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Misguided Attempts to Control Productivity Leave Burned Out Practitioners on Tilt

February 03, 2020

By H. Steven Moffic, MD
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

“When all of the scheduled patients show up, it makes work unbearable. Taking a break to use the bathroom or eat is then a luxury.”

— A physician

In studying and writing about burnout in healthcare professionals, I thought I had heard about all the systemic problems, and there are many. Electronic health records geared more to billing than patient care. Inadequate time with patients. Administration disengaging clinicians from developing workplace policies and procedures. And more. But I must admit that I just heard of a new one that may be coming to our workplaces. This is the control of bathroom breaks.

Now, physicians, especially surgeons, have always had to find ways to build in bathroom breaks in a tight schedule. If surgeons had a long surgery to do, they had to plan for a bathroom break. For instance, I’ve heard of vascular surgeons going to the bathroom or getting a soda after heparin was given to the patient, since they had to wait five minutes to proceed anyways.

However, something new maybe coming our way from the United Kingdom. Productivity in general has been stagnant there since 2008. Enter the StandardToilet Company. They have developed a toilet that slants forward in front, making it too uncomfortable for loitering. In Scotland, call center staff had to sign a contract limiting toilet breaks to 1% of their shifts. Not only that, but there is some concern that bathrooms can be places where workers, especially women, express anti-company sentiment and even discuss what to do about it. In the USA, a union filed a complaint against a Chicago-based workplace for “bathroom harassment.”

Perhaps it sounds absurd or a source of jokes. And it couldn’t come to a mental healthcare setting, could it? Keep in mind 10-minute medication checks sounded absurd not long ago and are now commonplace.

Actually, in health and mental healthcare, research continues to indicate that controlling is of limited benefit for productivity. Rather, it is the quality of the workplace that does. Engaging clinicians and other staff in how to address productivity seems crucial to avoid burnout. Wouldn’t it be better to hear constructive criticism in a staff meeting rather than reading it on bathroom graffiti? 

Allowing staff to have some service discretion is also helpful. You may have other strategies, but I would not recommend controlling bathroom breaks. They are necessary not only for physical comfort, but sometimes for a mental health break to, as one colleague said, relieve one of any sort of “toxic waste.”

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