Across more than a hundred healthcare presentations, one through-line has guided the work: helping leaders see what is coming next—and why they can no longer wait to act. The clips you are about to see, taken from a keynote given more than ten years ago, should feel both familiar and unsettling. They highlight how stubborn some of our fundamental challenges have been.

Bending the cost curve remains elusive. Despite waves of initiatives, the system continues to reward volume more reliably than value. Hospital sustainability still depends on more than margin management; it demands a deeper ethic of accountability and stewardship.

Authentic engagement means more than measuring satisfaction—it means centering patients lived experience in how care is designed and delivered. And increasingly, mobile data functions as the hospital’s information nerve center, shaping decisions in real time.

Today’s environment calls for practical futurism. Traditional forecasting tools that extrapolate yesterday’s data, protect legacy box structures, and perpetuate delivery systems that neither bend the cost curve nor address structural inequities are no longer adequate. Practical futurism asks us to redesign care around the hard trends we cannot escape: an aging population, the growing burden of chronic disease, and the digitization of everything.

That redesign is not just technical; it is moral. It requires the courage to change institutional priorities, to invest in minimizing and preventing illness rather than only treating it more efficiently once people are already sick, and to do so even when the current model still generates revenue.