Facility based Hemodialysis (HD) treats over 75% of Canadian patients with kidney failure. HD in Winnipeg costs approximately $60,000 per patient annually and predictions indicate this population will double within the next 10 years. This research investigates workflow bottlenecks for improvement in HD units of Winnipeg Health Sciences Centre. A validated discrete-event simulation (DES) model is built to evaluate different strategies in HD care processes for improvement based on proposed alternatives for renal program workflows. Simulation modeling is used to study the behaviour change of entities and resources in HD systems. Proposed alternative scenarios in the simulation model examine key performance indicators (KPIs) including wait-time to start dialysis machines, length of stay, and percentage of times that dialysis machines start within the target time. The application of proposed improvement strategies results in desirable outcomes on KPIs up-to 31%. The solution can be applied to support future HD units’ improvements.