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Facilitator's Note, 19 November 2019: Phase 4 Instructions

Hi Everyone,

 We have reached Phase 4 of our Trust CoLab scenario development process. Thanks so much for all your thoughtful contributions to date. Based on your inputs, we have now developed a scenario framework. This creates 4 “alternative futures”, designed to help us explore specific questions about the evolution of trust in medicine and health care from now until 2040.

In Phase 4, we’d like you to react to each of these scenario outlines. We have provided a number of prompt questions to guide your responses. More detailed guidance about the scenarios – and our request of you – can be found below. 

Please click on one of the four scenario summaries at this page: and respond to the prompt questions.  The deadline for Phase 4 submissions is Sunday November 24 at 11.59 pm ET. 

Best wishes,


Creating the scenarios
We created four scenarios based largely on your Phase 3 supports and comments, and also on your Phase 2 ‘combination storylines’. While we couldn’t do justice to the full variety of inputs we received, we settled on some of the most important issues that you raised:

  • An axis that focuses on the distribution of healthcare access and advances (drawing largely on issues relating to inequality and the scope of the healthcare system). 
  • An axis that focuses on data/AI and the resulting medical technology developments (drawing largely on issues relating to big data, AI, genomics, personalization).

Combining these axes creates a 2x2 framework containing 4 different scenario outlines. These scenarios are NOT predictions about what will happen. Instead, they should be seen as 4 distinct possibilities about what might happen. 

We would like you to offer your reflections on these outlines by answering a series of 4 prompt questions. Two questions ask for ideas on how to develop the storylines to make each of the scenarios more coherent and powerful. The other two questions invite you to think about some of the implications for trust, safety and regulation in each of these future worlds. 

Your contribution this phase
For each of these scenarios, we’d like you to provide responses to a few prompt questions.

Media headline
Think of an important or 'emblematic' event that could occur between now and the year 2040 in this particular scenario. Write a media headline describing the event—and don’t forget to include the year.

What would you add? 
We have provided only a very basic framework and description for each scenario. What themes or developments would you add to make this scenario more powerful and coherent? How it could be improved overall?

Role of trust
What happens to trust in this scenario? What people, organizations, or systems will underpin patients’ trust in medicine and health care in this scenario in 2040?

Tension between innovation and safety
How will the tension between innovation and safety in medicine and health care be negotiated in this scenario by 2040? What role might regulatory policy and industry standards play in managing any tradeoffs?

Some things to remember

  • We’ve described the scenarios in very high-level terms, providing only a very short description for each.  These are outlines and we want you to fill in the details.
  • Sometimes you will need to make assumptions about what else happens in this scenario, in addition to the brief description.
  • Don’t feel that you have to answer every question for each scenario. For example, you might want to focus on one of the questions and apply it to each scenario. Or you might prefer to choose to only think about one scenario and look at all the questions for that scenario.
  • Remember, we are looking for ideas, not fully completed responses. We would like each participant to contribute as much as possible. 
  • Some of these scenarios are more appealing than others. You might think some are more likely to occur than others. But the purpose of this exercise is not to focus on which issues that are more desirable or probable. Rather, the goal is to envisage a range of possible futures that might emerge, and explore the consequences of each of them.