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. 2016 Oct;9(5):748-54.
doi: 10.1093/ckj/sfw081. Epub 2016 Sep 20.

RENEW-a renal redesign project in predialysis patient care

Josephine Sau Fan Chow  1 , Kim Jobburn  2 , Margaret Chapman  2 , Michael Suranyi  3
Affiliations

RENEW-a renal redesign project in predialysis patient care

Josephine Sau Fan Chow et al. Clin Kidney J. 2016 Oct.

Abstract

Background: An ageing population and geographical growth, along with an increase in the number of people that reside in specific location, are increasing the demand for renal replacement therapies. Hospital-based haemodialysis units are struggling to cope with the associated physical, staffing and cost demands. Home-based dialysis therapies are known to be more cost effective with superior social, physical health and survival outcomes.

Methods: 'RENEW, a renal redesign project, examined the pre-dialysis health care experience of renal patients to find opportunities to improve patient care outcomes and increase the uptake of home-based dialysis therapies. This article details two crucial parts of the approach to change management: (i) diagnostics-an inclusive, client focused, multidisciplinary approach to identify issues relating to the pre-dialysis journey-and (ii) solution design-an inclusive problem-solving approach to identify and marry solutions to the issues identified during diagnostics.

Results: Based on feedback from patients/caregivers and staff interviews, utilizing a clinical redesign methodology, a new model of care was developed, implemented and subsequently embedded into clinical practice. The results have been evident via improved care coordination, enhanced patient preparation for dialysis, improved patient psychosocial welfare and, importantly, an increased number of patients planned for and commencing home dialysis. This has empowered patients by giving them the confidence, knowledge and skills to be actively engaged in their own care. The project resulted in significant expenditure avoidance.

Conclusion: Change management strategies with successful implementation are vital components of evolving clinical practice to achieve both clinical and organizational goals.

Keywords: change management; clinical redesign; dialysis; home dialysis.

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Figures

Fig. 1.
Fig. 1.
Governance structure for the RENEW Project.
Fig. 2.
Fig. 2.
Patient survival—Australian and New Zealand Data (ANZDATA) Registry, PD, 2007–12.
Fig. 3.
Fig. 3.
Technique survival—Australian and New Zealand Data (ANZDATA) Registry, PD, 2007–12.
Fig. 4.
Fig. 4.
Pre- and post-implementation interviews of patients and caregivers.
See this image and copyright information in PMC

References

    1. Kidney Health Australia. Chronic Kidney Disease in Australia 2015. http://www.kidney.org.au/health-professionals/prevent (December 2015, date last accessed)
    1. Population and Public Health Division. New South Wales Admitted Patient Report 2012. Sydney: NSW Ministry of Health, 2012. http://www0.health.nsw.gov.au/pubs/2012/pdf/admitted_patient_rpt2012.pdf (July 2014, date last accessed)
    1. Agency for Clinical Innovation. 2014.
    1. Agar JW, Hawley CM, George CR et al. . Home haemodialysis in Australia—is the wheel turning full circle. Med J Aust 2010; 192: 403–406 - PubMed
    1. Health Policy Analysis. NSW Dialysis Costing Study, 2008, commissioned by the Statewide Services Development Branch. NSW Department of Health, Sydney, NSW, Australia, 2009

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