
DALYS*
DALYs (thousands) Percent of total All causes
1. Ischaemic heart disease 2. Unipolar major depression 3. Cerebrovascular disease 4. Road traffic accidents 5. Alcohol use 160,944 15,950 9,780 9,425 7,064 6,446 100.0
9.9
6.1
5.9
4.4
4.0
6. Osteoarthritis 7. Trachea, bronchus, and lung cancers 8. Dementia & other degenerative CNS disorders 9. Self-inflicted injuries 4,681 4,587 3,816 3,768 2.9
2.9
2.4
2.3
10. Congenital abnormalities 3,480 2.3
*Disability Adjusted Life Years (a measure of disease burden) (Murray & Lopez, 1996)
Number of Medicare Beneficiaries
The number of people Medicare serves will nearly double by 2030.
76.8*
80 70 60 50 40
20.4
30 20 10 20.4
Disabled & ESRD Elderly
28.4
3.0
25.5
34.3
3.3
31.0
39.6
5.4
34.1
45.9*
7.3
38.6
0
1970 1980 1990 2000 Calendar Year 2010 * Estimated. Numbers may not sum due to rounding.
Source: CMS, 2004.
61.0*
8.7
52.2
2020
8.6
68.2
2030
45 40 35 30
%
25 20 15 10 5 0 Percent of Individuals Limited in Activities Because of Chronic Conditions (By Age) < 18 18Ğ44 45Ğ64
Age
65Ğ74 75 + (Robert Wood Johnson Foundation, 1996)
U.S. Health Care Costs
Medical care at end of life consumes 10%–12% of total health care budget and 27% of Medicare budget.
At least one third of all Medicare expenditures provide care for eventually fatal illnesses.
About 27%–30% of the total Medicare budget is spent in the final year of life.
Of total amount spent in final year of life, nearly 40% is spent in the last 30 days.
Hospice care can save 25%–40% of health care costs during the last month of life.
(Trupin, Rice, & Max, 1995)
One view of what we need to design a successful health care system for the future
Crossing the Quality Chasm: A New Health System for the 21st century
—Institute of Medicine (IOM), 2001
IOM Report: Issues
Between the health care we have and the care we could have lies not just a gap, but a chasm.
A system full of under use, inappropriate use, and overuse of care A system unable to deliver today’s science and technology; will be worse with innovations in the pipeline
IOM Report: Issues
(cont.)
A fragmented system characterized by unnecessary duplication, long waits, and delays Poor information systems and disorganized knowledge “Brownian motion” rather than organizational redesign A system designed for episodic care when most disease is chronic Health care providers operate in silos
IOM Report: Recommendations
Commit to a national statement of purpose for the health care system Six aims – – – – Safety: Avoid injuries Effective, evidence-based practice Patient-centered: Patient values guide decisions Timely: Reduce waiting and delay – Efficient: Avoid waste – Equitable: Care doesn’t vary by gender, ethnicity, etc.
(IOM, 2001, pp. 5–6, 9–12)
IOM Report: Getting Evidence Into Health Care Delivery
Ongoing analysis and synthesis of medical evidence Delineation of guidelines Identification of best practices in design of care processes Better dissemination to professionals and public Decision support tools Goals for improvement Measures of quality for priority conditions (IOM, 2001, pp. 19–20)
Question:
Are today’s emerging areas of practice aligned with the needs that will be present in the year 2020?
Answer:
We can’t know with certainty. But one approach that will help answer that question and guide planning in an informed way involves the creation of scenarios.
How to Best Think About the Future?
No absolute answer to the question, but tarot cards and crystal balls are not the answer.
Think of the drivers of change.
Use the drivers of change to imagine different scenarios of the future.
Imagine at least three scenarios; each should be plausible but different.
Step backward from future scenarios to think about what to do now to prepare.
What is Scenario Planning
?
A way of analyzing known trends in order to imagine conditions that define views of possible worlds These possible worlds are used as planning structures to guide thinking about potential courses of action
Four Scenarios
A. Familiar Territory (Expected) B. Scare City (Feared) C. Bold New Frontier (Aspirational) D. Shining City on the Hill (Visionary)
Scenario Profile Categories
Demographics Health care Mental and physical well-being Design and technologies for quality living Education Occupational therapy practice environment
OT Scenarios
Familiar Territory
Describes an expected future with enough opportunity for the profession to progress steadily along
Bold New Frontier
Describes an aspired future shaped by scientific and technological advances that could alter the practice of occupational therapy
Scare City
Describes a feared future where current challenges cascade into an era of limited opportunities for occupational therapy
Shining City on the Hill
Describes a visionary future where a more holistic view of health transforms occupational therapy and its role in society
Familiar Territory Expected Future Overview
Increasing numbers of elderly people benefit from early interventions, living longer and with less disability Community design aids mobility Health care services become more client-centered for clients who have insurance or can afford to pay Schools diversify in their ability to meet student needs
© Health Canada. Used with permission of the Minister of Public Works and Government Services, Canada, 2005.
Scare City
Feared Future Overview The lucky few buy their way up to the services they need Increases in disability overwhelm health care and school systems Promising alternatives exist, but they elude the majority As resources for quality of life grow scarce, mental and physical well-being decreases
Bold New Frontier
Aspirational Future Overview Advanced science and technology transforms health care and learning Buildings and communities are rationally designed for mobility and independence Traditional institutions are yielding to distributed venues for health, education, and social services iBOT 3000 ™
Shining City on a Hill
Visionary Future Overview The values of holistic approach to health lead to longer, more meaningful lives for everyone Prevention is reinforced by caring relationships People of all ages interact in livable environments Disabilities have lost their stigma as people openly pursue their full potential
Connecting the Dots
Current State Fewer than 1% of OTs work in mental health.
Much content in educational programs is about body structure and function.
Future Scenario Mental illness is becoming a major health burden.
Developments in stem cells, assistive technologies, etc., may restore functional ability.
Possible Implications Continuing education, education, licensure Educational programs may need to shift focus to lifestyle and QOL strategies.
What Will Be Likely, Regardless of Which Scenario is Closest to Predicting the Future?
Demonstrating value/efficiency Being clear about our mission (scope of practice) Putting patients first Constantly trying to improve Basing what we do on evidence Addressing needs of elderly
Group Assignments
Rank importance of drivers for the profession Consider current conditions Discuss scenarios Identify population needs for OT in the imagined world (scenario) Identify changes needed to get there in policy, education, practice, research
“ The future belongs to the unreasonable ones, the ones who look forward not backward, who are certain only of uncertainty, and who have the ability and the confidence to think completely differently.” 1
George Bernard Shaw
1 Handy, p. 16.
Task Group Deliverables
•Group rank of importance of drivers •Specific ideas about needed change in practice, education, research, policy •Summary of recommendations in written form •Demographic forms completed by each group member
National Dialogue
Conference focus groups, RA, ASAP, ASD Encourage state area dialogues with members and nonmembers Collate, digest information Interactive Web site Planning council to digest feedback and propose vision and 10-year plan (by 2007)
References
American Occupational Therapy Association. (2005). [Membership survey]. Unpublished raw data.
Centers for Medicare and Medicaid Services. (2005). Public programs: Medicare, Medicaid, SCHIP. In Health Care System: Facts and Figures. Retrieved June 1, 2005 from http://www.cms.hhs.gov/charts/healthcaresystem/chapter3.pdf
Handy, C. B. (1996). Beyond certainty: The changing worlds of organizations. Boston: Harvard Business School Press.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21
st century.
Washington, DC: National Academy Press.
Murray, C. J. L., & Lopez, A. D. (Eds.) (1996). Summary: The global burden of disease: A comprehensive
assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to
2020. Cambridge, MA: Harvard School of Public Health on behalf of the World Health Organization and the World Bank.
Narrow, W. E. (1999). One-year prevalence of mental disorders, excluding substance use disorders, in the United States. Unpublished.
National Institute on Aging. (2002). Aging in the United States: Past, present, and future (NIH Publication No. 95 4009). Washington, DC: U.S. Government Printing Office.
Robert Wood Johnson Foundation. (1996, August). Chronic care in America: A 21st century challenge. San Francisco: Institute for Health & Aging: University of California.
Sculley, J. (1989). The relationship between business and higher education: A perspective on the 21 st century. Communications of the Association of Computing Machinery, 32, 1056–1061.
The Center for Universal Design. (1997). The Principles of Universal Design, Version 2.0 Raleigh, NC: North Carolina State University.
ThinkExist.com. (2005a). Retrieved June 1, 2005, from http://en.thinkexist.com/quotes/mahatma_gandhi ThinkExist.com. (2005b). Retrieved June 1, 2005 from http://en.thinkexist.com/quotes/wayne_gretzky Trupin, L., Rice, D., & Max, W. (1995). Medical expenditures for people with disabilities in the United States, 1987. San Francisco: University of California.
VanItallie, T. B. (2002). Stress: A risk factor for serious illness. Metabolism: Clinical and Experimental, 51(6 Suppl. 1), 40–45.
Acknowledgments
This slide presentation was developed by the AOTA Vice President pursuant to his responsibilities for Strategic Planning. Appreciation is extended to Carolyn Baum, PhD, Leti Ford, Judy Wolf, Maureen Peterson, Cynthia Johansson, and Barbara Dickson for their assistance in its preparation.
© 2005 by the American Occupational Therapy Association, Inc. All rights reserved.