Scheduling Time for Breaks, Lunch, and Kaizen

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Call me old fashioned, but I figure any employee who works a full day deserves proper breaks, including a lunch break. This is true for nurses who work ten hour shifts. And, it’s especially true for the 65% of nurses who have worked a 12 or 13-hour shift. Many studies show that fatigue and errors increase with the longer shifts, putting patients at even more risk than usual.

While proper breaks might be a good idea for patient safety, quality, and employee satisfaction, breaks are not legally mandated under federal law and the law of most states. I still think they are a good idea and leaders should make it a priority to provide proper breaks.

Toyota makes it a priority, realizing that production associates who are rested will be more productive and will make fewer errors caused by mental or physical fatigue. Of course, it’s easier to choose to shut down a production line… there are still patients who require care in most hospital settings. So, hospitals should plan properly to provide coverage for breaks (although handing off a patient, if not done carefully, can introduce other risks).

Far too many nurses don’t get to take breaks. Hospitals are often short-staffed due to job vacancies. From one study:

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On 10 percent of the shifts, nurses reported no opportunity to sit down or eat a meal; on 43 percent of the shifts, nurses grabbed something to eat while responding to call lights or other patient needs.

Rogers found nearly 40 percent of nurses surveyed worked shifts longer than 12 hours, but the long workdays were not associated with an ability to enjoy a rest period. In fact, the numbers went down.

Forty-nine percent of nurses working shifts of 8.5 or fewer hours were able to escape patient-care duties during a break, compared with 46.7 percent working shifts of 12.5 hours or more. And the percentage of shifts free of patient-care duties decreased to 30 percent when nurses worked 20 or more consecutive hours.

The study surprisingly claims longer 12-hour shifts don’t lead to an increase in errors. Hmmm.

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If a hospital can’t find a way to provide proper rest breaks for nurses and hospital staff… if they can’t have the time to sit and rest and have a proper lunch break (or dinner break), that’s a fundamentally bad working environment, I’d say. Hospitals need to do better. It’s amazing that nurses care so much that they’d power through a lack of breaks or eat a few bites here and there on the run.

I talk a lot about the power of engaging hospital staff in Lean and Kaizen-style continuous improvement. Nurses and other hospital staff respond incredibly well when asked to bring forward and implement ideas that improve the workplace and patient care. This past week, I saw a radiologist help implement a small Kaizen idea (one that cost basically nothing to implement) that freed up enough time to generate an additional $800,000 in revenue each year. Other staff in radiology and pharmacy have been participating in Kaizen activities. Nobody has complained about a lack of lunch or break time, thankfully.

At other hospitals, nurses, physicians, and other healthcare professionals can’t participate in Lean or Kaizen if they don’t have time.

If the first Kaizen card that’s submitted by an employees says “let us have lunch breaks,” maybe there’s not enough basic stability in the workplace for Lean or Kaizen to work… unless we can solve that problem and help prevent mental and physical fatigue.

If somebody can’t get breaks or a meal, I wouldn’t blame them for not having the energy to participate in healthcare improvement.

As they say — take care of the staff so they can take care of the patients (and so they can improve healthcare).

Photo used under Creative Commons license from Flickr user mwichary.

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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an book titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

4 Comments

  1. Don Sharpe says

    “If the first Kaizen card that’s submitted by an employees says “let us have lunch breaks,” maybe there’s not enough basic stability in the workplace for Lean or Kaizen to work…”
    The ER nurses I work with frequently put in for OT to compensate for having to skip lunch breaks due to inadequate staffing & call volume.
    As a Paramedic I don’t get a scheduled break and our unit hour utilization is unmatched in Emergency Services… The answer? We make our own breaks, we hide, we are slow to complete charting… & patient care suffers.
    Some days it’s about survival. Yet our senior managers never seem to miss a meal or go home on time. Funny, that.

    1. Mark Graban
      Twitter:
      says

      I wish more hospital managers would be LEADERS, following the example from the military, where “leaders eat last.”

      10. Leaders Eat Last – Don’t eat until everyone else on your team does. You sacrifice personal interests and self-serving actions to support your team. This is symbolic of what should drive many of your decisions, and who knows, maybe you’ll shed a couple extra pounds you’ve been lugging around, too.

  2. Karin Anderson says

    I am working on a PDSA for much needed lunch breaks. I have had a few in my 25 years as a staff nurse. We are split between units, we are not lean and cannot figure out why lean did not work. I blame it on the pixis, and poor design of the hospital. I know that is the major problem of our unit.

    1. Mark Graban
      Twitter:
      says

      Hi Karin – Thanks for your comment. I’m glad you’re working on ways to be able to take the breaks that nurses need and deserve.

      What do you mean by “Lean did not work?”

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