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  1. Outline • What is ergonomics? • Benefits, concepts, factors, injuries, etc. • Ergonomics for Healthcare environments • Challenges, opportunities, main characteristics. • Example on Body Map • Exercise Ergonomics

  2. Ergonomics “The science of fitting the job to the worker”. • Multidisciplinary Nature of Ergonomics • Anatomy and physiology • Engineering Psychology • Engineering • Medicine • Anthropology • Biomechanics Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  3. Ergonomics

  4. Ergonomics

  5. Benefits of Ergonomics • Decreased injury risk • Increased productivity • Decreased mistakes/rework • Increased efficiency • Decreased lost work days • Decreased turnover • Improved morale Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  6. Ergonomic Concepts • Tool Design • Workstation Design • Material Handling Limits • Visual and Auditory Task Design Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  7. Factors Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  8. Psychosocial Factors • Significant Findings • Fear of being replaced by computers • Enlarged Jobs • Uncertainty about job future • Work pressure • Lack of co-worker support • Lack of productivity standard • Lack of participation in decision-making • Perception management not value ergo Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  9. Target Regions • Back • Lower Extremities • Upper Extremities Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  10. Design and Disease Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  11. Static Exertions • Holding activities • Carrying • Standing • Pushing and pulling • Arms raised Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  12. Ergonomics Stress Areas Hip Knee Source: Ergonomics for the 21st Century Ergonomics

  13. Workplace Indicators • Performance deterioration…Engineering • Quality Control problems • Absenteeism and turn-over…Human Resources • Musculoskeletal disorders…OSHA Logs WC reports • Complaints of fatigue and discomfort Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  14. Repetitive motion injury Cumulative trauma disorder Musculoskeletal disorder (MSD) Types of Injuries • Muscle pain • Joint pain • Swelling • Numbness • Restricted motion • Repetitive stress injury Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  15. Control Technology • Tool redesign • Workstation redesign • Job methods • Early detection • Job rotation • Machine pacing • Medical surveillance Source: http://www.usmra.com/repository/category/Ergonomics/Ergonomics_3.ppt. Ergonomics

  16. Static Work Position • static muscle strain • poor blood circulation • accumulation of waste • products • acidification • cramp • pain/discomfort • less movement insufficient nutrition of cartilage and discs Source: BMA Ergonomic-Biomechanics in Office Seating Course Name

  17. Sitting position (incorrect chair) Facet joints opened Wrong 15° Wrong Support of ischia and coccyx Source: BMA Ergonomic-Biomechanics in Office Seating Ergonomics

  18. Sitting position (correct chair) Facet joints closed Right 5° Pelvis support Right Coccyx free from seat Support of ischia Source: BMA Ergonomic-Biomechanics in Office Seating Ergonomics

  19. Correct Workstation reading/writing computer screen Source: BMA Ergonomic-Biomechanics in Office Seating Ergonomics

  20. Correct Workstation Source: BMA Ergonomic-Biomechanics in Office Seating Ergonomics

  21. Ergonomics

  22. Healthcare industry significant challenges • Rising Costs • Healthcare costs continue to rise faster than inflation. • Increased Demand • Demand for healthcare will grow, at least through 2030-2050. • Building Boom • Experiencing a huge hospital building boom. • War for Talent • Significant staffing shortages. Source: Ergonomics for Healthcare Environments Ergonomics

  23. Changes in Healthcare Industry • Changing Nature of Work • Regulations (HIPPA, Medicare Plus Choice) • technology • changing work styles (multidisciplinary teams) are exerting profound effects on healthcare. Source: Ergonomics for Healthcare Environments Ergonomics

  24. New Trends in Healthcare Industry • Evidence-based practice • Evidence-based design. • Value of applying ergonomics to the design of healthcare work environments. • Focus on the patient experience • Representing a shift from provider focus to patient focus • Environmental quality for both patients and staff. A golden opportunity to introduce ergonomic concepts and principles to the design and configuration of healthcare environments Source: Ergonomics for Healthcare Environments Ergonomics

  25. Unique Characteristics of the Healthcare Environment • Unique Setting • Nonstop operation - 24/7/365 “shift work and shared workplaces”. • Healthcare must serve entire population. • Regulations and information security. • A complete range of physical actions performed from less than ideal positions. • Multi-tasking with physical activity and highly skilled knowledge work. • Predominantly female workforce. Source: Ergonomics for Healthcare Environments Ergonomics

  26. Unique Characteristics of the Healthcare Environment • History & Tradition • Improving working environment. • Focusing on the patient and staff-patient interactions. (e.g. adjustable beds). • Untapped Potential • Staff workplaces not involving direct patient contact have not benefited from applying ergonomics. Source: Ergonomics for Healthcare Environments Ergonomics

  27. Areas of Potential • Market differentiation • In a war for talent, workplace makes a difference. • Culture image & strategic asset. • Performance • Performance improved 17.7% while the benefit -to-cost ratio was 24:1 • Staff Effectiveness, Errors, Staff Satisfaction, patient safety, stress, outcomes, overall quality. • Health & Safety • MSD injuries are very expensive! Source: Ergonomics for Healthcare Environments Ergonomics

  28. Why is Ergonomics Important? • Ergonomics focuses on people. • Good ergonomics yields improved performance and productivity. • Good ergonomic programs include training and change management. • Good ergonomics programs always yield more benefits and save more money than they cost. Source: Ergonomics for Healthcare Environments Ergonomics

  29. Design Approaches • Design for the extreme • e.g., doorways are designed so that the tallest person can walk through them • Design for the average • Where large population will use the same device or environment, for example: reception counter. • Design for the adjustable range • Maximize “goodness to fit”, for example: office chairs. Source: Ergonomics for Healthcare Environments Ergonomics

  30. Ergonomic Strategies • Adapt the workplace to the worker – not vice versa. People are very adaptive. • Support work in the way it is done • Optimize support for the primary task • Provide appropriate user control • Emphasize ease of use • Provide for Personalization of Space • Train people in the proper use of equipment Source: Ergonomics for Healthcare Environments Ergonomics

  31. The Practice of Ergonomics Source: Ergonomics for Healthcare Environments Ergonomics

  32. http://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.htmlhttp://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html Ergonomics

  33. http://www.osha.gov/SLTC/etools/hospital/index.html Ergonomics

  34. Hospital Examples of Ergonomic Design Issues and Opportunities • Task performed multiple • times a day for every patient • • REBA score = 9. • • High Risk Level : Action • needs to be taken SOON • • Use height-adjustable IV • stand that can be easily and • quickly adjusted. Source: Cornell University Ergonomics Web Ergonomics

  35. Laboratory Problems: Poor Surface Heights • Inadequate thigh/leg clearance • • Arm compression, flexed arms • • Lower back is not supported Source: Cornell University Ergonomics Web Ergonomics

  36. Laboratory Problems: Poor Chair Fit • Inadequate leg clearance because of low • surface height • • Sustained arm/elbow flexion • • No arm rests • • Feet aren’t flat on the ground or supported • • Lower back is not supported • • Consider alternative seating Source: Cornell University Ergonomics Web Ergonomics

  37. Microscopy: Arm Support Pads • Supports wrists and forearms in a neutral position. • – Allowing for a more comfortable working position with less fatigue. • • Helps provide support in a • more upright position • – Relieves fatigue and discomfort to neck and back. • • Eliminates resting elbows and • forearms on hard work • surfaces. Source: Cornell University Ergonomics Web Ergonomics

  38. Microscopy: Equipment • Expanded-pupil technology to enhance the ergonomic performance of the microscope: • Freedom to wear glasses • Increased eye distance allows for safety spectacles to be worn • LCD Displays or Video Microscopes • Reduces eyestrain by minimizing use of binocular lenses. • Reduces awkward neck posture Source: Cornell University Ergonomics Web Ergonomics

  39. Histology Equipment • Strain from swivel motion, turning crank, and lower back pain from leaning over machine • Decreased range of motion • Employees received carpal tunnel treatment, treatments of wrist and elbow tendonitis, and cervical neck pain • RULA score of 6 requires a change in position SOON and further investigation. • High-speed motorized unit for paraffin-embedded specimens. Motorized cutting mechanism and feed system. Source: Cornell University Ergonomics Web Ergonomics

  40. Radiology: Overhead X-ray • User characteristics play a significant role in injury risks. • User technique plays a significant role in injury risks. • REBA score = 10 • High Risk Level and necessary action is needed SOON. Source: Cornell University Ergonomics Web Ergonomics

  41. Radiology – Filing System • Filing Area – used 8 hours a day. • Constant reaching and bending. • Frequently Reported Filing Injuries: – Pulling X-Ray file folders from file racks • Right shoulder strain • Employee hit in face by falling folders • Lifting 6-8 file folders each time • Lower back strain (Lost Time -55 Days>$10,872) • Foot stool available is trip hazard • Employee fell - contusion to knees • REBA score = 9 • High Risk Level : Action needs to be taken SOON Source: Cornell University Ergonomics Web Ergonomics

  42. Readings • Best Practices for Site-Wide Hospital Ergonomics. • Ergonomics for the Physician Practice. • A physician's Guide to Ergonomics Standards. • Guidelines for Nursing Homes. • Ergonomics for Healthcare Environments. • Ergonomics Assessment. • Computer Workstations eTool - Evaluation Checklist. Ergonomics

  43. Musculoskeletal Disorders • For example, musculoskeletal disorders (MSD’s) have become a prevalent form of injury in modern business: • Fourteen fold increase in MSD’s from 1972-1994. • In 1994, 32% of all injury and illness involving sick days was due to MSD’s. • MSD’s costs in US very from $13-20 Billion annually. http://www.ufv.ca/faculty/kpe/fletcherg/Ergonomics/introduction/intro1.ppt Ergonomics

  44. Neck Upper Back Eyes Left Shoulder Right Shoulder Left Upper Arm Right Upper Arm Left Elbow Right Elbow Left Forearm Right Forearm Left Wrist Right Wrist Left Hand Right Hand Mid/Low Back Buttocks Left Thigh Right Thigh Right Knee Left Knee Right Lower Leg Left Lower Leg Right Foot/Ankle Left Foot/Ankle Source: Occupational Health Clinics for Ontario Workers Ergonomics

  45. Frequency Discomfort 0= Never 1= Rarely (Few Times /Month) 2= Frequently (Few Times/Week) 3= Constantly (Nearly Every Day) Marley and Kumar (1996): Body Map 0 No Discomfort 1 2 Fairly Comfortable 3 4 5 Moderate Discomfort 6 7 8 Very Uncomfortable 9 10 Extreme Discomfort Ergonomics

  46. legend Source: Occupational Health Clinics for Ontario Workers Ergonomics

  47. Group X (n=6) Source: Occupational Health Clinics for Ontario Workers Ergonomics

  48. Group X Right Side / Left Side legend Source: Occupational Health Clinics for Ontario Workers Ergonomics

  49. Group X Neck and Back legend Source: Occupational Health Clinics for Ontario Workers Ergonomics

  50. Thanks By: Rada Hussein rhussein@iti.net.eg Ergonomics