Scheduling Time for Breaks, Lunch, and Kaizen
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:
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.
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.