1. Vision and Vital Uncertainties for Nursing Futures Jonathan C. Peck President & Senior Futurist June 13, 1014

2. LEARNING OBJECTIVES Understand Why Aspirations Matter Explore Uncertainty in Alternative Scenarios Assess Nursing Likelihoods and Preferences Envision Nursing for Health & Wellbeing

3. Aspirations Model

4. IAF’s approach: Aspirational Futures

5. Forecasts Across Four Scenarios Macro environment US economy Culture Government Health Definition Status Locus Health Care Health Care Delivery Health Insurance Coverage Health Information Technology National Health Care Spending/GDP

6. Scenario #1 Slow Reform, Better Health Personalized medicine – with clouds of data Many diseases prevented

7. Scenario #1 Slow Reform, Better Health Innovations: Avatars & Adaptive trials Focus on health Social Determinants Greater Disparities

8. Scenario 1: Slow Reform, Better Health

9. Scenario #2 Health If You Can Get It 2013: Policy failures; Recession; Cuts to Medicare and Medicaid Economic Gaps Grow Political Extremes Pronounced Pessimism, Family Burdens

10. Scenario #2 Health If You Can Get It 2020: 75 million uninsured Business ethics trump medical ethics Affluent get medical advances Poor get crowded ERs & Minute Clinics

11. Scenario 2: Health If You Can Get It

12. Scenario #3 Big Data, Big Health Gains Cultural shifts affect health, policy and care to change local economics Success: ending food deserts, e.g., Harlem Children’s Zone Political change; shared vision; cooperation

13. Scenario #3 Big Data, Big Health Gains Local food & manufacturing “Personal data clouds”; Massive community data Prevention/ Preemption of chronic diseases; Models & Simulations; Adaptive Trials Personalized Vital Signs Digital health agents, gaming, social networking

14. Scenario #3 Big Data, Big Health Gains From PCMH to Community Centered Health Home Most providers integrated, capitated Healthy communities; self care d ecreases demand for physician services and hospital care Community Centered Health Home Triple Aim Effective self-care

15. Scenario 3: Big Data, Big Health Gains

16. Scenario #4 A Culture of Health Innate human drive for healthy growth Systems biology evolves into health ecology in all health domains Leaders creating environments for health

17. Scenario #4 A Culture of Health Boomers’ crisis creates focus on youth Reality TV shows what a “good death” looks like Health care incorporates new patient’s values

18. Scenario #4 A Culture of Health Health care spending capped locally Avatars for self-care reduce demand for medical interventions 2025: Unified Biological Systems Theory

19. Scenario 4: A Culture of Health

20. LikelihoodPreferability Scenario #1 Slow Reform, Better Health Scenario #2 Health If You Can Get It Scenario #3 Big Data, Big Health Gains Scenario #4 A Culture of Health Likelihood and Preferability

21. Recommend New Health Roles

22. Recommend Tech For Health Metrics

23. Recommend New Leadership

24. Recommend Remove Barriers to Health

25. From 2032 Back To 2014 Imagine Nurses Created A Culture of Health and Wellbeing in 2032. What would you be doing in 2014 to help? Are there new health roles for nurses? How will you measure nursing progress? Who inspires you to shape nursing’s futures?

26. Thank you! Jonathan Peck President & Senior Futurist Institute for Alternative Futures 703-684-5880 www.altfutures.org jpeck@altfutures.org