Preparing for the Future:

Tools for Uncertain Times

Scenario Planning Guide
September 2018

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This is a publication of Rural Health Innovations, LLC, (RHI), a subsidiary of the National Rural
Health Resource Center. The Technical Assistance for Network Grantees Project is supported by
Contract Number HHSH250201400024C from the U.S. Department of Health and Human Services,
Health Resources and Services Administration, Federal Office of Rural Health Policy.
TABLE OF CONTENTS

Introduction ............................................................................................... 2
Getting Ready ............................................................................................. 3
Preparation Worksheet .............................................................................. 3
Design and Approach ................................................................................... 5
Scenario Planning Event ............................................................................ 5
Sample Agenda ........................................................................................ 5
Identifying and Monitoring Milestones ............................................................ 7
Appendix ...................................................................................................... 8
Appendix A: Facilitating Scenario Development ............................................... 9
Step 1: Selecting a Scenario Development Method ....................................... 9
Step 2: Facilitator’s Worksheet ................................................................. 11
Appendix B: Scenario Development Worksheet ............................................. 12
Sample of Scenario Title and Description ................................................... 14
Appendix C: Template for Strategy Evaluation .............................................. 15
Cross Walk Scenarios with Current Strategies ............................................ 15
Appendix D: Scenario Monitoring and Tracking ............................................. 16

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Introduction
How can you and your network board make effective decisions when the future of
health care is so unpredictable? In contrast to traditional planning, which uses the
past as a guide for how the future may be, scenario planning uses a process that
encompasses a variety of possible futures. Considering a range of potential futures
leads to more resilient, flexible and innovative organizational strategies. This is an
important tool that network leaders can use to better prepare their organizations to
respond to uncertain times.

“Thinking through [scenario] stories, and talking in depth about their

implications, brings each person’s unspoken assumptions about the
future to the surface. Scenarios are thus the most powerful vehicles I
know for challenging our ‘mental models’ about the world and lifting
the ‘blinders’ that limit our creativity and resourcefulness.”
Peter Schwartz, The Art of the Long View: Planning for the Future in an Uncertain
World

This Preparing for the Future: Tools for Uncertain Times Scenario Planning Guide
provides worksheets to guide the planning and process of scenario planning, tips
and advice on when to use scenario planning and methods that will be helpful
planning with a group, such as a board. An important next step includes using the
scenarios to monitor the environment; watching for clues that a scenario is
beginning to take shape. This requires the planners identify milestones and
implement routine tracking methods to monitor them.
This guide compliments a webinar, Preparing for the Future with New Tools for
Uncertain Times, delivered to the Rural Network Allied Health Training program
participants in June 2018.
The content of this guide is based on information and facilitation details from
Rhydderch, Alun. (2009). Scenario Planning Guidance Note. Retrieved from:
http://webarchive.nationalarchives.gov.uk/20140108141323/http://www.bis.gov.u
k/assets/foresight/docs/horizon-scanning-centre/foresight_scenario_planning.pdf

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Getting Ready
Preparation Worksheet

Use this Preparation Worksheet to prepare, as the Facilitator, for a scenario

planning event. This worksheet will help you think through scenario planning steps.
1. What is our mission and what are our strategic objectives?

2. Strategic Focus or Question(s) to be answered:

• What will the ____________ environment look like in ____ years?

• What factors could play a major part in shaping our network’s future?

• Other:

3. Date and time frame for planning event:

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4. Who should participate (stakeholders, expertise, influencers – connectors,
practitioners, key staff, volunteers, anyone who must buy-in):
Tip: Work hard to get the right people. Set the date early, check back and
remind.

• Who has a view of potential alternative futures?

• Develop your ideas to talk with participants about attending the planning
event, i.e. how it will scenario planning help shape future decisions.
Answer the question each participant will have, “What’s in it for me?”

5. What is a location/setting option(s) and what planning materials are needed?

6. Get prepared to set the context of the planning event and provide participants
with the information they need to be engaged.
• Gather research, review and summarize relevant data that relates to your
objective and focus question.

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Design and Approach
Scenario Planning Event

This portion of the Scenario Planning Guide, Design and Approach, includes a
sample scenario planning event agenda with specific facilitation tips and tools. This
design incorporates important components; the event is participative in nature; the
design considers the current environment and also aims to identify relevant and
focused scenarios to consider for future planning. Specific facilitation tools are
referenced in this worksheet and templates are provided in the appendix.

Sample Agenda

8:30 – 9:00 a.m. Welcome, overview of the day, recap of

Scenario Planning goal(s) and process
• Review of Mission (why we do what we do) and Vision (what we want to do)
9:00 – 10:00 a.m. Overview of research gathered: Inform,
Discuss and Prioritize
• Information can be sent out ahead of time then briefly presented to the work
group
• Environmental Scan: Discuss the most impactful driving forces and critical
uncertainties. What is going on that impacts us? What will we have to adapt to?
• If useful, use the concept of “levers”, what helps us get to where we want to go,
and “blocks”, what keeps us from getting to where we want to go. See Behind
the Scenes with Strategic Planning I and II for a Levers and Blocks Facilitation
Worksheet.
10:00 – 10:45 a.m. Identify two to five possible scenarios

• Step 1: Select a scenario development method, either A) the 2 x 2 matrix

method or B) the branch method, Appendix A
• Step 2: Use the Facilitating Scenario Development Worksheet, Appendix A
10:45 a.m. – 12:00 p.m. Small Group Scenario Development to create
narrative “scenarios”

• Use the Small Group Scenario Development Worksheet, Appendix B

• The challenge at this step of scenario planning is to keep the group from
problem solving for each of the possible scenarios. Remind them that the factors
help us imagine different possible futures. That our work in this step is to
anticipate possible futures so that we can be strategic in planning for the
possibilities.

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12:00 – 12:45 p.m. Lunch break

12:45 – 2:00 p.m. Present small group findings and discuss

scenarios as a large group

• Each small group presents its assigned scenario. Allow time for clarification and
Q&A.
2:00 – 2:45 p.m. Identify patterns and insights

• Where do you have choices to make? What triggers were identified for each
scenario?
• Use the Strategy Evaluation template to cross-walk scenarios with current
strategies, Appendix C:
o Option 1: complete this step at the end of the scenario planning session
o Option 2: complete this step during your strategic planning session
2:45 – 3:00 p.m. Next Steps

• Review with the large group that the scenarios will be tracked and monitored so
they can be used as a guide for making strategic choices over the coming six to
18 months.

3:00 p.m. Adjourn

• Follow up: Thank participants, prepare a summary of work and use the
developed scenarios for strategic planning.

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Identifying and Monitoring Milestones
Next, identify specific milestones, or triggers, that allow the organization to watch
for signs developing within the environment that a scenario is playing-out. The
goal, while monitoring, is to avoid being surprised by changes in the environment
that impact the organization’s strategic objectives.
Within the scenario, each small group discusses the following questions and records
a list of milestones, or triggers, for the organization to watch for and monitor over
the coming six to 18 months. Use the Scenario Monitoring and Tracking Chart,
Appendix D.
• For each scenario, what are the milestones, or triggers? Identify significant
changes in the environment that we would anticipate within this scenario.
Identifying these milestones will tell us that our scenario is beginning to
come true.

• What date do we anticipate each milestone coming true?

• Use the Scenario Monitoring and Tracking Chart, Appendix D, over the next
six to 18 months to track changes in the environment identified as
milestones, or triggers, within each of the scenarios. This task should be
assigned to an individual, or a small group, and reported to leadership on a
quarterly basis.

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 APPENDIX

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Appendix A: Facilitating Scenario Development
The goal of scenario development is to identify specific scenarios that are described
well and with enough shared understanding that future planning will be effective
and will continue forward with all participants engaged in the process.

Step 1: Selecting a Scenario Development Method

A) 2x2 matrix includes using the two selected factors to label the axis using
polarities such as, “amount of” by “degree of” or “level of” by “presence of”.

For example:
On the x axis (horizontal) we are going to use the driver identified as ‘having
the highest impact on our organization’. In our example, this is
“collaboration”. Place the factor with the ‘highest’ degree of impact to the
right and one with the lowest degree of impact to the left.
On the y axis (vertical) we are going to label with the issue, ‘trend or factor
identified as having the highest uncertainty’. In our example, this is
“funding”. Identify the top of the axis with the most positive, or abundant
uncertainty of the factor, and the bottom of the axis with the most reduced,
or diminished uncertainty of the factor.

B) Branching: If there is one easily agreed-upon impactful factor, use the

branching method of scenario development. Using the agreed-upon factor as the
initial branch and then creating cascading branches for the unique way things could
develop from there.

Example:

During the presentation of issues and information, it becomes clear that the results
of a local election to be held within the next six months will have the most impact
on your organization’s future. Use “election results” as your initial branch, then use
other factors as cascading branches.

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If there is no clear consensus about which factor is most impactful and which factor
is most uncertain, you can facilitate group consensus by using any one of the
following methods:
• If there is clear consensus on a few factors, use those to create scenarios.
• If there is still no clear consensus, ask participants to explain why they
identified the factors they chose. Then, complete a second round of
prioritizing the top four to six issues from the first round; using asterisk or
dots to identify the top four to six issues. The goal is to find the two issues
that will structure the scenario narratives.
• Another option is to hand out index cards, one per participant. Ask each
person to write their top three uncertainties and their top three impactful
factors on the card. Have the individuals share their thoughts in pairs and
then have the pairs report out the large group their top impactful and top
most uncertain factors. Capture the report out on a flip chart. From this
narrowed list, use group discussion, or a second round of “voting”, to identify
the most impactful factor and the most uncertain factor.

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Step 2: Facilitator’s Worksheet
Appendix B: Scenario Development Worksheet
Within each small group, it is time to develop the scenario and imagine the
situation. Complete this scenario development worksheet and be prepared to report
out to the larger group. The results of this work will be used for the next steps of
scenario planning, including a cross-walk with current strategies.
“Thinking through [scenario] stories, and talking in depth about their
implications, brings each person’s unspoken assumptions about the
future to the surface. Scenarios are thus the most powerful vehicles I
know for challenging our ‘mental models’ about the world and lifting
the ‘blinders’ that limit our creativity and resourcefulness.” Peter
Schwartz, The Art of the Long View: Planning for the Future in an Uncertain World

For the scenario you have selected to work on:

• What are the factors or themes that are key descriptors of this scenario?
• What might this scenario’s environment ‘look like’? This is initial
brainstorming and ‘imagining possibilities’. These are early thoughts for
developing the narrative or story of the scenario.
• If this scenario does happen, what might be an impact on our mission and
vision?
• In what way are the scenario factors working together that describes a
unique scenario?
1) Scenario Title: Now as a small group, agree on a descriptive and easy to
remember title for this scenario, for example, a name of a song or show, or a
catchy phrase or metaphor.

2) Scenario Narrative – The External Environment: And lastly, within the small
group, paint the picture of the environment that would unfold as a future
environment. Describe the situation or tell the story that illustrates the situation.
For example: What is happening? Who are the players? What are the possible
events? Remember during this point we are thinking about the external
environment, not the internal reaction to the environment. Note: a sample
description is included at the bottom of this Appendix B.
3) “How is this scenario influencing us?” The internal reaction to the
environment: Using the narrative description of the scenario, what are the
implications or ramifications IF this scenario develops? As a small group, answer
the following questions and be prepared to report out to the large group a summary
of your discussion.
• Is there still a “fit” between our product/service and this environment?

• What capabilities will be needed?

• What are our present strengths/weaknesses/gaps in these capabilities?

• Who will be successful in this scenario? Why?

• Who will not be successful in this scenario? Why not?

• What are the risks to the organization?

• What might be good business or a good position in this model world/this

scenario?

• What is the likelihood of this scenario developing?

• What are the potential triggers / early warning signs this scenario is playing
out?

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Sample of Scenario Title and Description

This sample scenario title and description illustrate the importance of a title that
participants can remember and provide a shared understanding of the scenario.
Gaining consensus on the description will help keep planning moving ahead.

Title: “Joy to the World”

Description of the external environment within this scenario: In the next
funding cycle, our funding is increased by 25%. The federal government has
identified opioid use as an epidemic. We are expected to increasingly work with
community organizations on this issue. Schools, churches and volunteer
organizations are ready and willing to collaborate with us to supply a diverse
workforce. Partners are working well together. Social determinants of health are
being addressed by a coalition of highly collaborative partners.

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Appendix C: Template for Strategy Evaluation
As a large group, after each small group has reported the scenario title and
narrative, have the following discussion to identify how current strategies fit,
become ineffective or are not relevant within the different scenarios.
Within each scenario, moving across the row, answer the question for each
strategy, either as a yes or a no, “Does this strategy fit as a strategy?” In other
words, will it be an effective strategy within this scenario to move us toward our
vision?

Cross Walk Scenarios with Current Strategies

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Appendix D: Scenario Monitoring and Tracking
Use the Scenario Monitoring and Tracking Chart over the next six to 18 months to
regularly track changes in the environment identified as milestones or triggers
within each of the scenarios. This task should be assigned to an individual, or small
group, and reported to leadership on a quarterly basis.
Scenario Monitoring and Tracking Chart

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