Monday, October 19, 2020

The Agency Model

Even before COVID shone its ugly light on an extremely fragile and broken aged care system I had flagged the “agency model” of staffing in health care a really bad idea.  Yet in many areas from nursing to aged care it is the system of choice.  In order to explore this topic fully, I’ll start by giving you a short history of my experience with the system, the pros and cons and lastly a few other observations before I give you my summation.


So, where did I first see the agency model in action?  Well, agencies specialising in health care have been around as long as I can remember and they are important.  They were designed to fill gaps in health care facilities when someone is sick, on holidays or there is an sudden and unexpected gap in the staff roster.  But it raised alarm bells for me when I was admitted to a ward in a Sydney hospital 20 years ago for a kidney stone operation and it seemed that all the ward nurses were employed by an agency, not the hospital.  Interestingly enough, this was not the case in the operating theatres, only on the wards and I’ll explain why I believe this the case later.


In terms of pros for the agency model, I have already touched on one and that it makes it easy to keep the roster full in a profession where understaffing is not just problematic, but dangerous.  The second reason is that it is easy.  As any business owner that employs people knows, it is not an easy employing people, there is tax to pay, holiday and sick leave to accrue, superannuation, payroll tax etc…  Outsourcing staffing cuts down on your own administrative needs.


Before COVID, I identified two massive reasons why the agency model was a bad idea.  First, patient care.  This should be the most important thing in the running of any health facility.  Sadly it has taken a back seat to administrative streamlining and bureaucratic workload minimisation.  Now I don’t want to make the point that agency nurses are worse than other nurses.  They aren’t.  They are fully qualified and just as competent but they are almost being sent to work with one hand tied behind their back.  Over any given reporting period they can be working at multiple centres at irregular hours.  Being unfamiliar with the individual procedures at a facility and not knowing anyone else or where anything is means they cannot be as competent as other fulltime staff.  This not only decreases patient care standards but can endanger lives.


The second point is nurse and carer welfare.  Most nurses and carers would love a full time gig but the truth is when you just start out you have to work with an agency.  This can be daunting if you are fresh to the industry with no experience.  The hospital won’t put any time into training you because you probably won’t be there next week and they expect you to hit the ground running because they paid for a health care professional, not a trainee.  Think about what stress and pressure this puts nurses under and what it does to their mental health.  It’s really quite disgusting for what is probably the most vital, skilled and underpaid profession in our society.


However, since COVID another reason has come to light. Infection transmission.  In the age care system, which relies heavily on the agency model, COVID ran through aged care facilities like wildfire because infected workers were working at multiple facilities.  If they had only been working at one, they would have been able to contain the problem far easier if they could limit it to only one or two facilities.  This argument does not stop with COVID either.  Any contagion from flu to staff infections could potentially be spread in this manner.


The big question is what do we do about it?  The solution is easy.  The government needs to install a quota for staff in healthcare.  For example, a hospital has to have 90% of its staff as either permanent or fulltime staff.  It also needs to go further than that by saying that any department has to a minimum of 70% full time staff at any time so the 10% agency staff do not simply get dumped into the most undesirable department and shift.  It would also be advisable to disallow any temp from working in more than 3 facilities over a 30 day period.  There would be a lot of backlash against such measure, but the health industry would adapt and patient care would benefit.


Until next time,


Stay well

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