Discover to Deliver Pediatric Futures: Viewpoints of Future Medicine From a Pediatric Health Care System

Introduction

Future readiness can aid health care leaders in directional planning through numerous futures medicine methods [1]. Futures methods have varying structures, but all convene stakeholders, curate technologies, and layer future forces and capabilities, upstream strategic opportunities, and operational planning. This work is often unseen by frontline clinicians and develops alternative futures beyond 5 years from the current state. Future readiness within strategic planning for pediatric health care requires insights beyond those provided by adult health care systems’ approaches. The impact of family-centered care and pediatric-focused trends is critical in planning to create a world of well-being for all children. While we cannot predict the future, we can use futures methods to create the future we envision for all children. In a recent call to action by Mesko et al [1], the authors challenged health care leaders to support the systematic application of medical futures methods across large-scale projects and dedicated expertise. In pediatric health care organizations, including our Midwest independent nonprofit pediatric health care system, futures methods are used to anticipate and prepare for future challenges and opportunities to remain competitive and resilient in an increasingly unpredictable health care environment. Pediatric care is not just applying adult models to a family-centered care model; rather, it requires an understanding of the influence of parental roles and emerging childhood conditions that may shape the future. This Viewpoint examines the application of futures medicine methods across pediatric health care and illustrates how a pediatric futures framework can guide the discovery, decision-making, design, delivery, and demonstration of optimal well-being for children within our communities and health system.

Discover: Systematic Methods for Pediatric Futures

A systematic focus provides a basis for discovery through identifying emerging trends, signals, risks, and opportunities that may shape pediatric health and well-being across clinical, community, and societal contexts. Futures medicine methods have an established history in pediatric health care starting in 2010, supporting early discovery and long-term planning [2]. Multiple systematic methods can be used in the discovery efforts in futures medicine, including the Delphi method, scenario planning, megatrends, horizon scanning, and future forecasting. An early application of futures medicine methods came from the 2010 report by the American Academy of Pediatrics Vision of Pediatrics (VOP) 2020 Task Force [2]. The board of the American Academy of Pediatrics selected experts with a range of expertise to use the Delphi method and congregate to envision the future of pediatric health. The experts reviewed and aligned input via surveys and task force expertise, ranking upcoming trends with consolidation across the continuum of pediatric health care [2]. Scenario planning with crossing trends in a 2×2 method was used to help leadership explore the impact of potential actions in a variety of potential futures [2]. The 19 trends were consolidated into 8 critical megatrends with additional wild cards. Each megatrend had a best-case, worst-case, and most plausible scenario based on an expert consensus. Textbox 1 delineates the 8 megatrends and the current status of the futures envisioned by the VOP experts over the decades since the 2010 report. Many of the forecasted trends became reality and continue to impact us today, including pediatric workforce shortages, enhanced care delivery systems, a global pandemic, and the increasing complexity of pediatric care [3-6].

The International Society for Pediatric Innovation (iSPI) started in 2014 after the initial Delphi promulgation of the Pediatrics 2040 initiative to anticipate change in pediatric health care [7]. This global initiative continues today, providing an opportunity for pediatric stakeholders to use horizon scanning and futures thinking to anticipate the needs of the world’s healthy child [7]. The work by this coalition aligns with the STEEP (social, technological, economic, environmental, and political) framework, which encompasses technological innovations, global economics, social collaboratives, business partners, and external forces that share our interest in pediatric health impact [7]. Leadership from this collaboration has permeated globally through pediatric innovation and provides ongoing opportunities for achieving an ideal state of future pediatric health.

Decide: Leader Decisions With Strategic Direction

The areas of discovery are applied by executive leadership and board members to determine the macro vision of an organization. The administrative leadership in an organization drives the culture of change and the evaluation of capabilities and support for the application of the discovered trends, scenarios, and vision. This practical direction decides and then supports the future focus areas of prioritization. These key strategic priorities also support plausible and preferred futures. Strategic planning is an instrument that supports leaders’ decision-making capabilities. Their expertise is enhanced from education and knowledge in strategic direction methods such as SWOT (strengths, weaknesses, opportunities, and threats) and PESTLE (political, economic, sociological, technological, legal, and environmental) [8].

The mission and vision of each organization are a key part of which prioritization areas are focused on after information has been gathered and provided by futures methods teams. While revenue streams are key in strategic decisions in health care, we also have an ethical duty to envision and create a world of well-being for our pediatric patients and their families. Traditional fee-for-service revenue models in financial planning will overlook critical innovations and future-forward programs that serve lower-income patients, including some pediatric patients [9]. The future readiness approach emphasizes combining proven care models with adaptive business models that do not rely on fee-for-service alone but are managed over time for operational and financial sustainability. Philanthropic partnerships with strategic leadership are key to success in nonprofit sustainability in health care beyond small implementation programmatic support [10].

Design: Adaptive Strategy and Operational Alignment

As leadership shifts organizational direction to the potential futures based on the mission, culture, and financial direction of the organization, traditional design and implementation methods are used to bring the organization toward these goals [1]. Teams can intentionally create care models and technologies based on forward thinking and not only on immediate care needs or issues that have arisen in a crisis. Today, flexibility and organizational adaptability are imperative for survival, given the speed at which change is impacting the entire health care ecosystem. Leveraging STEEP factors and predictions allows health care organizations to maintain a wider aperture and focus on broad strokes with a longitudinal orientation, but it must be predicated upon our organizations’ ability to pivot and adapt on a day-to-day basis. In pediatrics, the complexity is even greater, as those who receive the care are not those who make the decision about their care [11].

For implementation and execution to be successful, strategy and planning are not enough. Strategy needs translation into operational planning and leadership from clinical leadership [8]. This includes teams knowledgeable about financial planning and analysis that can support the development of capital needs and operational and staffing support for enterprise growth. Funds flowing in strategic alignment with future readiness work combined with transparency of financial margins are a key part of health care management and sustainability where margins and reimbursement are often lower with a complex payer mix [12].

Deliver: Dissemination and Implementation of Health Care Models

Care delivery has the biggest impact from the previous year’s planning steps, combining all the visions from future readiness at the point of operational implementation. Transparent communication of why changes are happening while supporting effective teamwork through change is a crucial role of health care organizational leadership [13]. Adapting to change while delivering care can be both complex and complicated, but our patients’ outcomes are the results, so care teams must support innovative models to drive these changes [14]. Sustained execution of innovation pilots and support for research development for areas that are not yet ready for the standard of care start with early foresight and planning for areas that will be simple, complex, or complicated as they are implemented [15]. Ongoing communication from leaders is needed to maintain complex health systems’ directional focus. Objectives and key results (OKRs) methods can be used to maintain transparent goals and commitment to leadership direction and metrics [16]. This framework supports an approach to identify, strategically measure, and operationalize objectives.

Demonstrate: Assessing Impact and Monitoring Trends

Outcome evaluation through futures methods is continuous and requires ongoing trend monitoring. New disruptive innovations provide opportunities for a course shift toward one of the alternative futures imagined a decade prior. Ongoing benchmarking with peer children’s hospitals and real-world performance is possible with resources such as the US News Pediatric Best Hospital rankings, the Children’s Hospital Association’s annual benchmarking report, and repositories such as the Pediatric Health Information System (PHIS) database [17,18]. Ongoing outcome monitoring allows future development cycles to continue from day-to-day outcomes and helps leaders to assess their quality and outcome metrics as well as the implementation of new care models among peers [17].

Framework Summary

The visual in Figure 1 is a collective cumulation of the process that health care leaders could use to ideate their transition to using futures medicine methods in their strategic workflow. This is a compounding framework built on a rapidly changing landscape for ideal and alternative futures that are trending in our world. The global impact and assessments of potential megatrends underlie the tough decisions that drive the administrative direction. The next megatrend is not only on the horizon but occurs simultaneously in the world and may not be exclusive to pediatric health care or the health care ecosystem. This is especially critical and more complex in a competitive environment, where pediatric providers adapt and evolve to changing landscapes, megatrends, and competitor responses over time. Ongoing outcome evaluation and demonstration of metrics are key to success in this framework. Each of the Figure 1 areas builds upon the past and is an iterative process with continual efforts and expertise along the continuum. While it is a progressive model, there is ongoing ability to flex if there are disruptive transformations that shift leadership and administrative priorities.

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Illustrative Case Vignette: Implementation of Pediatric Futures Methods at a Pediatric Nonprofit Health Care Institution

The culture of future readiness has permeated groups such as iSPI and the VOP and created the conditions for the Strategic Services team at our institution to replicate these models within our strategy and planning approaches [2,7]. This was first implemented as our organization developed our 2020 enterprise strategic plan and, even more recently, refined as we developed our 2030 enterprise growth strategy.

Discover

In 2018, Children’s Mercy Strategic Planning leaders began exploring the idea of introducing future readiness into their planning process, through the development of a STEEP wall to assist with innovation development, strategic planning retreats, and the upcoming development of a 2020 enterprise strategic plan. A planning analyst at the time was tasked with bringing qualitative insights that provided a wider aperture, considering significant impacts that could affect the broader pediatric health care ecosystem. The guardrails were low: think about disruptive innovation, dual transformation, human-centered design, and systems thinking. These leaders brought the first versions of future readiness to Children’s Mercy by using STEEP factors and predicted megatrends first in the development of departmental strategic planning, then our digital health strategy with diverse cross-department stakeholders, and finally 1 to 2 years later—STEEP was used as a component of informing the 2020 enterprise strategic plan. Many of these trends have been fully realized today. During this period of discovery, the chief executive officer (CEO) of 25 years retired; a new CEO began in November 2018, and we were on the cusp of the COVID-19 global pandemic.

Decide

In 2020, the continuation of these strategies was dependent on individual staff knowledge and capacity. The organization had its first new CEO (and associated changes in senior leadership) in 25 years. As predicted by the VOP team in 2010, the COVID-19 pandemic disrupted the trajectory of many facets of life, including health care [2]. At the time, fiscal responsibility and operational excellence were key to survival; the megatrends and STEEP factors were unchanged, even after the pandemic. Some of the megatrends that remain are rapid urbanization, declining birth rates, and global warming. At the same time, as of this writing, pediatric patients’ complexity has increased, Medicaid payments have decreased, and health system consolidation has occurred both in competitive markets and across markets.

Design

In July 2024, the principal product manager in the Center for Pediatric Innovation renewed the focus on future readiness by curating and sharing key STEEP trends, working with the strategy team on the practical application of the trends, and considering future scenarios of pediatric health care. They used the future-back method to help inform innovative projects and planning retreats. Notably, the strategic futures methods insights team was composed of interdisciplinary and cross-functional professionals coming from the fields of business, public health, bioethics, nursing, allied health, innovation, remote health solutions (remote patient monitoring), and strategy (data analytics and business planning).

Deliver

In February 2025, the organization welcomed the current CEO following the retirement of the previous CEO [14]. Preparations to present a new future readiness concept were drafted and shared among strategy and innovation leaders (Figure 2 and Textbox 2). The organization initiated an aggressive growth plan with these discovery, decision, and process design backing theory. Additionally, our CEO brought new perspectives and considerations by way of agility, adaptability, and complexity [14]. Much of their forward-thinking leadership complements the origin story for STEEP to future readiness in the face of disruptive innovation, transformation, and human-centered design, and systems thinking.

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To arrive at prioritization and strategic alignment for our enterprise strategic planning, our team began with the widest aperture possible for discovery. We examined headwinds and tailwinds impacting the broader health care ecosystem, then specifically pediatric tertiary and quaternary care, and finally particular factors impacting our system straddling 2 states. The key factors included stagnant local population growth; Medicaid uncertainty, as HR 1 (enacted July 2025) limits states’ health care–related taxes and state-directed payments used to support higher Medicaid rates for children's hospitals, putting pressure on our largest payer source and on coverage for the children and families we serve [19]; competitive threats from for-profit and private equity entities in pediatric care delivery; our aging facility infrastructure; increasing recruitment challenges for pediatric specialties and subspecialties; market consolidation; and adult health systems closing pediatric units [20]. This served as the backdrop for the “discover” trends phase and the beginning of our progression along the discover to deliver pediatric futures framework and ultimately our enterprise strategies for organizational alignment: “decide” goals.

Currently, we are beginning to take a “push” versus pull approach to democratize future readiness across the organization for all leaders. We are offering foundational learning on future readiness through future readiness deep dives, which include both short- and long-term projects; internal communications in the form of presentations; our intranet site; and a collaborative newsletter that combines competitive intelligence, future readiness, market share data, market and industry insights, and innovative communication strategies. Aligning with an executive objective, a future readiness focus was formalized by the creation of a new strategy role that would partner with innovation and teams across the enterprise. This OKR approach aligned with ongoing development of the future readiness infrastructure. Table 1 delineates the future readiness infrastructure, goals, and key aspects of implementation at our institution led by the strategic futures methods insights team. We created a STEEPLE (social, technological, economic, environmental, political, legal, and ethical) whiteboard to help inform our planning process with an emphasis on our growth plan (Figure 3).

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Demonstrate

Although the discover to deliver framework focuses on pediatric health outcomes, this illustrative case demonstrates the uptake of future methods by the enterprise team and their application to our organizational culture. We are looking ahead to the next 5 to 10 years and keeping sight of macro issues that could impact long-term planning. A key component of future readiness is continuous evaluation of current systems, care delivery, and outcomes, so priorities can be adjusted proactively rather than waiting for the next 5-year planning cycle to conclude. Health care is changing much faster than in the past, especially with the rise of information systems and AI capabilities. Ongoing demonstration of goals and metrics is required for an enterprise to be adaptable and ready for the road ahead.

This past year, we provided education and convening of future readiness concepts, looked at the growth plan through a STEEP lens, assisted with division and service line planning retreats, provided education and opportunities to connect to research, and conducted deep dives and monitoring of future trends. Through the implementation of OKRs as well as key performance indicators, we measure the utility of future readiness leading to actionable initiatives. Notably, in some cases, future readiness will not lead to a specific implementation but rather steer efforts in a general direction. As health systems move toward more agile organizations, considering the broader ecosystem within health care and outside ensures we can adapt to changes—such as new technologies (eg, AI)—that reshape how care is delivered (eg, AI identifying tumors as accurately as humans and nurse triage agent for previsit assessment), from direct patient care to research and even our future workforce [21,22].

Health Care System Implications and Future Directions

Health care systems, especially those with pediatric care, have an ethical duty to support the future of our global population. By connecting discovery to delivery, pediatric organizations can strengthen resilience, support informed leadership decisions, and design care models and facilities that are responsive not only to current needs but also to the emerging realities that will shape child health in the years ahead. We anticipate a future state where future trends thinking and modeling are used at the individual and team levels and guided by leaders who integrate these frameworks into cultural aspects of their organization. Megatrend cards, trend slides, and STEEPLE whiteboard themes can be integrated as activities for initiative retreats and project planning. Innovative tools such as an AI-enabled chatbot and digital assistants may help staff with limited capacity or support and enable them to think more deeply with access to a greater knowledge base to further this work. The illustrative case above demonstrated feasibility and potential transferability to other health care systems with minimal infrastructure but significant future predictions. Pediatric organizations aim to collaborate on advancing digital health initiatives, such as those led by the Digital Medicine Society to create the Playbook for Pediatric Digital Medicine. Focusing on discovery and shared insights can help establish a foundation of trust while furthering the missions of each organization. This groundwork can lead to more significant collaborations that enhance health care for children [23]. While this work may be initiated by strategy teams, the use of futures methods must be embedded culturally with a democratizing approach to ideating the future of health care. Notably, these efforts could be adapted by other pediatric-focused institutions, including governmental and nongovernmental organizations at local, regional, and national levels.

Conclusions

Applying futures methods in health care has evolved from other industries over the past decade [1]. Pediatrics is familiar with the use of future readiness, and at our institution, we have been formally undertaking these efforts for approximately 8 years, with informal involvement in global futures innovations through iSPI extending beyond that period. While the discover to deliver pediatric futures framework was drawn from a pediatric institution, other health care systems can apply this continuum to their organizations with minimal adaptation. Early education in future methods and cultural permeation of thinking beyond daily outcomes and using futures medicine methods can enhance health outcomes for all with practical, structured frameworks. Systematically engaging health organizations through their strategy and local resources, with subsequent publication of the efforts and outcomes, is essential to advancing future methods and shaping meaningful dissemination of these important contributions.