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The 3 Horizons Framework: Future-Proofing Healthcare with the Right Innovations

As we plan for the future of healthcare, it’s important to focus on the sustainability and future viability of the system rather than just patching up existing issues with short-term solutions.


The 3 Horizon Framework by McKinsey presents a useful model. It helps us think and plan for the long-term rather than being stuck in the present, missing opportunities, or not spotting risks and decisions that will not stand the test of time.


What is the 3 Horizons Framework?

future of healthcare with the 3 horizons framework

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Horizon 1 (H1) represents the current state of our healthcare system. It is a system that is not built for the future and is losing its fit-for-purpose. Which is why we need to think about H3.


H3 is the horizon that represents the desired future. It is what we want our healthcare system to look like. H2 is the gateway to that better future. 


H2 sits between the present and the aspirational future. It represents disruptive innovations that can facilitate the transition to H3. However, as shown in the graph above, this horizon can be further subclassified: H2+ and H2-. The H2+ innovations help us reach H3, but H2- solutions return us to H1, which is not where we should be. 


Where are we now?


H1 is a system that is not maintainable. 


It is reactive and too heavily depends on urgent care. It is a system that, while functional now, isn't built to support future needs. Its decline is bound to happen because it is inherently flawed and functionally unfit for purpose, and it will also decline because of the eventual rise of better ways of accomplishing said purpose.


We are currently progressing towards H3, with more H2 innovations being rolled out. But it's important to remember that there are innovations that can form the base for H3, and those that merely resolve current problems without guaranteeing their long-term sustainability—H2+ and H2- innovations, respectively.


What type of innovation do we need?


So not all innovations are created equal.


An H2- innovation simply solves a problem that is happening now, but not in a sustainable manner—it isn’t built to last.


A good example of such technologies are legacy monolithic electronic health records (EHRs). Despite their age, their roll-out across healthcare systems continues at pace. They are expensive to implement, maintain, and configure due to their long development cycles and complexity. Interoperability projects fail to be realised due to spiralling development charges. The net result is that providers become locked into static or slowly adapting infrastructure that drains organisational budgets and mindshare. Eventually, this drag impacts innovation and slows progress towards H3. 


In contrast, H2+ innovations help deal with current problems while also providing for the future and actually helping to change ways of working to move away from the status quo. 


For example, highly configurable cloud-native modular clinical systems that align with current and future state care pathways and delivery models. High adaptability and a low latency of change allow the technology to move with the organisation as it grows and care pathways evolve. Improved user experience can help drive improved data quality, which sets the foundations for the next horizon, including for technologies like AI, where data quality will become an increasingly key component. 


Essentially, H2+ innovations provide foundations to build upon—foundations that are future-proof and robust so healthcare can usher in a sustainable H3 future.


Building a foundation first


There is still one consideration that needs to be remembered but is often overlooked.


And that is the tendency to leap directly to H3 without adequately addressing the right foundational innovations. 


You cannot jump over several layers of technology and innovations that are significantly further along the H3 path without first establishing the groundwork for the future. You should be wary of implementing AI trained on substandard, incomplete data sets captured via monolithic EHRs. The clinical literature is littered with research papers highlighting the poor results and clinical impact of such implementations, with sepsis alerts being one of the most high profile examples.


In a resource constrained environment, which is the reality most healthcare systems are facing, it is important that investments are made correctly. Leaders should recognise that the need for consistent investment in building strong foundations is the most reliable way to achieve success than gambling for a ‘home run’ H3 win. 


Consciously navigating towards H3


So the 3 Horizons Framework helps us understand what is failing in H1 and why, what we want H3 to look like, and the H2 innovations that will get us there.


But what is increasingly important to keep in mind is the difference between H2+ and H2- innovations. We need to think critically about the future and implement innovations that can help us reach H3, not those that keep us stuck in H1.




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