Accountability, Tolerance and Shapes of the Future

Scott Endsley of the Health Services Advisory Group had an intriguing response to our video scenarios, which I'm sharing with his permission. In an email, he wrote "In thinking about how these four scenarios fit possible axes, it struck me that they seem to represent two fundamental axes – accountability, and change readiness. I am attaching a crude model of these."

The graph is below.

I think Scott's model is an interesting one, but I'm also struck by some of the tension in the axis "tolerance for change." On the one hand, discipline models--where community values restrict individual autonomy and choice--at least theoretically seem to be describing systems less tolerant of change. On the other hand, health and health care are in the midst of a long growth cycle, so in practice, breaking that cycle (through something like a discipline system) would, at least in certain respects, represent a significant change from ongoing trends, whereas continuing to grow would represent an unwillingness to change.

In either case, I think Scott identifies a couple key drivers of change that can help us think through future scenarios. Keep your responses to the scenarios, or to Scott's graph, coming.