This report originally appeared in the November 2009 issue of DOTmed Business News


There has been a growing interest in ergonomic solutions in the medical field over the past few years with some recent innovations on the horizon which could change the way health care practitioners carry out their responsibilities. Ideal ergonomic design caters to patient and provider, offering comfort and safety to each.

Many health care professionals may experience back pain, carpal tunnel, headaches and other ailments during the course of their careers. Often, the cause can be traced to poorly designed equipment which causes stress on the body.

However, when ergonomic options are introduced, it may mitigate those factors. By doing so, it has the ability to improve the quality of care given as doctors are able to concentrate more on their patient rather than a discomfort they might otherwise experience.

People typically don't perform well when they're in pain or fatigued; likewise, they don't perform well when there are design barriers to quality and productivity. Ergonomic applications are used to improve human performance through product and process design and engineering.

So why is there resistance on the part of the medical field to adopting some of these innovative ergonomic technologies? "Practitioners tend to be very skeptical about new solutions, until they are convinced that the measures will not restrict how they work," says Eric W. Golden, president and CEO of Equipois Inc., Los Angeles, Ca. In other words, practitioners must be convinced that ergonomic alterations will not only improve safety and comfort, but will not be a detriment to the efficiency they've developed.

However, some experts assert that there's more to ergonomics than just comfort or safety during primary use. "A robust human-centered design approach would focus on usability in all of the expected human interfaces through the entire design life, from manufacturing to disposal or reclamation," says Peter Budnick, Ph.D., CPE, president and CEO of Ergoweb and founder of Ergobuyer.

The FDA shares Budnick's thoughts, but that doesn't mean it's all smooth sailing.

"Although the FDA has been pushing ergonomics/human factors, the approval process for medical devices also creates some barriers to the ultimate success of these designs," says Dr. Budnick. The new product development and approval process is so time-consuming and expensive, human centered design advancements sometimes take a backseat to other functional requirements. Further, once a product has received approval, even small changes to improve ergonomics for patients and caregivers may be avoided so as not to force a new FDA approval process for the changes.

Dr. Budnick says, "There is a new design process standard for ergonomics under development between the International Ergonomics Association and the International Organization for Standardization called EQUID (Ergonomics Quality In Design). It lays the foundation to be used when designing for humans." He says that many people use words like Ergonomist, Human Factors Engineer, Usability Expert and User Experience Designer when describing their skills or services. "In fact, there is a wide variance of skill and knowledge among practitioners in this field, so I highly recommend that those seeking assistance or expertise in ergonomics look to professionals certified by the Board of Certification in Professional Ergonomics," says Dr. Budnick.

Ergonomic applications

Dr. Budnick highlights prescription drug labeling as an example of an ergonomic application many would overlook. He explains that such labeling has been fraught with poor design that literally guarantees tens of thousands of health issues or even fatalities each year due to errors in prescribing, administering or ingesting drugs. Often referred to as "human error," they are recognized as design errors by ergonomists. Applying a human-centered design approach would eliminate the majority of these mistakes. This example captures what ergonomists consider the cognitive domain. "In this case," says Dr. Budnick, "tiny writing and poorly conceived color coding conflict with effective human decision making, especially under the pressure demands typical in health care environments."

Another example, patient handling, focuses on protecting the caregiver. Patient handling has emerged as a hot-button issue for hospitals and long-term care facilities, driven by high injury rates among caregivers at a time when there's already an acute shortage of properly trained and qualified professionals in many regions. "To put it bluntly," Budnick says, "caregivers, especially the nursing population, which has a preponderance of woman, cannot be expected to lift and manipulate patients without risking injury. In many cases, the patients far outweigh the caregiver; the patient may not be cooperative; and handling a flexible, moving human body is difficult and dangerous under any circumstance." Many hospitals have pursued a "zero-lift" policy or other means to reduce or eliminate the amount of patient handling required of staff. The magnitude of this problem has also led to states as diverse as Texas and Washington to enact patient handling legislation, and HR 2381, Nurse and Health Care Worker Protection Act of 2009, was recently introduced at the federal level.

Equipois Inc. has developed a "zero gravity" mechanical arm technology that holds tools and other payloads in order to increase worker productivity and reduce injuries.




The zeroG was developed by Equipois in collaboration with inventor Garrett Brown. In the course of its market research, Equipois learned from numerous industry experts that certain activities requiring people to work for long periods with arms outstretched poses significant risk of shoulder and arm injuries. Such activities - like lengthy surgical or dental procedures and use of precision hand tools - can have very high injury rates and force employees to retire early due to injury, introducing enormous costs to employers and employees. Golden says, "In response to this need, we developed a prototype product, the zeroG, which supports the weight of the human arm, while allowing all required range and freedom of motion." Utilizing Equipois's patented zero gravity spring and cam-operated mechanical arm design, the zeroG will relieve the user of the burden of supporting his or her own arm without restricting freedom of motion. Initial target applications will focus on activities where the need to work with arms outstretched either poses significant risk of injury or significantly limits workers' stamina or precision. Candidates include dentists, dental hygienists, surgeons, surgical technicians and nurses. The zeroG could also assist people, who due to disability or injury, have limited muscle control.

Computer workstations

Now becoming common, mobile workstations that house a computer and a variety of other items needed by healthcare professionals allow the caregiver to bring their work with them wherever they go. Wall mounted solutions that can be folded or rotated out of the way when not in use are valuable assets at nurse and patient care stations where space is at a premium, and different caregivers use the same station at different times. "These examples protect providers by eliminating the need to carry heavy and awkward computers, improve space utilization and care delivery performance, and create a better customer/patient experience," says Dr. Budnick.

The problem with these workstations, in many cases, is price. Ergonomically designed workstations can initially be more expensive than purchasing run-of-the-mill office equipment. Those in charge of purchasing such equipment need to consider the long-term cost-to-benefit picture. Although the initial expense may be more, workers experiencing back pain and carpal tunnel syndrome brought on by poorly designed workstations will be less productive and more prone to taking sick leave, likely costing a facility more than the initial investment in the ergonomically designed work stations.

Ergonomic Design Meets Function

Grant Davidson, Vice President Philips Design, Chief Design Officer Healthcare, and Marja Zuurman, Philips Creative Director, Healthcare sector are part of a team at Royal Philips Electronics that have earned the company awards acknowledging beneficial applications of ergonomics. In fact, Philips earned 22 awards at the prestigious annual iF competition, seven in the healthcare category, which recognizes high quality design across a range of criteria including degree of innovativeness, functionality, workmanship, design quality and ergonomics. "The iF product design awards are highly prestigious and any product that wins one has to meet the highest standards of design, including ergonomic factors, which create solutions to improve people's health and well-being," says Davidson.

Because many medical devices are now computer based, Zuurman explains that the research team at Philips spends a great deal of time using ergonomic computer hardware modules to study and identify what makes medical devices work best. Specialists consider all factors including human error and patient safety - huge factors in the usability of medical devices. Product specialists then design an ergonomically sound product, which is tested extensively both in-house and on-site to make sure the medical devices is appropriately evaluated and meets the needs of the user.

The future of ergonomics

Tamara James, Ergonomics Director, Duke University, has offered an ergonomics program for the past 16 years which addresses many of the health concerns affecting hospital employees including lifting, repetitive motion, awkward postures and more. "We see these issues in nursing, surgery, pharmacy, radiology, maintenance, laundry, housekeeping, and elsewhere," says James. She believes that good design of the human computer interface is critical for reduced injuries and errors. Her wish is for the development of a better mechanism to relay information about good (and bad) designs to manufacturers of specialized medical equipment so that "only the best possible designs are introduced into the marketplace." She also hopes that when a company designs a product they feel is ergonomically sound, the company checks with an ergonomic expert to make sure that the product meets the requirements to bring safety and comfort to both users and patients.

Those are requests we can all be comfortable with.