#004 Wins in the Workplace: Bleep free breaks - Dr Aneliya Kuzeva

Grievance/initial motivation

Personal experience during nightshifts when I noticed that junior doctors were regularly doing 12 hours shifts without a single break and being bleeped for jobs that are non-urgent at any time of the night. I spoke with others who had felt the same and agreed that changes were needed.

Research – what information did you have to find out to ensure that you had all the necessary facts and couldn’t be tripped up at any point? How did you go about finding this information?

I collected information through a survey to assess whether my impression of lack of breaks, and the resulting increased stress level, was indeed shared among larger group of junior doctors.

Then I asked for information from switchboard for the number of bleeps on average received by FY1s during the night shift.

I reviewed the junior doctor contract for rules around breaks: it stipulates that we are entitled to one 30 min break after 5 hours, a second 30 min break after 9 hours and breaks should be taken separately but if combined must be taken in middle of shift. Our trust was in a position where we did not have any way to guarantee that a junior doctor takes even one break overnight.

Target – as a result of your research, which individual, group, committee or organization did you identify as having the power to enact the change you wanted to see?

The BMA representatives (I was also part of this group) as well as the Guardian of Safe Working and the chief registrars.

Allies – who did you identify as potentially on your side?

Foundation doctor representatives, Chief Registrars, Guardian of Safe Working, BMA Reps

Resources – what resources were available to help you win? This could include volunteers, online survey tools, social media skills, negotiation skills etc.

Small working group meetings with the stake holders identified above.

Barriers – what were the main things in your way? This could include apathy amongst your supporters, push-back from your target or anything else that you found challenging.

We had to find and implement a simple universal change that could work in the two sites of the Trust.

Strategy – Based on your research and an understanding of your target, allies, resources and barriers, what strategy did you then employ to win?

Survey, data gathering and working group as above. When we had our idea for bleep-free breaks, we also involved senior nurses in order to help convey the message as this could only work if everyone understood and was on board.

Outcome – what happened?

We introduced a ‘’bleep free’’ period of one hour when the nursing team would only bleep for true emergencies/unwell patients. At the point when I left the Trust, we had just initiated the pilot trial to run at one site of the hospital. If successful, it would have been extended to both sites and become a permanent arrangement.

Evaluation

1. What went well?

2. What went not so well?

3. What could be done differently next time?

4. What could the BMA do to help support and replicate the success of this campaign in future in other locations?

5. What advice would you give to other doctors wanting to do something similar?

The idea was well received by senior members of the management and many senior staff are passionate about juniors wellbeing which helped implement this change. Even then as this change involved multiple different departments and members of the management team it took long time before we were able to come to an agreement and start the trial, approximately 6 months. The BMA are able to help with successful suggestions from other trusts.

My advice to others looking to do something similar -

Aim to find someone as passionate as you are to support at more senior level. When you present your case and idea people can be extremely helpful and willing to support you. You just need to persevere, dedicate some time and keep the momentum of good work going.

If you’d like to ask Aneliya any questions or are considering running a similar campaign in your own workplace, you can email her on aneliya.kuzeva@gmail.com