Dynamic Modelling to improve Renal Services

Outcome

OUTCOME
Synergia’s approach, using system dynamics modelling, led to a greater understanding amongst management and clinical staff of what was driving demand and what options the DHB had to develop different responses. This led to a better understanding of the impact of managing aggravating factors, managing renal disease, and investing in primary care, on the dialysis volumes and the dialysis treatment options. The outputs of the model suggested that whilst the total demand volumes would be very difficult to change in the medium term, changing the renal service practices within the hospital and in their relationships with the primary sector could have a significant impact upon the level of dependence exhibited by patients and consequently the modality choices available to them.

The modelling was also used to develop future scenarios based on different mixes of these intervention strategies. As a result the DHB discovered that they could have a major impact on the volume and type of dialysis treatments for their patients and that simply increasing in-centre facilities was not the only option. This understanding had consequences worth millions of dollars for the DHB.

From a service on the ‘back foot’ they are now a service with a sense of control over their destiny. Their particular concerns are understood and their approach is being supported. Over the next decade the demand for renal dialysis services will increase and unless the health system is going to limit access renal services will need to be expanded. However, this work has shown that despite the ageing population it does not mean a continual increase in expensive in-centre facilities.

The use of simulation modelling increased understanding and blew away a number of untested myths about the growth in demand and the service responses required. Good service design, and an understanding of the characteristics of demand within a given population can lead to far more innovative options that are less expensive and, most importantly, far better for patients.