RENEW-a renal redesign project in predialysis patient care.
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.


CONCLUSIONS
Change management strategies with successful implementation are vital components of evolving clinical practice to achieve both clinical and organizational goals.
Clinical Innovation & Business Unit, South Western Sydney Local Health District, Clinical Stream Office, Liverpool Hospital,Reception Point 101, Clinical Building, Locked Bag 7103, BC1871, Liverpool, NSW 2170, Australia; University of Sydney, Sydney, NSW, Australia; University of Tasmania, Hobart, TAS, Australia.
Josephine
J
Sau Fan Chow
Clinical Innovation & Business Unit , South Western Sydney Local Health District, Clinical Stream Office, Liverpool Hospital, Reception Point 101, Clinical Building, Locked Bag 7103, BC1871, Liverpool, NSW 2170 , Australia.
Kim
K
Jobburn
Clinical Innovation & Business Unit , South Western Sydney Local Health District, Clinical Stream Office, Liverpool Hospital, Reception Point 101, Clinical Building, Locked Bag 7103, BC1871, Liverpool, NSW 2170 , Australia.
Margaret
M
Chapman
Clinical Innovation & Business Unit, South Western Sydney Local Health District, Clinical Stream Office, Liverpool Hospital,Reception Point 101, Clinical Building, Locked Bag 7103, BC1871, Liverpool, NSW 2170, Australia; University of New South Wales, Sydney, NSW, Australia.
Michael
M
Suranyi
change management; clinical redesign; dialysis; home dialysis
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