ACR Bulletin

Covering topics relevant to the practice of radiology

Future Shock

No one can predict the future, but scenario planning can help you prepare for the best, worst, and everything in-between.
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Scenario planning looks at a range of possible futures, including futures that are likely and futures that are unlikely, and tries to identify common actions and initiatives that benefit an organization across the broadest range of potential futures.

—ACR Vice President Alexander M. Norbash, MD, MS
January 26, 2021

When it comes to scenario planning, 2020 was the year we’ve been training for. While no one can predict the future, we can plan for a variety of timelines and prepare our practices and careers accordingly. And in this tumultuous year, scenario planning has never been more relevant.

To understand how radiologists can use scenario planning to meet healthcare’s ever-changing needs, the Bulletin caught up with ACR Vice President Alexander M. Norbash, MD, MS, chair of radiology at the University of California at San Diego School of Medicine and co-director of the 2020 Radiology Leadership Institute® (RLI) Summit Spotlight; Frank J. Lexa, MD, FACR, chief medical officer of the RLI and chair of the ACR Commission on Leadership and Practice Development; and Liam Fahey, PhD, co-founder and executive director of Leadership Forum and professor of management practice at Babson College. Fahey was also a speaker on scenario planning at the 2020 RLI Summit.

How is scenario planning different from strategic planning?

AN: Strategic planning typically refers to a plan utilized as a roadmap to take an organization forward in a 3- to-5- year time window to accomplish ambitious goals. Such a strategic plan looks forward to a single, most likely, and pragmatic future point — where conditions and probabilities are concerned and plans for that single, most likely future. Scenario planning, alternatively, presumes that we cannot be confident about a single, most likely future since there are so many variables that shift and change as we arrive at the future. Scenario planning looks at a range of possible futures, including futures that are likely and futures that are unlikely, and tries to identify common actions and initiatives that benefit an organization across the broadest range of potential futures, also typically within a 3-to-5-year time window. For example, not many single-point strategic plans would have necessarily included a pandemic, although a scenario planning exercise two years ago could have easily included such disasters as pandemics as we are considering a broader range of optimistic and pessimistic futures.

FL: With scenario planning, you’re generating ideas. Scenario planning is eventually getting to the point where you understand a future that could be radically different. For example, when the Yom Kippur War occurred in the 1970s and affected the oil industry, the Royal Dutch Shell Oil Company had already somewhat predicted it and was prepared. They had engaged in scenario planning and one of the scenarios imagined what might happen if a war in the Middle East occurred — shaken oil markets, cartel behavior, and boycotts. So, when the war actually happened, they had already considered the possibilities of what would happen to their company and had formulated a strategy based on that. Strategic planning asks the question, “What do you do about those changes?” It’s your action plan.

LF: The intent of doing scenario planning is to understand what kinds of opportunities or threats may be confronting you, what kinds of strategies might or might not work, and what kinds of operations make sense. Scenario planning generally provides input into most phases of strategic planning.

Why is scenario planning an important skill for radiologists to learn?

AN: Scenario planning empowers radiologists to think about the future and anticipate course corrections to position themselves better. It’s particularly valuable for radiologists, given the issues surrounding the specialty: turf conflicts, intense scrutiny due to our income profile, and the fact that we are not as visible to patients. Radiologists need to be strategic and understand how they can adapt for a better future.

FL: Scenario planning is a way of trying to think about “what if” types of questions. For radiologists, it’s important because many of us have jobs that are very immersive. We’re focused on the “here and now” — reading our studies — and don’t always step back to consider what could happen in the future. The future is likely to be different than the one we expect. Things are changing while we’re working, and we don’t want to get left behind in the future because we’re so focused on today.

LF: We’re all living in a world of change — social, cultural, technological, and political. For radiology, we’ll see changes to things like the population of radiology patients as well as the advent of new and disruptive technology. The intent of scenario work is to anticipate those possible events and plan how your practice or department will meet the future.

How can radiology turn challenges into opportunities through scenario planning?

AN: Mindset is a determinant of success in many instances. One of radiology’s challenges is that the specialty has been very strong and secure in many of the things we do, and that security has granted us a level of resistance in moving in a different direction. Part of what we must do is not only engage with new ideas, but also create a more entrepreneurial or solution-oriented mindset by understanding that change is constant. Scenario planning is a bit of a paint-by-numbers approach to understanding how we deal with problems and formulate solutions that are optimistic and deal with the inevitability of change. It’s done in a structured and stepwise progression — starting with deciding on deliverables and goals and ending with creating a roadmap for successful implementation.

FL: Once you have an inkling of what could happen in the future, you try to make those things that feel like threats manageable — or even turn them into successes. If you think that we’re going to a single-payer plan, how do you adapt to do well under that plan? And what changes can you make before everyone else is trying to do the same? Scenario planning is like choreographing and practicing a dance, because you want to be ready to make the right moves, but you also want to ensure that you’re using your resources wisely. You can’t be ready for every potential threat. We all have limited resources and must balance the present with the future. Look at the things that are most likely to happen and anticipate the unexpected.

You can’t be ready for every potential threat. We all have limited resources and must balance the present with the future. Look at the things that are most likely to happen and anticipate the unexpected.

—Frank J. Lexa, MD, FACR

The ACR Strategic Plan update process is currently underway. How does scenario planning figure into that process?

AN: Currently, there are many complex drivers and forces that are affecting our specialty. Everything from payment reform to holography to cloud computing to big data and AI. With the understanding that the future is going to be hard for us to predict, scenario planning is an ideal tool for the ACR to use to build its strategic plan — especially given all the uncertainties we dealt with in 2020.

FL: We live in a rapidly changing world. Scenario planning should help inform ACR about what to expect about a variety of changes that could come in the future. And if this process succeeds, it will help us build a strategic plan that will have a shelf life several years into the future, because the plan will have anticipated various changes versus a set future. This better positions the ACR to provide ongoing member value and better support the specialty.

What can radiologists do to start scenario planning or get involved in the ACR’s Strategic Plan update process?

AN: Learn, reflect, and engage. Read articles in the JACR®, visit the RLI’s resources, and browse publications like Harvard Business Review. Engage with others who are also interested — fellow physicians, business administrators, friends in other fields. This way, you have the chance to develop your ideas. We all have so much to learn from each other.

FL: A lot of people think the ACR’s Strategic Plan is very secret and behind closed doors, but we have a lot of people involved and we are very interested in input from a wide variety of people — both members and non-members. Learn more about how you can contribute by contacting Pamela Mechler, MS, CAE, ACR vice president of strategic planning and business excellence, at Scenario planning and strategic planning are both critical skillsets for radiologists, and training about these leadership topics and more are available from a variety of RLI programs.