The Adoption of Ergonomic Innovations for Injury Prevention – Sonographer’s scanning support device.
Bo Glimskär*a
a.) Centre for Health and Building, KTH Royal Institute of Technology, Stockholm, Sweden
* Corresponding author: bo.glimskar@chb.kth.se
Abstract
Studies of how people relate to the risk of occupational injury indicate that there is a tendency to underestimate the risk at work compared to other risks in society. Ultrasound examinations of the heart involve a static and very uncomfortable working posture for the sonographer. As a result many sonographers experience shoulder and neck pains which can result in long term sickness leaves.
The purpose of the study was to evaluate how a more radical ergonomic innovation, a remote controlled ultrasound robot for cardiac examinations, Medirob, has been adopted. The study was conducted by interviews with department heads and heads of clinics, responsible for the
procurement of the equipment.
The results of this study have shown that it is not maybe enough to solve an ergonomic problem with an innovation to get it accepted and used. To prevent injuries the intervention must also have other qualities, for example improved productivity.
Background
Studies of how people relate to the risk of occupational injury indicate that there is a tendency to underestimate the risk at work compared to other risks in society. Most people are aware of
traumatic injury and are willing to prevent such injuries. But they consider the risk of an occupational accident to be low [1].
Musculoskeletal symptoms or musculoskeletal disorders (MSDs) are defined as , “the conditions that involve the nerves, tendons, muscles, and supporting structures of the body” [2].
MSDs are especially prevalent in diagnostic sonographers [3‐6].
Ultrasound examinations of the heart involve a static and very uncomfortable working posture for the sonographer. As a result many sonographers experience shoulder and neck pains which can result in long term sickness leaves. Because of the difficulty in replacing these highly skilled
individuals this can cause big disruptions at the cardiac‐ or medicine departments. In the worst case the sonographer might not be able to return to this job again [7].
More than 80% of sonographers experience work‐related pain and more than 20% of these suffer a career ending injury [8]. Sonographers responding to a survey indicated that the shoulder, neck, wrist and lower back were the most prevalent sites for pain and discomfort. An increasing loss of
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Results
In Sweden there are about 80 hospitals of different sizes and half of them have clinic/departments where ultrasound examinations are a frequent work. Since Medirob was introduced to the market only 4 are sold.
A total of 9 clinic / department heads were interviewed. 3 who bought the equipment (I), 3 who had tested the equipment but have chosen not to buy (II) and 3 that have chosen not to test the
equipment (III).
The results of the interviews show that all respondents were aware of the equipment, the Medirob, and all admitted that they have MSD problems in each department.
The approach to the MSD problems has primarily been job‐rotation; 8 of 9 state that the
Sonographers only work with ultrasounds examinations either morning or afternoon. However, MSD problems persist, but on a somewhat reduced level.
The image quality and examination time are important factors in the introduction of new working practices. Asked how the Medirob affects the quality of the pictures or the task time or how the respondents answered as follows:
How do you think or know Medirob affects the quality of the pictures?
Table 1. Quality effects
positive no change negative
I 2 1
II 1 2
III 3
How do you think or know Medirob affects the time for an examination?
Table 2. Time for an examination
positive no change negative
I 2 1
II 1 2
III 3
Users of Medirob point out the importance of getting extra time for practicing to handle the Medirob. After introduction and training, the number of ultrasound examinations per day has to be reduced during a transitional period.
The departments that bought the Medirob have all acquired the equipment due to one or more of the sonographers at the department had such severe MSD problems that they frequently was on sick leave.
Non‐users were asked if, hypothetically, the examination time was decreased by 20% per patient, would that have an effect on the decision to purchase? All of the non‐users claimed that this would have a positive impact on the decision.
How do you think a 20% reduction on the time for examination would affect your decision?
Table 3. Effects of a time reduction
positive no change negative
II 3
III 3
Other comments about Medirob were:
• Only 1 of the 9 respondents thought that the price of Medirob (~ $ 100,000) had an effect on the decision to buy or not to buy.
• A bit unwieldy
• Not the same feeling as driving manual
• Hard to learn to drive with joystick
• Hard to fine tune the transducer
• Does not work on all patients (heavy overweight)
Discussion and conclusions
Recommendation to reduce the risk of MSD so far, has been more specific ergonomic interventions reported in the literature including adjustable chairs, beds, and equipment, varying postures throughout the day, reducing the amount of reaching to and over the patient, alternating between standing and sitting when scanning, alternating scan hands, rotating between scan types, doing stretching exercises, providing education programs on proper posture and technique while scanning, and taking frequent breaks. It appears that these recommended ergonomic interventions have not had a significant effect on improving the health and safety of cardiac sonographers according to Horkey [8]
The intervention, Medirob, might have a major impact on reducing and preventing MSD problems among Sonographers. Still, there are only a few users and they all have such severe problems that the intervention helped them to stay in the occupation.
The majority of the heads of clinics/departments said that they did not want to change the way they work because it takes time to learn how to do things in a new way. A great number said that the work is not done fast enough with the tool. When asked how much faster the work must be done in order to change a working method the answer for the majority is “the same speed.” Still, 6 heads claimed a need for improved productivity.
The results of this study have shown that it is not maybe enough to solve an ergonomic problem with an innovation to get it accepted and used. To prevent injuries the intervention must also have other qualities, for example improved productivity [13, 14].
A limitation of this study is the small sample of interviewed persons and the limited use of the innovation Medirob. Further research needs to be conducted to evaluate the innovation and to evaluate if an ergonomic innovation needs to have more qualities than just “reduced work‐load” to be used to prevent injuries.
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