Dynamic Modelling to improve Renal Services

improving quality and efficiency of renal services

The demand for renal services has been growing at a significant rate over the last decade and DHBs are faced with demands for increasing investment in facilities.

ISSUE
Many Boards have invested in better and larger facilities only to find that their estimates for demand have fallen well short of reality; the new facilities that they thought were going to be sufficient for ten years are already overflowing. Now they are faced with the requirement for further investment in dialysis facilities and no confidence that their investments will be sufficient.

The rising tide of chronic conditions, resulting in renal failure and ultimately the need for dialysis, is becoming a major concern for DHBs who want a robust planning process to support the design of a sustainable renal service which gives them greater ability to predict and manage demand and thereby manage costs more effectively. They know they have to invest but they do not want to be on the back foot, responding to continual demands for new staff and new facilities.

To solve this problem Synergia utilised dynamic simulation modelling techniques to provide a robust analysis of what was driving demand and what options the DHB had to manage it. The modelling not only provided a robust tool to forecast demand under a range of scenarios but also a tool to understand the nature of the service and how it could be redesigned to meet both clinical and management requirements.

The DHB had made significant improvements in its service over the last few years, extending its dialysis facilities and recruiting more staff. However, the service was stretched with staff focusing on day-to-day coping strategies, moving and shifting patients to free up machines for unexpected arrivals and/or acute emergencies. Little if any development work was being undertaken as staff had no free time to do it. They were acutely aware that care was sub-optimal. It was a service on the 'backfoot' coping with the demand, but only just. Adequate facilities quickly became inadequate and an unplanned request for additional facilities was made. An unhappy Board had little choice but to fund the request but demanded that the situation be addressed so that they would not be faced with more unpleasant surprises. There was a strong desire to ‘get on the front foot’ and develop a plan that was based on a robust and realistic understanding of demand and the resources needed to manage it.