And now… for the final award! Jason Stein chose the cards that represented the most revolutionary idea in care delivery.

Like the winner of the Patient Advocate Warrior award, who suggested a partnership between the postal service and health workers, the Care Delivery Revolutionist award also suggests that patients would benefit from a transdisciplinary merging of the health and logistics industries.

Congratulations @lshultz82! Here is what Jason had to say about how a realtime database of available hospital beds could bring much-needed transparency to the care delivery system:

“This series of cards combines the greatest creativity and pragmatism. A real-time database of available peri-hospital resources could bring powerful and much-needed transparency to hospital care.

What is new and potentially significant in this series of cards is the players’ perspective that access to hospital and post-acute care services could function more as a utility like a power grid, highway system, or water supply.

We already intuit and know that real-time applications can push valuable and actionable information into the hands of motivated people so they can make decisions that are best for their circumstance.

Examples include real-time traffic information pushed via electronic road signs or mobile device apps so drivers can make rational route decisions; or applications allowing commuters to see the price of gas in various locations and enabling traders to see stock prices. The underlying concept is sound and recursive through different industries and applications.

Rational resource allocation can be arranged rationally upstream by both coordinators (healthcare employees) and end-users (patients and caregivers).

Imagine the downstream efficiencies if hospital flow coordinators, ambulances, or patients themselves could gain access to real-time understanding of where resources are and are not:

• a pre-hospital patient with an urgent condition might opt to drive to the 3rd closest ER but the one with the shortest current wait time – and participating as an active member in the triage process might offer greater sense of control and satisfaction to patients.
• an in-hospital care coordinator could help a patient leave the hospital sooner and more satisfied if the available skilled nursing facility beds that matched the patient’s preference and needs were transparent to all.
• a post-hospital home health nurse might be able to enlist the support of interested neighbors or community groups to implement a plan for regaining an elderly patient’s function and independence in the home

The time has come to leverage real-time information on behalf of patients in our hospital continuum of care. These players have hit upon something significant. “

Ever in pursuit of the Triple Aim, hospitals of the future need to strike the balance that creates better care and better health at lower costs. Throughout the game, conversations grew around reimbursement models, technology innovations, and new models of delivering care.  Harold Luft chose the following card chains as winners – congratulations Czars!

The first interesting idea “would have hospitals directly focus on what they can do keep people healthy.  Hospitals are large employers, so they can identify with the needs of other large employers, both in terms of the costs of health care and productive employee time lost due to illness.  They may also begin to realize that they can partner with others, e.g., by fostering the availability of healthy foods, or working to reduce gun and domestic violence, to improve population health.  The health professionals within hospitals have the credibility push forward those agenda items.”

And the second winner begins  ”with a card that had (at least) two branches.  I think the second branch was more productive.  The comments move the discussion from the somewhat simplistic notion of a single payer as a solution to focusing on the importance of better information for patients and consumers to make choices for their own care, and implicitly, to pressure the system to perform better.”

Reinventing the hospital also means rethinking the roles and responsibilities for hospital employees. The judge for this award, Eric Howell, knows this world well – as he is Section Chief of Hospital Medicine, as well as Deputy Director of Hospital Operations, for the Department of Medicine, at Johns Hopkins Bayview Medical Center. The following two card chains stood out to Dr. Howell, and also shows how the best Foresight Engine ideas really do come from the combined ideas of the crowd:

“I think the emergency care in the community meets several needs of society: reduces ED crowding, meets the needs of the patient in a more patient-centered environment (home usually), likely would involve the outpatient provider, and would likely cost less.”

“I like the revolutionizing doctor training, because I think current doctor training costs too much (many-if not most- new MD grads have >$100k in debt), takes too long (many specialists finish in their late 30’s or even 40s!!) and doesn’t include critical training for the 21^st century (leadership, teamwork, quality improvement, medical finance).”

Mobile phones and sensors have already changed how we quantify and track our individual health, however the care delivery system as a whole remains centralized around the physical locations of hospitals. For the Mobile Innovator award Wil Yu was looking for the most creative idea for transforming care delivery into a nimble, mobile system – keeping up with people on-the-go or reaching out to those stuck at home. Wil thought the following idea was most interesting:

 “Hospitals remain central hubs while mobile clinics, extensions of services provided at hospitals, visit neighborhood on regular basis”

His runner-ups for other interesting or likely developments:

Wil wrote: “The evolution of care delivery to new models that incorporate more mobile and decentralized elements will be shaped by the need for greater patient engagement and the viability of new workflows that do not cannibalize existing business lines. Delivery systems will remain the trusted source for core services but will likely seek to augment that role by extending their reach into the community and home. Much of this will be enabled by an emerging IT infrastructure. A variety of partnership models and alliances with external care stakeholders will be tested to see if positive health outcomes can be achieved in a more efficient manner.”

Congratulations mobile innovators! These are some great ideas that could open up access to care when it is urgent and integrate wellness services into everyday interactions.

Next up on the award list is the Patient Advocate Warrior (Most creative idea for reinventing patient experience), which was judged by Tim Rawson of the Innovation Learning Network.

His winner is @krash63*, whose idea was for the United States Postal Service (USPS) to partner with hospitals to have letter carriers/healthworkers check in on high-risk patients along their routes. Recent years have certainly brought a resurgence of the house call, especially with ageing or homebound patients. The UK-based goodgym encourages meeting personal fitness goals by literally running to the home of your elderly or homebound “coach” to pay a friendly visit, or deliver some groceries. But with the USPS on the brink of bankruptcy this year, could this be the new business model that saves it?

As you can see from the dashboard view below, @krash63’s card gained a lot of momentum.

Here is what Tim had to say:

“I wanted to make sure the card I picked was not only unique, but also provided a large impact on patient experience…This well-played card may very well not be the ultimate answer, but I think the novelty and usefulness of the idea could lead to a larger discussion.

The Familiar: The United States Postal Service has been around since the late 18th Century and a visit from a postal worker at your door is an extremely common occurrence for most.  From a patient perspective, answering our doors and cooperating to give vitals and answer a few questions requires very little behavior change (a big plus when talking health care).  Also, the infrastructure for a potential “army” of stethoscope-wielding-letter-carriers is already mostly in place. The people, the trucks and the routes are a big part of the equation.

The New: The idea of taking an existing service such as the USPS and adjusting their mission is both novel and exciting. Targeting a partnership with an organization that is already reexamining their niche in a changing market is another strong opportunity. With electronic forms of communication chipping (more like carving) away at USPS revenue, an adjusted business model might prove enticing for the USPS.

The Impact: I see this idea as “half pain reduction, half joy induction”.  We would see reduced barriers to health care (i.e. rural settings, time off work, transportation issues, etc). Also, the mobile health teams could provide early detection to reduce the number of potentially expensive/traumatic emergency room visits.  On the flip side, the potential joy created for patients could be huge.  Let’s face it, the idea of getting care in a “home setting” harkens us back to the days of the good old fashioned “house call”. And an argument could be made that most of us like getting friendly visitors checking in on us to make sure we’re doing okay.

… just make sure the dog stays in the back yard.”

May I suggest that Columbia’s Mailman School of Public Health start working on this initiative?

*krash63 turns out to be one of the other judges, Kristi Miller-Durazo, which Tim didn’t know. The best part is that Kristi also picked one of Tim’s cards in her group of winners for Community Health Catalyst. Sounds like they should start working together to make this future!

The results are in! All month we will be rolling out the awards for the most innovative ideas that emerged from the Future of the Hospital.

First up is Community Health Catalyst, awarded by Kristi Miller-Durazo of the American Hearth Association.

Early in the game we saw two camps forming; one group thought the hospital should be reserved for emergencies and acute care, while the other envisioned the hospital of the future as a central hub for community health and wellness.  As you will see from Kristi’s winning cards, when the hospital is the cornerstone of a healthy community, it becomes a place you could actually look forward to visiting. So, in the spirit of working together as a community toward healthier people, neighborhoods, and cities – this award goes out to 3 players.

@BrookeS suggested “Rather than a “hospital” make community hubs that intersperse school/edu, retail, business and health. Places to live rather than survive”

@noswar said “maybe these campuses have large open “health parks” at the core for concerts, playgrounds, farmers market, trails, etc. I’d go”

This vision of community health removes this stigma from a visit to the hospital and encourages health lifestyles through social gathering or physical activity.

@Greenguy13 had a slightly different take. He suggested that hospitals move to become part of “major transit hubs. Due to building size, place transit on first floor to combine physical footprints.”

This concept could make health awareness part of the everyday routine, with little extra time-investment required.  It could be a great way to bring in hard to reach audiences.

Congratulations, community health catalysts! Wear your badge with pride.

Do you have any ideas about how hospitals can start implementing some of these ideas? Connect with other community health catalysts @FutureHospitals

This is unprecedented—over just 24 hours, 637 people from around the globe came together to generate 4,528 ideas for reinventing the hospital. Players from everywhere from San Francisco to Omaha, the United Arab Emirates to New Zealand forecasted on topics ranging from the big meaning of community wellness to the small details of hospital billing codes, and everything in between. Big thanks to everyone who played!

But it’s not over yet. In the coming days, look for a blog post highlighting key ideas that emerged over the course of the game. And over the next week, our judges will check out the cards, make their decisions, and, on January 21, we will start rolling out the awards for the best microforecasts and player contributions. These will be announced on the blog and via Twitter (@FutureHospitals).

After that we’ll be diving in deep, analyzing the data for a report to the organizations who made the game possible. We’ll be identifying key themes, threats, and opportunities that emerged from the discussion.  If you’re interested in getting access to the report, please contact Dawn Alva at dalva@iftf.org. And if you want to stay in the loop with Institute for the Future and our future Foresight Engine games you can follow us via Twitter @IFTF.

Thanks to all who played and congrats to the final top 15 on the leaderboard for their contributions.  The leaderboard crosses the globe from San Francisco to Omaha, from UAE to New Zealand.

Want to find out how they did it?  Click here to learn more.

One really interesting card that Rachel pointed out to me called for a new kind of college degree that would better prepare people for new roles needed to reinvent the hospital.

There had already been quite a bit discussion in an earlier chain discussing what these new roles could be:

… as well as some interesting suggestions for who could fill these roles, including the patient’s family and community members.

20 minutes left of game play!  There is still some jockeying on the leaderboard and great microforecasts are being played.  Here is an at-a-glance overview of what’s surfacing:

As with our earlier word frequency analysis, we removed ‘health’, ‘care’, ‘hospital’and ‘patients’ from the top 5 most common words.  Community has become continued to be a prominent theme, as well as data, change, and need.  Some surprises appear now.  Words like:  make and gamemechanics.  What concepts do you want to make sure surface in the final push?  Play the cards fast and furious now!