Last week in The Ergonomics Report™ I wrote about recent research on people’s ability to multi-task, noting that we often believe we’re effective multi-taskers but, for the vast majority of us, the research proves otherwise. Researchers did identify a small percentage of people, dubbed "supertaskers", a topic I’ll revisit later in this article. In the article I shared my opinion that ergonomists need to consider mental loading — or cognitive ergonomics — as well as physical loading.
Some ergonomists focus primarily on the physical nature of a task, looking at physical loading risk factors like force, posture, repetition and duration, but tend to overlook mental loading, or cognitive ergonomics issues. There are many jobs that require multi-tasking, both physical and cognitive. Complex systems, such as the control rooms in an oil refinery or power plant, the cockpit of a jet aircraft, and even an automobile, all require performance during a complex mix of tasks, and the human loading is often more cognitive than it is physical in these environments.
Don’t design for the rare supertaskers; do design for the rest of us.
So, I was happy to stumble across this article on foodservice kitchen design, Designing an Efficient Kitchen, that focuses on "Crew-Centric Design" (human centric design = ergonomics) and contains a section on cognitive ergonomics.
Ergonomics is the science of designing a job, equipment or workstation to reduce effort, strain and injuries. This typically applies to physical design applications such as making sure the grill or prep table isn’t too low to cause back strain, or positioning a broiler overhead so it’s not high enough to cause visual impairment or burn accidents.
Ergonomics can also apply to the mind. According to principles of cognitive ergonomics, assessing the learning and mental processing capabilities of kitchen staff is just as important as preventing injury. “The brain can only handle so much,” Martinez says. “It’s all about how you communicate information.”
Ergonomics in Healthcare — So Many Opportunities
Electronic Medical Records (EMR)
Maybe you’re old enough to remember the 1980’s, when computers began appearing in offices. Remember how the monitors, CPUs, keyboards and mice were just thrown onto desks that were designed for writing and reading tasks? For many, that equipment/task/person incompatibility led to pain, injury, and a stagering negative impact on productivity, quality, and human resource costs. Well, as Electronic Medical Records systems are becoming a requirement, guess what’s happening? That’s right, computers and their accessories are being lugged around by hand, or simply dumped in already cramped healthcare facility spaces.
Writing in the Wall Street Journal, Personal Finance Editor Andrea Coombes provides a first hand observation of a growing problem for healthcare providers — ergonomics, or the lack thereof.
… Over the last year, when I’ve gone to my doctor I’ve noticed an increasing number of nurse practitioners walking from patient to patient lugging laptops, into which they spend a lot of time peering during exams — the machines sometimes perched on their knees as they hunch over them. While I love the potential for greater efficiency and the immediate access to information, I do miss talking with caregivers whose attention is a little less divided …
One thing seems likely. The growing use of information technology in the doctor’s office will create a whole new class of patients: nurses and doctors whose backs or shoulders give out on them. Read her complete comments …
Fortunately, there are systems and equipment specifically designed to improve the ergonomics of medical recordkeeping, and healthcare facilities will do well to invest in good design, or pay the price — likely a very heavy price — in the future.
But there are far more opportunities for improved ergonomics in EMR than protecting and improving the performance of caregivers alone. What about the patient?
Pauline W. Chen, M.D., writing in the New York Times (An Unforeseen Complication of Electronic Medical Records), shares her experience the first day new EMR computers arrived:
… as I settled in to see my first clinic patient, I realized I had no idea where to sit. The new computer was perched atop a desk in one corner of the room; the patient sat on the exam table on the other side of the room. In order to use the computer, I had to turn my back to the patient as I spoke to him. I tried to compensate by sitting on a rolling stool but soon found myself spending more time spinning and wheeling back and forth between patient and computer than I did sitting still and listening. And when my patient did talk, his story came only in spurts because every time I turned my back to him to type, the room fell silent …
… just because EMR improves information sharing and retrieval, it doesn’t necessarily follow that our communication with patients and colleagues will also be better.
Doctors often must consider several issues simultaneously when seeing a single patient — all the potential diagnoses and possible treatments, the patient’s history and list of medications, any possible adverse effects or interactions, the limits of that patient’s health care coverage and numerous preventive health issues, to name just a few of those considerations. The addition of an electronic records system can push some doctors into what one EMR expert refers to as “cognitive overload.” [emphasis mine]
Hmmm. "Cognitive overload" sounds a lot like something a professional ergonomist could help with (see Cognitive Ergonomics, above). I’m guessing that many physicians might consider themselves "supertaskers," but I’d be willing to bet that, as a group, they are no better at multi-tasking than most others, and that they are more likely to make errors under multi-tasking conditions.
Good ergonomics, like good healthcare systems, require a comprehensive approach that considers the entire process, start to finish, and includes both physical and cognitive ergonomics perspectives (see Human Systems Integration, below)
Report: Safe Practices for Better Healthcare
We’ve written many times about the unnecessary and avoidable errors in the delivery of medical care. Ergonomics plays an important role in understanding the root cause of errors, and in the design of systems, equipment and processes that will reduce those errors. The National Quality Forum (NQF) is an organization whose goal is to improve the quality of healthcare. They’re releasing an update to their manual Safe Practices for Better Healthcare. I’m glad to see at least one prominent Ergonomist on the advisory committee: Pascale Carayon, PhD, Proctor & Gamble Bascome Professor in Total Quality, University of Wisconsin-Madison.
According to NQF,
- Preventable medical injuries are actually on the rise—by one percent a year
- Healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year
- At least 1.5 million preventable drug events occur each year due to drug mix-ups and unintentional overdoses
- Eighteen types of medical errors account for 2.4 million extra hospital days and $9.3 billion in excess charges each year
- Preventable errors have been estimated to cost the United States $17 – $29 billion per year in healthcare expenses, lost worker productivity, lost income and disability
The 10 Commandments of Ultrasound Ergonomics
Carolyn Coffin and her colleagues at Sound Ergonomics have been on a mission to improve the ergonomics of ultrasound for at least the last decade. Coffin and her colleagues have been instrumental in design improvements among ultrasound equipment manufacturers, and are also responsible for the creation of the S’Ergo Shoulder Assist, a portable device designed to support the sonographer’s arm in the extended positions required by the task. This is a simple but effective article that uses the following list of "sonography sins", including pictures, and then presents a best practice for each scenario that will reduce the exposure.
Sonography Sin No. …
- Arm abduction
- Going beyond your reach
- Excessive neck flexion and extension.
- Twisting your neck
- Twisting your trunk
- Bending your trunk
- Wrist flexion and extension
- Using a pinch grip
- Improper seating and sitting postures
- Not moving enough
Last week we published an article, 3 Step Process to Reduce Caregiver Error in the Selection of Safe Patient Handling Equipment, by guest contributor Jill Kelby. The article was very well received, and I encourage you to read it if you missed it. Jill, through her company, Ergo-PATH System, will also be presenting a series of seminars titled Safe Patient Handling System: How to Design, Implement and Sustain SPH for Long Term Success. Ergoweb and Ergobuyer are sponsoring the seminar series, and we encourage anyone dealing with the challenge of establishing a sustainable safe patient handling process to attend.
Ergonomics and the Upper Big Branch Mining Disaster
The American Psychological Association interviewed Steve Shope, PhD, using the recent Upper Big Branch coal mining disaster as an example of the need for better Human System Integration (HSI). HSI, in my opinion, is another phrase that means the same thing as, or falls within the broad scope of, ergonomics. Definitions aside, Shope makes a good case for the role of ergonomics, — or human factors, or whatever we might call it — in creating a safe system.
There is a rapidly growing field of science called Human Systems Integration (HSI), which looks at ways in which humans and complex systems can be better integrated. This field encompasses human factors training, command and control, decision making, fatigue, team work, and ergonomics. Human factors is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system. NASA and the Department of Defense (DOD) both have large research efforts in HSI. It is my feeling the integration of HSI research and methodologies can make a tremendous improvement in mine safety and mine efficiencies.
New Long-Term Study to Investigate Health Risks Mobile Phone Emissions
Over the years we’ve written many times about research into possible health risks associated with the use of cell / mobile phones. Most of the studies have failed to identify a link between mobile phone signal emissions and ill effects like cancer, but like all scientific endeavors, many questions remain. This major long-term study, called Cosmos (cohort study on mobile communications), is designed to probe the question deeper.
The project will recruit 250,000 phone users across five different European countries including the UK.
It will last between 20 and 30 years and aims to provide definitive answers on the health impacts of mobile phones.
Research to date has shown no ill effect, but scientists say those studies may be too short to detect longer term cancers and other diseases.