Abstract for: Exploring the Role of System Dynamics in Transition Design: A Case Study of Unplanned Dialysis Prevention in Thailand

Chronic Kidney Disease (CKD) affects 788 million people globally. As the disease progresses and patients experience kidney failure, they will require dialysis to sustain life. However, due to the complex multi-stakeholder coordination required for treatment planning, approximately 45% of CKD patients in Thailand initiate dialysis unplanned. Unplanned dialysis is associated with higher morbidity and mortality rates, accruing preventable strain to the workforce and budget. We employ a transition design approach to choreograph a shift to a more coordinated system. We hypothesise that there are at least three ways system dynamics can contribute to the transition design process: firstly, to set a shared vision for transition, secondly, to help ground theories of change, and thirdly as a tool to aid transitionary policy design by building models that can be adapted for use over time. In our work, we conducted a series of interviews and co-design workshops with key stakeholders using an experience-based co-design approach (EBCD). In our analysis, we consolidated a problem tree and developed an early draft of a causal loop diagram from the interview and workshop inputs. We learned that priority is often given to mitigating critical situations with unplanned dialysis rather, thereby detracting from long term solutions rooted in prevention. We hope to identify and set priorities for policies to tackle the problem of unplanned dialysis by developing a system dynamics model for unplanned dialysis and integrating it with an existing model for dialysis policy in Thailand to test the wider implications of the suggested policy interventions. Beyond Thailand, we hope to reveal and demonstrate the potential contributions of system dynamics modelling to complement transition design processes.