1. Dynamic Modelling to Support Collaborative
Planning and Decision Making
Case Studies
October 2012
David Rees
Founding Partner
Synergia Ltd

2. 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.

3. 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 II
Energy sustainability in households,
transport and SMEs
Renewable Energy & the Smart
Grid
Exploring the supply and demand
dynamics in a future based on extensive
use of renewable energy sources

4. 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.

5. 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.

6. 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 care
investing 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

7. 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.

8. Exploring the Impact of Adherence to Asthma Medication on
Healthcare 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.

9. 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 and
stakeholders,
in
CounIes
Manukau,
New
Zealand.
They
explored
the
Quality of primary
care provision
Use of
primary care Anti-smoking
sales/marketing
regulations
social marketing
plausibility,
usefulness
and
implicaIons
of
the
model.
Data
were
Sources of
Use of smoking quit
products and
collected
from
30
people
using
quesIonnaires,
and
from
field
notes
and
stress services
interviews,
both
of
which
were
themaIcally
analysed.
Use of mental health
services by stressed
Smoking bans at
work and public
places
Results
Stressed Use of quality Sm oking
fraction primary care
PotenIal
users
readily
understood
the
model
and
acIvely
engaged
in
Prevale nce
Secondhand
discussing
it.
None
disputed
the
overall
model
structure,
but
most
Diagnosis
and control
smoke
wanted
extensions
to
the
model
to
elaborate
areas
of
specific
interest
Particulate air
to
them.
Local
data
made
lisle
qualitaIve
difference
to
data
Uncontrolled
pollution
Chronic Disorder
interpretaIon
but
was
nevertheless
considered
to
be
a
necessary
step
Pre vale nces
Poor diet
to
support
confident
local
decisions.
fraction
High blood
pre ssure
Conclusion
High
First-tim e CV
e vent and death
Obesity cholesterol
Some
limitaIons
to
the
model
and
its
use
were
recognised,
but
users
Prev alence
Diabetes
rates Recurrent CV
ev ent and de ath
could
allow
for
these
and
sIll
derive
use
from
the
model
to
qualitaIvely
Inadequate
rates
compare
decision
opIons.
physical activity
fraction Non-CVD Post-CVD
Implica$ons
Use of weight loss People
Popn
First-tim e Popn
The
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 Popn
and
is
likely
to
become
established
as
part
of
the
rouInely
used
suite
of
deaths deaths
tools
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