The formation of Integrated Care Systems (ICSs) has seen health and social care organisations and their partners coming together to view the delivery of care at a system level.
This systems thinking approach starts to formally recognise that NHS organisations and systems have always been linked informally as networks, where organisations are independent but intrinsically interdependent and interlinked, where the actions and position of one can impact many. Think of it as like a galaxy, where each planet is on its own, but intrinsically forming part of a delicate dynamic with other planets within its solar system and those solar systems within a wider galaxy. Any small adjustment to one of those planets can upset the whole ecosystem – from the local solar system to the wider galaxy, until the whole system settles into a new equilibrium.
Taking this teleological lens, we can start to understand why complex issues such as high-cost agency spend, are best explored at a system-based level.
Many People leaders in health and social care will recognise how their own recruitment and retention strategies have been impacted by the action of neighbouring partners within the system, such as a local competing hospital implementing new spot rates or incentives for bank staff, drawing their own bank workforce away to other providers.
From the lens we have just explored, when this action happens often the impacted organisation has no choice but to follow suit and implement the same pay approach, until a new equilibrium is reached.
Whilst the initial action taken to increase the rates for bank staff gave the first organisation the initial edge, once others follow suit and reach that new equilibrium the competitive edge is removed. With no competitive edge differentiating between employer offers, we settle back into the old dynamic, albeit with a new baseline, where in trying to compete or keep up, we’ve now baked in additional costs.
I often describe this simplistically as the butterfly effect – the local actions of one organisation ripple out across systems and regions. So, in considering how best to tackle a complex problem like high-cost agency spend in a way that reduces short-term thinking, it’s best to do this at a wider, macro level, working together with partners and stakeholders to ensure that actions taken have been explored for unintended consequences and support the collective whole.
For more information about how SCW can support bringing organisations and stakeholders together to tackle high-cost agency spend, contact
