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.

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.

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].

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].

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.

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].

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.

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.

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.

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.