Troubleshooter: How to survive dental practice that does not allow breaks

QUESTION: For the last 20 years in our dental practice of 15–20 people, we have never had scheduled lunch breaks. Each staff member takes a break when the schedule allows, and most breaks are taken while standing up in the break room. Our assistants and hygienists typically have back-to-back schedules with no blocks for lunch or any type of breaks. The owner-dentist's reasoning is that we always have cancellations in the schedule, which allows for breaks.

I recently posted this on our whiteboard: “If you had the power to change anything here, what would it be?” A couple of replies referred to lunch breaks and breaks in general. Our doctor believes if hygienists are scheduled for a half-hour lunch, that is half an hour of no production.

A couple of years ago the doctor had everyone sign a consent to waive their half-hour meal break, which is required by law in our state. We do have some who are happy to work the entire day without having to punch out and lose a half hour of pay, but there are others who want the freedom to take a break. I would like to facilitate a change. I just have no idea how to start, how to develop a solution, and how to implement it.

ANSWER FROM REBECCA BOARTFIELD, HR specialist at Bent Ericksen & Associates:
As you have already indicated, your state employment laws require meal periods. While it may be part of your culture to forego a meal period, clearly by your description that is not working for everyone. This unhappiness could very likely lead to one of your employees filing a claim against your employer for not providing meal periods as required, and in doing so, this could end up being quite costly for your employer.

In doing research for my response, I came across several articles that point out liability that has befallen other employers in your state and warn of the potential for serious liability if employers fail to provide meal periods to their employees.

One article states: "As the Attorney General indicates, however, an employee may voluntarily waive the meal break. Of course, such a waiver must be obtained from the employee without any coercion or pressure. Because of the risk involved in meal break violations, if an employer allows employees to work through breaks, we recommend that it obtain written waivers of the meal break period. A written waiver will help demonstrate that the employee voluntarily waived his or her right to a break."

I do not recommend ignoring those employees who do not like the practice of not taking meal periods. I also would not wait to make a change.

Going forward, for those who wish to keep things status quo, allow them to move forward, assuming they signed a waiver. For those who wish to keep things status quo but have not signed a waiver, have them do so immediately. For those who do not wish to keep things as they are, immediately revoke the waiver (if they signed one) and change their schedules such that they can now begin to take a lunch break as allowed by law.

I also caution against retaliation toward anyone who revokes their waiver of a meal period. These people should not be harmed in any way as a result of availing themselves of a meal period that is absolutely their right.

Unfortunately, you are in a position in which you must make your employer aware of the unhappiness some of the employees have with this cultural practice as well as the risks of continuing in the same direction. There is only one fix, which is what I described, that will prevent possible liability, and it may not be the one that is the most agreeable to the employer. There really isn't a perfect solution that will make everyone happy.

It is worth remembering that full meal periods can result in happier, healthier employees who may be more productive. Meal periods can reduce employee burnout and turnover. These factors may actually offset some or all of the lost production due to scheduled meal periods.

ANSWER FROM JULIE WHITELY, BS, RDH, hygiene consultant and certified in human resources:
I admire your willingness to step up to identify potential problems and seek solutions. It seems we’ve shifted to a culture where it’s more the norm to walk away from a situation that frustrates us before we determine if something can be done to change it. Employers are not always in the loop when it comes to how employees are feeling about office decisions or working conditions. Without that knowledge even those employers who are willing to make changes are left unaware. I think it is wonderful that you’re looking for alternatives in a respectful and professional way.

Now on to your question! Do you know what costs employers more in production than unpaid break time? Decreased employee morale, which can show itself in anything from a decrease in productivity, increased sick time, increased turnover . . . the list goes on. A break during the workday has many positive benefits for employees and employers.

• Increased job satisfaction
• Increased motivation and performance
• Increased movement, which can help to combat some of the physical issues that can accompany a dental career
• Decreased sick time and decreased turnover from less stress, burnout, and injury and pain
• Increased productivity

That last one often surprises people. Some believe that the more someone works, the more productive they are. This may be true to an extent, but there comes a point where the opposite is actually true. Fatigued employees will not have the same level of motivation as ones who are refreshed. For example, is your ability to relate to patients compromised after many hours without a break? This can lead to patient dissatisfaction and decreased patient retention rates.

Are your skills as sharp when you’re tired and sore? Likely not. Do you have the patience to educate patients on needed treatment when you’ve been with patients for seven hours straight? It is likely easier to defer that FMX until “next time,” or do a prophy on a patient who may need more therapeutic care? This adds up to lost production and revenue. There is also a decrease in the quality and standard of patient care, as well as a less-than-desirable work climate. This may cause some employees and patients to look for another practice.

All that being said, I cannot help but wonder if the no scheduled breaks issue is a symptom of a much bigger problem in your office. You mentioned that the decision has been made to waive your right to a break because there are always holes in the schedule, which allow for impromptu breaks. When we have times allocated for patient care and there is no one in the chair, it is far more costly than the “productivity lost” during a 30-minute unpaid lunch break period.

Your office may want to take the opportunity to address where these holes are coming from and create plans to minimize these openings. On average in your state, a one-hour missed hygiene appointment can result in a loss of a couple of hundred dollars of production, not to mention the restorative treatment that will not be diagnosed and planned. Consider the cost if this is happening daily or multiple times per day.

My advice to you is two-fold. First, respectfully request a time to meet with the practice owner. Depending on your comfort level, this can be done alone or as a group with other employees. Approach the conversation from a business vs. emotional standpoint.

Second, I would address the elephant in the room. The loss of productivity from unpaid breaks doesn’t seem to be the main issue. The holes in the schedule are an issue. Offer that you would like to propose to work with the doctor and team to brainstorm why this is happening and develop systems to minimize this issue, as it has the ability to greatly limit the practice over the long term. It’s a two-part problem. One is the loss of revenue and growth from the unfilled appointment slots. The other is the dipping morale and loss of productivity and employee retention that can come with waiving meal breaks. You need to address both.

I would recommend that you come up with ways to track the open time, where it is coming from, and if your newly implemented systems are helping bring down that number. Value needs to be created around these appointments with your patients. What we say, how we say it, how we schedule and track recare, and what we say to patients when they fail or cancel appointments is important. I encourage you and your team to explore this together.

Again, I commend you for your efforts. We are health-care providers focused in the field of prevention. We need to practice what we preach, and self-care (in the form of taking breaks in this case) is important for our wellness and ability to be the best for our patients. It is up to the practice owner to decide the culture he wants to represent and how he manages the practice. In much the same way, it’s up to us to determine where we’re able to compromise and where a work situation may no longer suit our value system.

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