Dynamic Modelling to Support CollaborativePlanning and Decision MakingCase StudiesOctober 2012David ReesFounding PartnerSynergia Ltd
Long-Term Planning in Local Government (2011/12) (Work Conducted for District Council) David Rees, Synergia, Auckland, New Zealand While they had detailed and robust ﬁnancial planning underpinning their Long Term Plan, a District Council found it diﬃcult to respond quickly to requests for alteraIon to the plan. What would be the consequences, for example, of shiLing a major capital project back by two years? What would be the consequences of adding or deleIng any of the projects currently in the plan? While their ﬁnancial models were detailed and robust, they were unable to answer quesIons such as these in an easy, ﬂexible and speedy way. The development of a dynamic simulaIon model, calibrated with their own ﬁnancial model, provided them with a tool that enabled them to conduct mulIple ‘what-‐if’ scenarios. The model ‘dashboard’ allows them to quickly modify assumpIons in their LTP and see the consequences for revenues, expenditures and their overall ﬁnancial posiIon over the lifeIme of the LTP.
Using Systems Modelling to Integrate Multiple Workstreams within Energy Sustainability Research (2011) (Work Conducted for University of Otago Energy Research Centre) David Rees, Synergia, Auckland, New Zealand Faced with data coming from mulIple research streams within the mulI-‐disciplinary research team, the research centre wanted ways of integraIng their ﬁndings. The purpose of the modelling was to disIll the key ﬁndings from the diﬀerent research streams and any uncover issues that may have emerged during the research process. Phase II of that research project is now underway and over the next four years we will be working with the research team, using dynamic modelling to integrate the research workstreams, and use the simulaIon capabilites to explore future scenario arising out of the research. Phase II (2012 – 2016)Energy Culture IIEnergy sustainability in households,transport and SMEsRenewable Energy & the SmartGridExploring the supply and demanddynamics in a future based on extensiveuse of renewable energy sources
Regional Transport in Canterbury: Health Impact Analysis (2010) (Work Conducted for Environment Canterbury) David Rees, Synergia, Auckland, New Zealand Dr. Adrian Field, Synergia, Auckland, New Zealand In October 2009 Environment Canterbury iniIated a Health Impact Assessment (HIA) of its Regional Land Transport Strategy. The aim of the HIA was to assess the links between transport planning, health determinants, and health outcomes for the Canterbury RLTS. This simulaIon model supported the HIA by exploring the links between transport planning and health outcomes that were idenIﬁed in the iniIal scoping workshop. The HIA idenIﬁed some of the linkages, such as those between safety and cycle use and focused its analysis on three key areas; safety, mode choice and healthier environments. The aim of the simulaIon model was to help inform policy by quanIfying some of the key linkages and the size and Iming of potenIal health impacts resulIng from policy opIons being considered in the RLTS.
Op$ons for Demen$a Care (2010/11) (Work Conducted for Health Workforce New Zealand) David Rees, Synergia, Auckland, New Zealand Geoﬀ McDonnell, AdapIve Care Systems, University of NSW Dr. Ray Naden, Clinical Director, Synergia In work we undertook for Health Workforce New Zealand, Synergia explored the opportuniIes for improving care for people with moderate demenIa in the home and community secngs, and the potenIal impact this may have upon admissions to aged residenIal care (ARC). The report provided an overview of the modelling used to explore the dynamics of home-‐based care – speciﬁcally carer stress – and its impact upon reducing admissions to ARC. The report then provided a descripIon of the models of care required to bring that reducIon about. Because demenIa is an area in which there is a paucity of data, our modelling had to bring together informaIon from a number of sources. Furthermore, it had to allow a range of scenarios to be run under a range of diﬀerent assumpIons. The model allows stakeholders to obtain a richer understanding of what the future possibiliIes are, the constraints upon those possibiliIes, and the variables that have an impact upon determining which scenario is more likely to come to pass.
A Population-Based Approach to Planning Mental Health Services in Primary Care (2010) ((Work Conducted for Health Research Council) David Rees, Synergia, Auckland, New Zealand Philip Gandar, Synergia, Auckland, New Zealand The issues that any region faces in planning Primary Mental Health Care (PMHC) are varied and complex. There is no one soluIon that can be applied across the country, and because of this it is important that planners in each region know their own populaIon and its needs, and the characterisIcs of the people and resources who can respond to them. This model is designed to help facilitate conversaIons about PMHC in local regions, so that they can design soluIons that best ﬁt their parIcular circumstances. It takes a systems approach because we know investing in that any soluIon that does help improve mental health services will be funds service improvement capability of required to address many issues. IsolaIng a single issue simply will not resources available service amount of work. To facilitate the conversaIons we have designed a model of the key elements within PMHC and how those elements link together. The access resources investing in social levels demand determinants model of careinvesting in risk management need for MH adequacy of requirements model is based on our conversaIons with planners and providers within each DHB and focuses on key themes that are common across all. Social services provider resources Strength model of change in care social strength average level of individual functioning attributes prevention & management of risk factors developing moderate developing severe quality of symptoms symptoms care No Significant Mild Moderate Severe Symptoms developing Symptoms becoming Symptoms becoming Symptoms symptoms moderate severe recovering recovering recovering mild moderate severe Requiring Secondary PMHC entering Care discharging from interventions secondary care secondary care <funds available> SMHC interventions service provision
Review of Aged-‐Care Workforce (2010) (Work Conducted for Health Workforce New Zealand) David Rees, Synergia, Auckland, New Zealand Geoﬀ McDonnell, AdapIve Care Systems, University of NSW Dr. Ray Naden, Clinical Director, Synergia A System Dynamics (SD) Model was designed to provide a framework for meeIng the challenge of Older People Receiving developing and managing the future aged-‐care workforce. It did so by describing the dynamic Care relaIonships between older people in need of health care services, the services that have been established to respond to those needs and the workforce that exists within each service. Service Configuration Central to the model is the key quesIon; “What is the workload that the workforce has to undertake?” Furthermore, the model highlights that workload is a funcIon of those receiving care and the conﬁguraIon of the services designed to provide that care. Trainees Workforce In addiIon, the conﬁguraIon of the services is a funcIon of the work needed to be done and the workforce able to undertake it. As a consequence, discussions about future workforce requirements has to be based on an understanding of the dynamic interplay between each of the three elements. The need for care was modelled by using funcIonal impairment as the key modiﬁable factor. The data for calculaIng this was taken from the Department of StaIsIcs and from the Australian Bureau of StaIsIcs survey of disability, ageing and carers, which was calibrated for the New Zealand populaIon. This survey (which is a self assessment) provided the best available data on the likely levels of funcIonal impairment (disability) in the populaIon. FuncIonal impairment was deﬁned as any limitaIon, restricIon or impairment, (physical or cogniIve) which has lasted or is likely to last for at least 6 months and restricts everyday acIviIes. Model projecIons indicate that those 65+ with severe funcIonal impairment will rise from 127,874 in 2010 to 207,409 by 2026. Research indicates that the rates at which people develop funcIonal impairment could be reduced by as much as 30%. If this did occur the numbers of people with severe funcIonal impairment would rise to 175,178, by 2026; a reducIon of 43,000 when compared with the baseline.
Exploring the Impact of Adherence to Asthma Medication onHealthcare Utilisation (2010) (Work Conducted for private healthcare provider) David Rees, Synergia, Auckland, New Zealand Recently a private healthcare provider completed a trial of a medicaIon adherence programme, which involved targeted text messaging designed to change percepIons and improve adherence to asthma preventer medicaIon. The results were impressive, showing a 39% increase in adherence, versus the baseline, aLer 6 months. The quesIon that this raised for the Company was whether or not this improvement could have signiﬁcant enough impacts upon healthcare uIlisaIon to jusIfy further investments in the programme. Of special interest was whether or not the impact upon healthcare uIlisaIon could be signiﬁcant enough to interest Pharmac in supporIng the programme. To help answer this Synergia was commissioned to develop a dynamic simulaIon model that could explore the impact of increased adherence, generated by programme, on healthcare uIlisaIon. This would then enable the Company to make a more rigorous assessment of its commercial viability in the New Zealand market.
A Whole of System Approach to Compare Op$ons for CVD Interven$ons in Coun$es Manukau, New Zealand (2009) (Australia New Zealand Journal Of Public Health. (2012) Volume 65, Issue 3.) Timothy Kenealy, SecIon of Integrated Care, South Auckland Clinical School, University of Auckland, New Zealand David Rees, Synergia, Auckland, New Zealand Nicolese Sheridan, SecIon of Integrated Care, South Auckland Clinical School, University of Auckland, New Zealand Allan Moﬃs, Director of Primary Care, CounIes Manukau District Health Board, New Zealand Sarah Tibby, Programme Manager, Long term CondiIons, CounIes Manukau District Health Board, New Zealand Jack Homer, Homer ConsulIng, Voorhees, New Jersey, United States. Objec$ve To assess the usefulness, to planning and funding decision makers, of a naIonal and a local System Dynamics model of cardiovascular disease. Methods In an iteraIve process, an exisIng naIonal model, based on earlier work by Jack Homer, was populated with local data and was presented to Tobacco taxes andstakeholders, in CounIes Manukau, New Zealand. They explored the Quality of primary care provision Use of primary care Anti-smoking sales/marketing regulations social marketingplausibility, usefulness and implicaIons of the model. Data were Sources of Use of smoking quit products andcollected from 30 people using quesIonnaires, and from ﬁeld notes and stress servicesinterviews, both of which were themaIcally analysed. Use of mental health services by stressed Smoking bans at work and public placesResults Stressed Use of quality Sm oking fraction primary carePotenIal users readily understood the model and acIvely engaged in Prevale nce Secondhanddiscussing it. None disputed the overall model structure, but most Diagnosis and control smokewanted extensions to the model to elaborate areas of speciﬁc interest Particulate airto them. Local data made lisle qualitaIve diﬀerence to data Uncontrolled pollution Chronic DisorderinterpretaIon but was nevertheless considered to be a necessary step Pre vale nces Poor dietto support conﬁdent local decisions. fraction High blood pre ssureConclusion High First-tim e CV e vent and death Obesity cholesterolSome limitaIons to the model and its use were recognised, but users Prev alence Diabetes rates Recurrent CV ev ent and de athcould allow for these and sIll derive use from the model to qualitaIvely Inadequate ratescompare decision opIons. physical activity fraction Non-CVD Post-CVDImplica$ons Use of weight loss People Popn First-tim e PopnThe System Dynamics modelling process is useful in complex systems services by obese turning 35 events surv ived CV e vents and deaths Non-CVD Popn Post-CVD Popnand is likely to become established as part of the rouInely used suite of deaths deathstools used to support complex decisions in CounIes Manukau District Health Board. Keywords Cardiovascular diseases, system dynamics, populaIon health, decision making, health care quality access and evaluaIon