Professor Alan Hedge’s 3000-page, CuErgo “dinosaur” – his description – is antediluvian by design. The ergonomics website of Cornell University (CU), it dates from the very dawn of the Internet, and its present-day style of text-only links and data evokes that era. This dinosaur is evolving—holding on to its signature characteristics, but shifting its focus to healthcare-related ergonomics in response to today’s needs.
It is well fed with information from research studies and class work by students and faculty of the Cornell Human Factors and Ergonomics Research Group (CHFERG), which is directed by Professor Hedge, in the Department of Design and Environmental Analysis. The site focuses on ways to enhance usability by improving the ergonomic design of hardware, software, and workplaces to enhance people’s comfort, performance and health. CUErgo refers to its approach as ergotecture.
The professor founded the venerable resource in 1993, and has maintained it from the start. He explained in a June interview with The Ergonomics Report® that he wanted to keep the website simple because many visitors from around the world are coming on from a slow dialup. “So the last thing I want is all the singing, dancing stuff on there.”
The user statistics for the site, which has the high Google ranking of 7/10, suggests visitors don’t miss the singing and dancing: The figures would delight any search engine optimization expert. The CuErgo home page alone drew some 900,000 visitors between November 1997 and June 2009. A visitor counter on one page, “Ergonomic Guidelines for arranging a Computer Workstation,” shows almost half a million visits as of 22 June 2009.
One draw for visitors is the feast of evaluation forms, surveys, worksheets, assessment forms, estimators, tip lists, checklists and other tools. The Musculoskeletal Discomfort Questionnaire has been translated into Spanish and Turkish, and soon will be available in Farsi for Iranians.
Two tools on the site, RULA (Rapid Upper Limb Assessment) and REBA [Rapid Entire Body Assessment], are noteworthy for their utility and as markers in the evolutionary process.
A postural targeting method for estimating the risks of work-related upper limb disorders, RULA was developed to evaluate people doing sedentary work by ergonomists Dr. Lynn McAtamney and Professor E. Nigel Corlett from the University of Nottingham in England. Professor Hedge describes it as a tool that can be used for a quick answer to whether a person is more at risk or less at risk. He added that most of the RULA evaluations were conducted on computer workers.
“REBA came along later [in the late 1990s] … for jobs like nursing,” the professor explained. “Nurses don’t spend a whole lot of their time sitting down, so it became clear that there was a need for another tool … that would address standing work.” Ergonomist Dr. Sue Hignett at the University of Nottingham and RULA’s Dr. McAtamney developed REBA. “Sue works on healthcare, so the focus of that was very much looking at standing work and the standing work of nurses.”
There was little development of tools specifically for healthcare settings until hospitals started to computerize, the professor explained. “We began looking at that issue first.”
Healthcare and End Users
CuErgo’s evolution reflects the growing preoccupation with healthcare reform in the United States. More and more tools on the site will be developed for the healthcare environment, the professor said, “because that’s one of the growth areas at the moment for ergonomics. Four or five tools on the site focus specifically on looking at healthcare settings."
The professor noted that hospitals are being transformed into electronic workplaces, with patients electronically monitored and nurses needing to enter and retrieve information with computer systems. The Obama administration’s “huge push” for healthcare reform has meant $19 billion to develop a standardized, computerized health care delivery system across the nation, pressuring hospitals to update and upgrade their computer systems. The push, he said, has led to the development of equipment like the computer cart, “because you can’t have a nurse carrying the computer around everywhere, and they have to have other things that they can more around as well.”
Because of hospitals’ rapid adoption of computer technology, the professor said, the CuErgo focus on healthcare computerization began with the needs of radiology departments. That is where you have very intense computer use, he added, with a radiologist sitting there for a couple hours at a time looking at multiple screens and trying to figure out what is wrong with a patient. “The first tool we developed for that was the Digital Reading Room Ergonomics Checklist. The idea there was that most reading rooms in hospitals were designed for film-based systems, and simply bringing computers in and computer screens without changing anything about the room led to a suboptimal environments and suboptimal performance.”
He added the Healthcare Computer Cart Ergonomic Checklist in 2009, and the Healthcare Computer Wall-station Ergonomic Checklist followed recently. This latest tool features 20 items, and users respond with a binary Yes/No on whether the wall-station satisfies the item or not. They address the important ergonomic design considerations, and all dimensions are based on the latest anthropometric data for US adults. It can be used to evaluate a single wall-station or to compare multiple wall-station designs.
The professor observed that hospitals “are expanding their capabilities like crazy, … building new wards, new facilities.” Typically, new hospitals put a wall unit in every patient room, assuming that “it is also going to improve the ergonomic design of the delivery of the technology for the nurse or the physician.”
The most recent trend is this big push to improving the patient experience and being able to share medical information with patients at their bedside, he said, and “there is this move now to try to have adjustable wall units in every patient room so that the nurse or physician can come in, they can pull up information, they can show it to the patient they can then enter any other information in there into the unit. It’s fixed into the wall, moves up and down and adjusts to different heights.”
A Focus on Checklists
The parallel evolutionary path for CuErgo is the focus on checklists. They widen the use of the site’s tools to end users who are not necessarily ergonomists. “When you look at the rate at which healthcare is growing and the number of healthcare establishments—there are about 600,000 healthcare establishments in the [United States]—about 1 percent of those are hospitals. There are about 300 people in the human factors healthcare technical group. I mean there is no way the professional [ergonomist] can deal with the latent demand here. That is one of the reasons, beginning with the reading room checklist, that we switched from developing assessment forms or evaluation forms to developing checklists.”
They are different from other tools on the site, he explained. Typically what happened before the development of checklists for healthcare was the development of tools such as surveys questionnaires, evaluations forms or assessment tools,” he said, but these are designed for interpretation by professional ergonomists. In the present situation, end users might not have the skill level to use them and need something simpler.
With no real guidance out there for choosing carts and wall units, he said, planners don’t know how to choose from the products on the market. All the manufacturers say their units are ergonomic, so, without help, the hospitals might be left simply with picking “the one that looks the prettiest.” He described checklists as “a quick and systematic way of comparing different designs.”
A checklist is really something that the end user can use, he said, because you are basically going through and saying, “’Does it do this? Does it do this? Does it do this?’ And at the end of the day, you can add up and, Wow! There are 20 things and it does all 20. That’s a good design. Or here are 20 things and it only does five of them. That’s not such a good design. So the checklist is really something that is aimed at the end user.”
He noted that the checklists are used by ergonomists at some of the hospitals he is consulting with. “Typically, they are using it as one component in their ergonomic process.”
The Question of Motivation
The one thing that was very clear from visiting CuErgo and interviewing Dr. Hedge was the amount of work involved in setting up and maintaining the website. “I don’t sleep as much as I should,” he responded when asked where and how he finds time in a punishing academic schedule to serve the needs of his dinosaur.
He said he started CuErgo as a means of sharing the work of the Cornell Human Factors and Ergonomics Research Group, situated in a university town in the middle of nowhere, with the world. "Who’s going to bother coming here? I couldn’t be out there getting information to people, so I wanted to make information as readily available as possible – plus the fact that Cornell’s what’s called the land grant university for New York State. [This means] part of our academic mission is to make scientific information accessible to the lay public [and] to help them as much as possible.”
Along the way, the national and international attention the site attracted – as evidenced by the web statistics for CuErgo and the professor’s email in-box – shows the world appreciates sharing what CuErgo has to offer.
The benefits appear to be mutual: “To be able to keep in contact with the world and to have people contact you about things, the website is just fantastic,” Professor Hedge said.
Sources: Professor Alan Hedge; http://ergo.human.cornell.edu/
This article originally appeared in The Ergonomics Report™ on 2009-06-24.