This report originally appeared in the November 2010 issue of DOTmed Business News

A couple of years ago, Tamara James received a call from a physician who had just received delivery of anesthesia equipment and had the vendor awaiting sign-off. The clinician was calling to voice his concern about the screen on the unit not being very adjustable.

“He told the vendor, ‘I don’t think we can accept this because it’s not ergonomic,” says James, the ergonomics director of the Occupational and Environmental Safety Office for Duke University Health System. “He called me and said, ‘Could you please come over here, look at this piece of equipment and tell us if it’s acceptable?’”

After the unit was examined, the vendor was asked to take the product back and make some modifications, significantly reducing the risk of injury for its users.

Such awareness of the importance of ergonomics embodies a culture change that’s making its way through the health care space. Patient safety is always at the forefront of hospital administrators’ minds, says James, but staff safety must also be a part of that equation.

“What we’ve been trying to stress across our health system is that there’s a really close connection between staff safety and patient safety,” she says. “You need to have your staff safe to keep your patients safe.”

The ergonomics sector strives to create a better fit between the environment or the job at hand and the user. Companies that manufacture ergonomic equipment or furniture seek to reduce the potential for injury and maximize comfort for the users.

“It’s important to understand that when ergonomics is practiced appropriately, there are benefits on a lot of different levels,” says Jonathan Puleio, an ergonomist and director of consulting for Humanscale, an ergonomics solutions company. “By improving the fit between the environment and the worker, we not only reduce a person’s risk of developing an injury but we can also dramatically improve the workers’ comfort, as well their performance.”

Computerizing health care
The transition of the health care realm from a paper to a digital environment may seem like a forward-thinking move, but the industry is way behind corporate America. Office environments became computerized throughout the 1980s and as a result, spurred a wave of injuries among employees the following decade.

“Nobody thought about ergonomics in the ‘80s,” says Alan Hedge, professor of ergonomics at Cornell University in Ithaca, N.Y.

Today, as health facilities play catch-up, they are encountering the same problems.

“Health care is the last sector of the American economy to computerize,” says Hedge. “Hospitals are introducing computer technology without really thinking about the potential for injuries to the people who are using it and the potential for that technology to actually result in more mistakes. That’s why ergonomics is proving a value when looking at the health care establishment.”

In terms of the likelihood of sustaining injuries, the health care environment happens to be the second riskiest sector to work in – the only more dangerous industry is mining.

“I mean [health care] ought to be the safest place to work, right?” says Hedge.

Extent of injuries
When health care employees experience discomfort or sustain injuries on the job, the pain impacts more than just the individual – it may cost the hospital a pretty penny.

“As it turns out, when folks are experiencing discomfort, they’re not only less productive but they’re more likely to make mistakes. Poor ergonomic setups also lead to fatigue,” says Humascale’s Puleio. “From a cost perspective, having a group of employees who are uncomfortable or are experiencing pain is a very costly proposition.”

Examples of potential injuries for health care professionals include chronic back pain, spinal injuries, carpal tunnel syndrome, repetitive stress injuries, cubital tunnel syndrome, neck and shoulder strains, tendonitis and eyestrain. Such injuries contribute to higher levels of workers’ compensation claims, decreased productivity, inefficiency, turnover and an increased potential for errors.

Puleio cites a study published in the Journal of the American Medical Association that examined computer use among office workers. It found that more than 52 percent of the population was working with discomfort and the average loss of productive time exceeded five hours per week.

“When [the researchers] generalized the results to the U.S. population, they estimated that this is more than a $61.2 billion problem,” says Puleio.

Injuries affecting nurses — an aging workforce in America — are most often associated with manual lifting of patients. However, nurses also face the problems associated with today’s digital hospital environment.

“Now there’s a tendency to have a computer in every patient’s room or have a computer on a mobile cart that gets pushed around a hospital,” says Cornell’s Hedge. “Those computers are usually not properly adjusted to the people who are using them, so they work in awkward postures for long periods of time, and as a result, injuries to nurses are on the increase from repetitive motion problems.”

Jim Owens, director of Humanscale Healthcare, echoes this trend. Although technology has been around for quite some time, it has only recently made significant inroads in health care, Owens says, increasing the time hospital staff spends working with technology.

“There are studies that show that nurses and caregivers are spending anywhere from three to 5.6 hours per day on the computer,” he says.

Industry experts say facilities across the country are beginning to realize the importance of ergonomic solutions and are either hiring ergonomists or designating a staff member to be responsible for an ergonomic plan. Cornell’s Hedge says one upstate New York hospital used to accrue $1.5 million worth of injury costs on an annual basis. With the help of the university’s ergonomic expertise, the facility trimmed the number down to less than a quarter of a million within about an 18-month period.

“There are massive savings with very little investment in changing how people work,” says Hedge.

Hospital spaces tend to be designed as completely fixed environments and thus lack adjustability and control on the part of the user.

“As a result, given that we range considerably in size and shape, we find that employees are forced to conform their bodies to this predetermined set of variables,” says Humanscale’s Puleio.

Fortunately, facilities can curb their injury rates and keep their employees safe and comfortable through a number of ergonomic solutions. One group of health care professionals, particularly in need of proper workstations, are those who often spend upwards of eight hours a day identifying ailments on computer screens.

Solutions for radiologists
A decade ago, radiologists viewed X-ray images on light boxes, but today the computer screen is their tool of the trade. The shift from print to digital makes the job easier but also puts radiologists at a greater risk for injury.

Amir Rotlevi, VP of AFC Industries, Inc., a manufacturer of ergonomic radiology furniture and workstations, says radiologists often perform repetitive motions that can cause stress injuries.

“Radiologists need work areas that will support good posture and prevent them from straining during these tasks, allowing them to shift position comfortably while performing their job,” says Rotlevi. “They should have a height-adjustable desk that allows them to alternate between sitting and standing positions and be careful of their back.”

A 2008 study published in the Journal of the American College of Radiology examined the prevalence of repetitive stress symptoms and responses to ergonomics solutions among 107 radiology professionals working in a PACS-based radiology department. More than half of the respondents, 57 percent, reported experiencing repetitive stress symptoms. After receiving ergonomic chairs, 70 percent of the respondents reported improvements in symptoms and 80 percent reported improvements when they switched over to ergonomic workstations.

AFC Industries dubs its Whitestone Workstation as the company’s “radiology dream station.” The workstation includes electronic adjustments of work surface height and tilt and independent electronic adjustment of monitor platform height and focal length. The Whitestone Workstation also includes an environmental heating and cooling system, which enables radiologists to directly regulate the temperature and alleviate the heat that’s produced by the computer units.

Humanscale also offers ergonomic solutions for the medical community – everything from glare filters to lighting options. The company’s M8 Monitor Arm accommodates a variety of monitors weighing up to 42 pounds. Humanscale’s Owens emphasizes the importance of all ergonomic elements working in harmony for a truly safe and comfortable workspace.

“It’s really not one product; it’s looking at the environment as a whole,” he says. “If you remove one element from this ergonomic setup, you can potentially be trumping what you’re trying to achieve in these locations.”

Cornell’s Hedge says radiologists need to keep some basic principles in mind in order to avoid injuries and potential errors in their work. Physicians need to position their computer screens in a comfortable viewing position. Investing in monitor arms is an easy way to improve the ergonomics of the job, enabling radiologists to control the position of the screens. Because radiologists are mostly sedentary, they also need a comfortable, ergonomic chair.

“Preferably one that has a higher back, so they can actually lean back and rest their back and shoulders against the back of the chair,” Hedge says.

To avoid applying strain on the shoulders and the wrists, radiologists should position the keyboard and computer mouse at a comfortable distance in front of them. Finally, radiologists should take periodic breaks to stretch. These simple alterations to the workspace “let you fundamentally change how people work,” says Hedge. “And if they have less risk of injury, they’ll be more productive at the end of the workday and feel better.”

Implementing ergonomics
Although ergonomic solutions have advantages for both the hospital staff and administration, it’s not always easy to find the funds necessary to alter the working environment. However, ergonomic experts argue that the negative financial impact associated with the loss of productivity, injury rates and employee turnover outweighs the price of the initial investment.

“The cost of having uncomfortable and unproductive workers happens to be so high that the equipment is a drop in a bucket, relative to what the hospital or the health care facility is paying on a daily basis,” says Humanscale’s Puleio. “They may not have excellent methods to measure this lost productive time, but there are volumes of research out there stating the cost of these issues.”

AFC Industries’ Rotlevi says facilities that fail to provide their employees with proper ergonomic work areas are at risk of workers’ compensation lawsuits. Avoidable ailments, like carpel tunnel syndrome, can lead to expensive legal battles to fight in court.

“The better question is, ‘Can facilities afford not to invest in ergonomics?’” asks Rotlevi.

Duke’s James came to the health system 17 years ago to work on a few ergonomic projects as a consultant. Today, she works with four full-time ergonomists for a health system that has more than 35,000 employees. She says she knows of other ergonomists who have gone on to start projects at other hospitals.

Cornell’s Hedge suggests that hospitals consider investing in ergonomic design right at the beginning of a new project or remodeling endeavor.

“Ergonomics is only a cost if you already bought the wrong things,” he says.

Later this month, professionals from a variety of industries will converge in Las Vegas, Nev., for the largest ergonomics event in America – the National Ergonomics Conference and Exposition (ErgoExpo). This year, the ErgoExpo will feature a number of educational opportunities that focus on using ergonomics to increase safety, productivity and profitability in the workplace.