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Health care organizations’ decision-making for the future relies on anticipating changes. Reliable predictions are becoming increasingly difficult, creating anxiety and requires long-term adaptive planning to cope with unforeseen circumstances. The purpose of this study is to gain insights into the awareness of uncertainties that decision makers in healthcare have, particularly when making long-term investments.

This is a qualitative study with an explorative purpose. The data were collected through semi-structured and open interviews with board members of long-term care organizations.

The study revealed that respondents are most uncertain about the future financing of their real estate system. Another concern revealed is about the shortage of care professionals combined with an increasing demand for future care. Despite most decision makers do recognize uncertainties during the decision-making process, decision makers hardly address the level of these uncertainties. Although this study did find that some decision makers are aware of deep uncertainties, in terms of “unknown unknowns,” they have no actual approaches for dealing with such situations.

Decision makers at healthcare organizations are uncertain as to their ability to anticipate technological, economic, social and political developments, as well as predict future healthcare system transformations. Some decision makers are aware of deep uncertainties, in terms of “unknown unknowns” and “unidentified unknowns,” but they lack an actual approach to deal with such situations. This study examines how strategies adapt to unforeseen developments or how to deal with deep uncertainties in healthcare as complex adaptive system.