The Adoption of Ergonomic Innovations for Injury Prevention: Examples from the building construction and health care industries

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TRITA-STH REPORT 2014:6 ISSN 1653-3836

ISRN/KTH/STH/2014:6-SE ISBN 978-91-7595-417-2

The adoption of

Ergonomic Innovations for Injury Prevention

Examples from the building construction and health care industries

BO GLIMSKÄR

DOCTORAL THESIS IN TECHNOLOGY AND HEALTH STOCKHOLM, SWEDEN 2014

KTH ROYAL INSTITUTE OF TECHNOLOGY

SCHOOL OF TECHNOLOGY AND HEALTH

www.kth.se

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AcademicdissertationwhichwithpermissionfromtheRoyalInstituteofTechnologyinStockholmis

presentedforpublicexaminationfortheDegreeofDoctorinTechnologyandHealth,Injury

Prevention;Friday,January30,2015,13:00inroom7093,Marinensväg30Haninge.

TRITASTHReport2014:6

ISSN1653Ͳ3836

ISRN/KTH/STH/2014:6ͲSE

ISBN978Ͳ91Ͳ7595Ͳ417Ͳ2

©BoGlimskär,December2014

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Abstract

Agoodworkenvironmentisimportantfortheindividual,forindustryandforsociety.Thework

environmentresearchhas,predominantly,targetedidentificationofproblemsandthemeasurement

ofthesizeoftheseproblems.

Innovationstoreducetheincidenceofmusculoskeletaldisorder,MSD,havebeenintroducedin

differentbranchesofindustry,butwithlimitedsuccess.

Fewoftheergonomicinnovationsdevelopedforthebuildingandconstructionindustryhavereached

asufficientlevelofadoption.Ergonomicinnovationsinthehealthcaresectorareofanincremental

characterandseemtohavesimilarproblemsofadoptionastheonesinthebuildingand

constructionindustry.

Threeexamplesofergonomicinnovationareexaminedinthethesis:

x agluespreaderforfloorlayers

x afourͲwheelwalkerwithaliftingdevice

x asonographer’sscanningsupportdevice

Thestudiesshowthatanergonomicinnovationisnotadoptedforpreventionofoccupationalinjury

unlesstheinnovationalsohasotherrelativeadvantagesapartfromtheergonomicones.Forthe

groupwhoalreadyhassustainedaninjury,itisenoughthattheergonomicproblemsaresolved,

whiletheother,symptomͲfreegroup,requiresotheradvantagesinordertoadopttheinnovation;

increasedproductioneconomyseemstobethemostprominentpotentialadvantage.

Keywords:Ergonomics,musculoskeletaldisorders,ergonomicinnovation,adoption,fourͲwheel

walker,liftingdevice,sonographersupport,floorlaying.

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Sammanfattning

Engodarbetsmiljöärviktigtförindividen,förnäringslivetochförsamhället.Den

arbetsmiljöforskningsomhittillsbedrivitsharfrämstvaritinriktadpåattidentifieraproblemoch

mätastorlekenavdessa.

Innovationerförattminskaförekomstenavbelastningsbesvär,MSD,harinförtsiolikabranscher,

menmedbegränsadframgång.

Fåavdeergonomiskainnovationersomutvecklatsförbyggbranschenharnåttentillräcklignivåav

adoption.ErgonomiskainnovationerinomhälsoͲochsjukvårdenäraveninkrementellkaraktäroch

verkarhaliknandeproblemmedadoptionsomdeibyggbranschen.

Treexempelpåergonomiskinnovationerharundersöktsiavhandlingen:

•enlimspridareförgolvläggare

•enrullatorförseddmedenlyftanordning

•enrobotsomhjälpmedelvidultraljudsundersökningar

Studiernavisarattenergonomiskinnovationinteanvändsiförebyggandesyfteominteinnovationen

ävenharandrarelativafördelarförutomdeergonomiska.Fördengruppsomredanharenskada,är

dettillräckligtattdeergonomiskaproblemenlöses,medansymtomfria,kräverandrafördelarföratt

adopterainnovationen.Enförbättraproduktionsekonomitycksvaradenmestframträdanderelativa

fördelenföradoption.

Sökord:Ergonomi,muskuloskeletalabesvär,ergonomiskinnovation,adoption,rullator,ultraljuds

robot,golvläggning.

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Acknowledgements

Intheearly80'sabunchofhappyenthusiastsstartedtheByggergonomilab(Bel)atKTHwiththegoal

ofcreatingabetterworkingenvironmentfortheconstructionworkers.Iwasoneofthesehappy

guys(yes,itwasjustguys).Iwanttothankmycolleaguesfromthattime,noonementionedandno

oneforgotten,youhaveinspiredmetothisThesis.

Ergonomicsthenwasavirtuallyunknownconceptintheconstructionindustry.Bel’sworkresultedin

alargenumberofnewproductsandprocesseswithreducedworkloadsasaresult.However,there

arestillworkloadproblemsintheconstructionindustry,thishasgotmethinkingaboutwhether

therewerefactorsthatwemissed.Hopefully,thisthesisprovidesasteponthewaytoananswerto

whytheindustrystillhasproblems.

WhenIreturnedtotheacademicenvironmentabout5yearsago,Iexperiencedthesame

enthusiasmatCHB,wherethegoalwastocreateopportunitiesforlifelonglivinginyourown

apartment.Todesigntheresidence,developmeansandconditionstocontinuelivingat"home"for

aslongaspossible,Isawthatasachallenge.Inthiswork,IwouldparticularlyliketothankJenny

Hjalmarsson,acoͲworkerinthreeofmystudies,forhercooperationandmutualsupportwhenwe

thoughttheoutsideworldwasunfair.

AspecialthankstoToreJLarsson,mysupervisor,forpushingmeandgivingthesupportneededfor

thisThesis.Asummaryof30yearsindevelopingergonomicinnovations.

StockholmDecember2014

BoGlimskär

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Listofpublications

I. Glimskär,B.,Lundberg,S.,Barrierstoadoptionofergonomicinnovationsintheconstruction

industry.ErgonomicsinDesign:QuarterlyofHumanFactorsApplications2013,21:26

II. Hjalmarson,J.,Glimskär,B.,Gettingupfromthefloor–Olderpeoples’abilitiesand

experiences.SubmittedtoGeriatricRehabilitation2014.

III. Glimskär,B.,Hjalmarson,J.,Lundberg,S.,Larsson,T.J.(2013)Awalkerusedasalifting

device.DisabilityandRehabilitationAssistiveTechnology,onlinehttp://

informahealthcare.com/idt

IV. Glimskär,B.,Hjalmarson,J.,(2013)Atestofawalkerequippedwithaliftingdevice.Assistive

TechnologyResearchSeries,33,3Ͳ9.

V. Glimskär,B.TheAdoptionofErgonomicInnovationsforInjuryPrevention–Sonographer’s

scanningsupportdevice.SubmittedtoErgonomicsinDesignJanuary2015.

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Authorcontributions

I. Theauthorperformedthestudy,analyzedthedataandcompiledthepaper.S.Lundberg

supervisedtheauthor.

II. J.Hjalmarsonandtheauthorperformedthestudy,analyzedthedataandcompiledthe

paper.

III. TheauthorandJ.Hjalmarsonperformedthestudy,analyzedthedataandcompiledthe

paper.T.J.LarssonandS.Lundbergsupervisedthework.

IV. TheauthorandJ.Hjalmarsonperformedthestudy,analyzedthedataandcompiledthe

paper.

V. Theauthorperformedthestudy,analyzedthedataandcompiledthepaper.

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1 Introduction

Inordertounderstandwhyitissohardtomakepeople,companiesandorganizationsadoptanduse

ergonomicinnovationsforinjuryprevention,thisthesisseekstoinvestigatethefactorsgoverning

adoption.Thismeansthattheanswerstoquestionshavebeensoughtwithinalargenumberof

theoreticalareasrelatedtoinnovation,adoption,management,motivationalpsychology,health

behaviorandergonomics.

Fromthiscomplexanddiversetheoreticalenvironment,referenceshavebeenpickedtofindsupport

forthehypothesesofthethesis,whichimpliesthatthedifferenttheoreticalsubjectareashavebeen

farfromexhaustivelycovered.

1.1 Problemstatement

Agoodworkenvironmentisimportantfortheindividual,forindustryandforsociety.Thework

environmentresearchhas,predominantly,targetedidentificationofproblemsandthemeasurement

ofthesizeoftheseproblems.

AlargeUSstudyofoccupationalinjuryandillnessfrom1997concludedthatthetotalnationalcostof

musculoskeletaldisorderswasatthesamelevelasthecostofallcancertreatmentinthecountry[1].

Ina1994Canadianstudyofmusculoskeletaldisorders,alldirecttreatmentcostsforhospitalcare,

drugs,researchandindirectcostslikeforegoneproductivityduetodisabilityandpremature

mortalitywereestimatedtorepresent3.4%oftheCanadianGNP[2].

AccordingtotheEuropeanSurveyonWorkingConditions(ESWC)undertakenin2010,24.7%of

Europeanworkerscomplainofbackache,22.8%ofmuscularpains,45.5%reportworkinginpainful

ortiringpositionswhile35%arerequiredtohandleheavyloadsintheirwork[3].

TheEuropeanworkforcealsosufferconsiderablelowerlimbsproblems;meninthebuildingand

constructionindustryarethemostaffectedbykneeproblems,whilewomenintheretailsectorand

inhealthcarereportmoreproblemsinhips,legsandfeet[3].

TheSwedishNationalWorkers’CompensationInsurancein2011recorded15000newcasesoflongͲ termdisability(inexcessof3months)duetomusculoskeletaldisease.Thecaseswereequally

distributedbetweenindustrialoccupationsandsocialandhealthcare[4].

Innovationstoreducetheincidenceofmusculoskeletaldisorder,MSD,havebeenintroducedin

differentbranchesofindustry,butwithlimitedsuccess.

TheconstructionindustryistheonesectorthatisoverͲrepresentedcomparedtootherindustriesin

termsofworkenvironmentproblems,andinparticularjobͲrelatedMSDinjuries.Swedenisoneof

thefirstcountriestoattempttodevelopnewaidsandchangeworkingmethodswithaviewto

reducingandpreventingMSDinjuries(Byggergonomilaboratoriet,KTH1978–1985).Although

numerousergonomicproductinnovationshavebeendevelopedandofferedonthemarket,onlya

fewhavehadanymajorimpact[5].

Theinnovationsgeneratedbytheconstructionindustryareincrementalinnatureratherthanradical.

Thisisaconsequenceofthewayinwhichtheindustryisorganized.Theconstructionindustryhasa

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complexorganization[6]andislargelyprojectͲbased.ThisleadstoshortͲtermthinkingandsub

optimization[7],whichinhibittechnicaladvancesandinnovations[8].Thetimeconstraintsand

budgetsassociatedwithindividualprojectsdonotallowfortheaccommodationoflargerandmore

radicaldevelopmentalinitiatives.

ThetrulylargeͲscaleprojectssuchas,forexample,theEricssonGlobeortheÖresundProjectare

abletoaccommodatemorepervasiveresearchanddevelopment.Insuchprojects,thecompanies

involvedare“forced”tofindnewsolutionsandmaterialstomeetthecustomer’srequirements.This

entailstheinvolvementofacademia,researchinstitutionsandcompaniesintheproductionprocess.

Inthesecases,theconstructioncompanyactsprimarilyasthepartyorderingthenewtechnology,

andtheresearchanddevelopmentthatisdoneoccursoutsidethecompany.

AccordingtoBengtLarsson[9],thismeansthatthebuildingcompanyismoreanadopteranduserof

newtechnologyratherthanadeveloper.However,itmustbenotedthattheindustryandindividual

companieshaveworkedtoimproveandorganisetheprocessofdevelopingprojectͲbased

productionmethods.Qualitycirclesandothertypesofdevelopmentgroupshavebeenorganisedat

constructionsiteswiththeprimarypurposeofsolvingproductionproblems,creatingworkaidsand

otherproductionͲenhancingsolutions.Incrementalinnovationsintheconstructionindustryareoften

intendedtoimprovetheworkenvironment,reducejobͲrelatedstresses,and/orimproveworking

postures.

Veryfewoftheergonomicinnovationsdevelopedforthebuildingandconstructionindustryhave

reachedasufficientlevelofadoptionandtheythereforedisappearfromthemarketafterashort

periodoftime.Ergonomicinnovationsinthehealthcaresectorarealsoofanincrementalcharacter

andseemtohavesimilarproblemsofadoptionastheonesexperiencedinthebuildingand

constructionindustry.

Thelevelofadoptionintheintroductionofamechanicalpatientliftingdeviceinthehospitalsetting

[10]waslow.Thereasonsforthiswere,primarily,thatthestaffexperiencedthatusingthedevice

requiredmoretimeandthatitwasnotavailablewhenitwasneeded.

InordertoreducetheincidenceofMSDinthebuildingandconstructionindustry,astudyofthe

introductionofa”hydraulicladderliftthataidedwithloadingandunloadingofladdersoffvanroofs”

wasundertaken[11].Thisinnovationalsometwithdifferentobstaclestoadoption,mainlythatthe

investmentwasconsideredtoohighinrelationtothepositiveergonomicadvantages.

Inacomprehensivesurveyof848freshmarketvegetablefarmers[12],wheretheintroductionofa

numberofdifferentergonomicinnovationswereevaluatedaftertheproductshavingbeenavailable

inthemarketforthreeyears,showedalowlevelofadoption.Offiveergonomicinnovationsunder

scrutiny,fourhadreachedanadoptionlevelof2.4–13.4%.Theobstaclestoadoptionvaried

betweencost/profitabilityandknowledgeof,andpossibilitytotest,theinnovation.

NursingstaffhaveadocumentedhighriskofMSDandoccupationalinjury[13].Aswithbuildingand

constructionworkers,theloadsandrisksfornursingstaffareassociatedwithheavymanual

handling,particularlyinthemanualtransferofpatients.Engkvistetalstudiedtheergonomicsof

patienthandlingoveraperiodoftenyears(1994–2003)andconcludedthatneitherthemethods

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forthemanualhandlingofpatients,northelevelofoccupationalinjuryriskhadchangedtoany

noticeabledegree[14].

Afewreviews,aimedatclarifyingtheeffectsofergonomicinnovationsonworkload,havebeen

conducted[15],[16].TheAuthorshavetriedtoassesswhichmeasureshavebeeneffectiveandwhat

thedegreeofeffectivenessthemeasureshavehad.Theirconclusionsarethateducationand

informationalonehaveverysmalllongͲtermadoptioneffects;acombinationofthemechanical

devicewithinformation/educationwillhavealargerimpact.

Towardstheendofthe1970ies,aConstructionErgonomicsLaboratory(Byggergonomilaboratoriet,

BEL)wasstartedattheinitiativeofthelabormarketpartiesandtheSwedishBuildingand

ConstructionResearchCouncil,andlocatedattheRoyalInstituteofTechnologyKTH.Theaimofthe

Laboratorywas,basedontheworkenvironmentprioritiesoftheindustrypartners,toinitiateand

conductR&DprojectsaimedatcreatingabetterworkenvironmentandtoreduceMSDinthe

buildingandconstructionindustry.

Inordertoovercometheobstaclespreventingthechangeofworkpracticesandtheaversion

towardsnewmethods,theworkattheLaboratory,inadditiontochangeanddevelopmentprojects,

alsoincludedmethodsfordescribingtheeffectsofworkloadonbuildingandconstruction

productivity.

Theproblemsolvingmethoddevelopedwascalled”SystemGroups”[17],whichimpliedthatthe

problemidentification,theproblemsolutionandthesolutiondevelopmentwasconductedina

structuredmanner,togetherwiththerelevantoccupationalgroups,companies,manufacturersand

industrialpartiesinaseminarformat.

Todescribeandexplainhowworkposturesandworkloadsinfluenceworktime,ameasurement

techniquecalledErgoͲIndexwasdeveloped[18].TheErgoͲIndexmodelenablescomparisons

betweendifferentworkingmethodsforfulfillingataskfrombothergonomicandeconomicalpoints

ofview.Thetotaltimetocompleteaworkingtaskconsistsoftheoperationtimeplusthepausetime

thatisrequiredaftertheworktorecoverfromfatigue.Themodelcalculatesthepausetimebased

onphysicalloadandoperationtime.

Descriptionsofworktaskswiththehelpofdifferentexpressed”loadlevels”arehardtounderstand

andtheirlongͲtermconsequencesarenotevidenttothoseexposed.Todescribeandexpressload

levelsintermsofproductionfigureswouldincreasetheopportunitiesforinvestmentandtheuptake

ofergonomicinnovations.

Insummary,theeffectsofdifferentinformationmeasuresandtheparticipationofexposedusersin

theinnovationprocesshavebeenstudied.Thesignificanceoftheeffectsofproductiontechnology

andphysicalaccessibilityhasalsobeenstudied,butwehavenotfoundanystudiesofother

productionͲrelatedeffectsrelatedtosuccessfuladoptionofergonomicinnovations.Onthewhole,

thestudiesarefewandindustryͲspecificorgeneralconclusionsontheadoptionofergonomic

innovationscannotbedrawn.

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1.2 Theoreticalframework

ThedefinitionofErgonomicsasformulatedbytheInternationalErgonomicsAssociation(2003)has

beenworded:

”..thescientificdisciplineconcernedwiththeunderstandingoftheinteractionsamonghumansand

otherelementsofasystem,andtheprofessionthatappliestheory,principles,dataandmethodsto

designinordertooptimizehumanwellbeingandoverallsystemperformance”.

Ergonomicscanbedividedintothreesubtypes;physical,cognitiveandorganizationalergonomics

[19].Allergonomicsisfocusedontheunderstandingoftheinteractionbetweenhumansand

systems.Themainfocusofthepresentstudyisphysicalergonomics.

Thedefinitionsofthreedifferenttypesofinnovations—incremental,radicalandfundamental—are

commonlyaccepted.ThesetermsaredefinedbyRoussel,Saad,Ericksonin“ThirdGenerationR&D”s

54[20]:

Incremental: Normal,smartutilisationofexistingscientificandtechnicalknowledgeinanewway,

characterisedbylowriskandmodestprofitability.

Radical: Creationofknowledgethatisnewtothecompany(andpresumablytheworld)fora

particularbusinessgoal,characterisedbyhigherriskandhighprofitability.

Fundamental:Creationofknowledgethatisnewtothecompany(andpresumablytheworld)in

ordertobroadenanddeepenthecompany’sunderstandingofascientificortechnical

field,characterisedbyhighriskanduncertainapplicationinthecompany’soperations.

Inorderforaninnovationtobesuccessful,itshouldfulfilthefollowingfivecriteriaaccordingto

Rogers[21]:

1Relativeadvantage

…thedegreetowhichaninnovationisperceivedasbetterthantheideaitsupersedes.

Thedegreeofrelativeadvantagemaybemeasuredineconomicterms,butsocial

prestigefactors,convenience,andsatisfactionarealsoimportantfactors.Itdoesnot

mattersomuchwhetheraninnovationhasagreatdealof“objective”advantage.

Whatdoesmatteriswhetheranindividualperceivestheinnovationasadvantageous.

Thegreatertheperceivedrelativeadvantageofaninnovation,themorerapiditsrate

ofadoptionwillbe.

2Compatibility

…thedegreetowhichaninnovationisperceivedasbeingconsistentwiththeexisting

values,pastexperiences,andneedsofpotentialadopters.Anideathatisincompatible

withthevaluesandnormsofasocialsystemwillnotbeadoptedasrapidlyasan

innovationthatiscompatible.Theadoptionofanincompatibleinnovationoften

requirestheprioradoptionofanewsystem,whichisarelativelyslowprocess.

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3Complexity

…thedegreetowhichaninnovationisperceivedasdifficulttounderstandanduse.

Someinnovationsarereadilycomprehendedbymostmembersofasocialsystem;

othersaremorecomplicatedandareadoptedmoreslowly.Newideasthataresimpler

tounderstandareadoptedmorerapidlythaninnovationsthatrequiretheadopterto

developnewskillsandunderstandings.

4Trialability

…thedegreetowhichaninnovationmaybeexperimentedwithonalimitedbasis.New

ideasthatcanbetriedontheinstallmentplanwillgenerallybeadoptedmorequickly

thaninnovationsthatarenotdivisible.Aninnovationthatistrialablerepresentsless

uncertaintytotheindividualwhoisconsideringitforadoption,asitispossibletolearn

bydoing.

5Observability

…thedegreetowhichtheresultsofaninnovationarevisibletoothers.Theeasieritis

forindividualstoseetheresultsofaninnovation,themorelikelytheyaretoadopt.

Suchvisibilitystimulatespeerdiscussionofanewidea,asthefriendsandneighborsof

anadopteroftenrequestinnovationevaluationinformationaboutit.

1.2.1 Theadoptionprocess–innovationdiffusion

Adoptionisanindividualprocesswhereapersonundergoesaseriesofstages,fromfirsthearing

aboutaninnovationuntilfinallyadoptingit.

Thediffusionprocessisanumberofphenomenathatdescribeshowaninnovationspreadsamong

consumers.

Adoption,thedecisiontointroduce,completelyorinparts,anevidenceͲbasedpracticeisacomplex

process[22].Itisparticularlychallengingtomodifypracticalworkroutineswhenthedecisionmakers

oftheorganizationdon’tfeelthatthechangesarenecessary[23].

Adoptionattheindividuallevelislimitedbytheindividual’sknowledgeof,andabilitytoassess

and/orchooseasuitableinnovationtosolvethespecificproblem[24].Thepotentialoftheindividual

toadoptaninnovationisalsolimitedbyorganizationalfactorslikehierarchy,culture,andattitudes.

Irrespectiveofwhetheratanorganizationalorindividuallevel,theadoptionscanbeclassified

accordingtothefollowinglevels[21]:Innovators,Earlyadopters,EarlyMajority,LateMajorityand

Laggards.

Figure1.Adoptercategorization.(Rogers2003[21])

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ModelsoftheadoptionprocessalwaysincludeamomentwhenthepotentialUserassessesthe

innovationinordertodecidehowwelltheinnovationcanfulfilanexperiencedneedorsolvea

perceivedproblem[25].Theassessmentcanbedoneindifferentways,butiftheneedorthe

problemisexistingandwellͲknown,theassessmentincludesacomparisonbetweentheinnovation

andtheexistingwayinwhichtheneedissatisfiedortheproblemsolved.

ItcanbetakenforgrantedthatthepotentialUserofanewproductwillassessitinrelationtohow,

andtowhatdegree,itwillinfluencethesystemofuse,i.e.theworkprocess.Theinfluenceofthe

productontheprocessofworkrepresentsthesystemdependencyoftheproduct.

TherelationbetweentheUserandthesocialsystemwillaffecttheUser’sabilitytoexerthisorher

influenceovertheadoptionprocess.ThelessdependenttheUseris,themoreindependentthe

adoptionprocessandviceversa.

Hammarkvist[25]concludesthatthemoresystemdependenttheinnovation(asacomponentina

largersystem),andthemoresystemdependenttheUser(othersmakingthedecisions),themore

difficultitistogettheinnovationadopted.

1.2.2 Rateofadoption

Therateofadoptionisdefinedastherelativespeedinwhichmembersofasocialsystemadoptan

innovation.Rateisusuallymeasuredbythelengthoftimerequiredforacertainpercentageofthe

membersofasocialsystemtoadoptaninnovation[21].

Withintherateofadoption,thereisapointatwhichaninnovationreachescriticalmass.Thisisa

pointintimewithintheadoptioncurvethatthenumberofindividualadoptersensuresthat

continuedadoptionisselfͲsustaining.However,literatureoninnovationindicatesthatthereisa

slowdownintheinnovationdiffusionprocessafterarapidtakeoff[26],[27].

Theslowdown,alsoknownastippingpoint,chasmorsaddle,occursbetweenearlyadoptersand

earlymajority.Thatmeansthatthereisachasmbetweenearlyandmainmarket.Moore[26]

suggeststhatthemarketforinnovationsisinitiallyrepresentedjustbyearlyadoptersandthatthe

mainmarketdevelopsinasecondstageofdiffusion.

Figure2.Innovationdiffusioncurve.(afterMoore1991[26])

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2. Howseriouspeoplethinkthattheoccurrenceofthediseasewouldbe.

3. Howbeneficialpeoplebelievecertainactionswouldbeinreducingtheirsusceptibilityto,or

severityo,ftheconditioninthelightofanybarrierstotakingaction.

Acomplementarytheoryconstructhasbeentermed“selfͲefficacy”.Thistheorypostulatesthat

healthbehaviorisdeterminedbyoutcomeexpectationsandefficacyexpectations.Outcome

expectationsconsistofthebeliefsaboutwhetherornotagivenbehaviorwillleadtogiven

outcomes.Efficacyexpectations,orselfͲefficacy,consistofbeliefsabouthowcapableoneisof

performingaspecificbehaviorinparticularsituationsthatleadstotheoutcomeinquestion[34].

InastudybyRobertKelly[35],findingswerethathealthbeliefsandselfͲefficacywereclearlyrelated

tomotivationforchangeinmostlifestyleareas.Thestudysuggeststhatthepredictivevalueof

motivationaloneisstrongestin“simple”behaviorslikeseatbeltuse.Forotherbehaviors,“complex”

oneslikedealingwithstress,motivationmustprobablybeaccompaniedbyaneffectivemethodfor

changebeforechangewilloccur.

Theorizingabouthealthbehaviorchangeshouldnotbereducedtothemotivationphaseonly,while

omittingthesubsequentactionphasethatismoredecisiveforbehaviorchange[36].MostsocialͲ cognitivetheoriesassumethatanindividual’sintentiontochangeisthebestdirectpredictorof

actualchange.Butpeopleoftendonotbehaveinaccordancewiththeirintentions.Thisdiscrepancy

betweenintentionandbehaviorisduetoseveralreasons.Forexample,unforeseenbarrierscould

emerge,orpeoplemightgiveintotemptations.Therefore,intentionneedstobesupplementedby

other,moreproximalfactorsthatmightcompromiseorfacilitatethetranslationofintentionsinto

action.ThestudybySchwarzer[36]aimedtotestTheHealthActionProcessApproach(HAPA)to

examinetheapplicabilityanditsuniversalityacrossdifferenthealthbehaviors.HAPAsuggestsa

distinctionbetween(a)apreͲintentionalmotivationprocessthatleadstoabehavioralintention,and

(b)apostͲintentionalvolitionprocessesthatleadtotheactualhealthbehavior.

Fig4.GenericdiagramoftheHealthActionProcessApproach.(Schwarzer2008[36])

Ithasbeenshowninthestudythatthemodelisinlinewithdatafromvariousculturesanddiverse

samples.Inalloftheirstudiedcases,evidencesuggestedthattheapproachwassuccessful.Themain

additionoftheHAPAtopreviousmodelsliesintheinclusionoftwovolitionalfactors:volitionalselfͲ efficacy(eithermaintenanceorrecoveryselfͲefficacy)andstrategicplanning(eitheractionorcoping

planning).Thepurposeoftheseadditionswastoovercomethegapbetweenintentionandbehavior.

(19)

Moststudiesonhealthbehaviorchangeconcernseveremedicalriskslikecancerorcoronary

problems.Evenconfrontedwithsuchsevererisks,peoplearereluctanttoproceedfromthe

intentiontochangebehaviortoactuallychangingit[37],[38],[39].

Tochangeone’smethodofworkinginordertopreventMSDduetoworkͲrelatedhazardous

exposuremightbeanevenbiggerchallenge.

2 Scopeofthestudy

Thisstudyisanattempttoshedsomemorelightonthevariablesthatseemtogoverntheadoption

processofincrementalergonomicproductinnovationinthehealthcaresystemandinthebuilding

andconstructionindustry.Understandingtheinterplaybetweeninnovationandadoptionrequires

definingtherelevanttermsandtheirsignificanceintherespectiveindustries. Theterm“innovation”

isusedinmanydifferentcontexts,andinterpretationsofitsmeaningconsequentlyvary.

Thehypothesisofthestudyisthatanergonomicinnovation,aimedateliminatingahazardous

exposurerelatedtoanincreasedriskofMSDamongcareworkersandconstructionworkers,willnot

beadoptedbytheUserforpreventionpurposessolelybasedonitsergonomicproperties,butwill

requiretheinclusionofpropertieswhichmaketheproductionprocessmoreprofitable.

Theresultsofthestudycouldbeusedinthedesignandmarketingofincrementalergonomic

innovationsintheworkplace.

3 Methodsandmaterial

3.1 Productinnovationsandstudies

Thethreeinnovationslistedbelowhavebeenchosensincetheyweredevelopedinrelationtoa

statedMSDproblemwithintheoccupationalgroupsinvolved.Theinnovationsfulfiltherelative

advantageofreducingoreliminatingtheergonomicworkload.Wouldthisrelativeadvantagebe

enoughtoresultinapreventativeadoptionoftheinnovation?

(I) AconsiderableergonomicproblemamongfloorͲlayersinthebuildingconstruction

industryisthespreadingofglueoverthefloorbeforeputtingonthecarpet.A

retrospectivestudyoftheadoptionofaproductinnovation,aglueͲspreaderdeveloped

withthehelpoffloorͲlayersinthe1980ies,wasundertaken(study1).

(II) Oneoftheheaviestworktasksinhealthandagedcareistohelppeopleupfromthe

floorafterafall.Wehavestudiedhowoldpeople(+75yearsofage)prefertogetup

fromthefloor(study2).Basedonthis,aliftingdevicetosupportpeoplegettingupfrom

lyingtostanding,wasdeveloped(study3).Followingthis,theliftingdevicewastested

andevaluatedbycarestaff,whodeployeditintheirdailywork(study4).

(III) Tofurtherinvestigateifthedegreeofadoptionchangeswithanincreasedsystem

dependency,amoreradicalergonomicinnovation–aremoteͲcontrolledcardiac

ultrasoundrobotͲwasstudied(study5).

(20)

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(21)

Thetablebelowsummarizesthestudiesundertakenandtheirrespectivepurposes.

Table1.Overviewofallstudies

Innovation(I) Innovation(II) Innovation(III)

Timeperiod 1990–2012 2010–2013 2005–2014

Design Fieldstudy Laboratory Laboratory Fieldstudy Fieldstudy

Objectives Degreeof

adoption

Quality

Workspeed

Ergonomics

Problem

identification Ergonomics

Development Evaluation

Evaluation

Adoption

Ergonomics

Adoption

Quality

Workspeed

Ergonomics

No.ofparticipants 50 20 20 10 9

Typeofparticipants Companies Senior

citizens

Senior

citizens

Care

workers

Hospitals

Publications(year) Study1(2013) Study2

(2013)

Study3

(2013)

Study4

(2013)

Study5(2014)

3.2 Study1

Theaimofthestudywastodescribewhichdifferentproductioneffectsgovernthechoiceof

adoptinganinnovationthatsolvesanergonomicproblem.

WedecidedtostudytheattitudesamongfloorlayersinSwedentodaywithregardtotheuseofthis

tooltwentyyearsafteritsintroduction.Wedidthisbymailingaquestionnairetoarepresentative

selectionoffloorlayingcompaniesinSweden.Thiswasalsoawaytoimplicitlystudythe

managementsupportforthismethod.TheselectionwasdonetogetherwiththeSwedish Flooring Trade Association. Outofatotalof278companiesinSweden,50wereselectedforthestudyand44

answeredthequestionnaire,Table1.Theyweredividedintothreedifferentcategories:small

companieswith1Ͳ3employees,mediumͲsizedcompanieswith4Ͳ20employees,andfinallybigger

companieswithmorethan20employees.Thiswasdonetoseeifthereareanydifferencesbetween

companiesofdifferentsizes.

Theeffectsstudied,aftertheintroductionoftheinnovation,wasperceivedergonomicload,quality

ofworkconducted,productiontimeanddegreeofadoption.

Table2.Theparticipatingcompanies

Category* Frequency Missing Valid answers

Small (1-3) 8 2 6

Medium (4-20) 35 2 33

Large (>20) 7 2 5

n 50 6 44

*Numberofemployeesinthecompany

Iftheselectedcompanydidnotanswerthequestionnairewithintwoweeks,wesentareminder.If

therewasstillnoanswer,thecompanywasregardedasadropoutandamissinganswer.

(22)

3.3 Study2&3

Studies2and3wereconductedinordertofindoutiftheinclusionofpeopleinvolvedinaproblem

areaandparticipatinginthesolutionoftheproblemwillfacilitateadoption.

Thestudiesaimedtohelpsolvingoneconsiderableprobleminanageingpopulationpronetofalling

overandnotbeingabletogetupagain.Thefirststudy(Study2)identifiedthecriticalphaseinthe

processofgettingupfromlyingtostanding.Thiswasneededinordertoprovideasolutiontothe

problemandinitiatethedevelopmentandtestingofasolution(Study3).

Theaimwastodevelopaprototype,basedonaninclusivedesignmethodologydevelopedat

CambridgeUniversity[41]andthentestingtheprototypetoverifytheapproach.Apanelof20users

subsequentlytestedtheprototype.Thesetestswereobservedandfilmed.

Inclusivedesignimpliesthataproductorserviceisdevelopedinresponsetoanexpressedneed.

Translationofaneedintoasolutionthatfulfilstheneedrequiresareliabledesignmethod.Thereare

manywaystodescribethisprocess,butarecognisedmethodis”Thewaterfallmodel”[41].It

consistsoffourmainsteps:

Step1ͲDiscover:Systematicallyexaminetheneedinordertoascertainthatthedevelopment’s

challengeactuallyfulfilstheneedsofallpartiesinvolved.Thisleadstoafirstoutput,an

understandingoftherealneed.

Step2ͲTranslate:Processingandunderstandingtheneedyieldsadefinedandcompletedescription

ofthechallengeofthedevelopment.Thisleadstoasecondoutput,aspecificationofrequirements.

Step3–Conceptcreation:Generationofpreliminaryideasthatareevaluatedbasedonthespecified

requirementsleadtothefinaloutput,theconceptproposal.

Step4ͲDevelopment:Adetaileddevelopmentanddesignofthefinalproduct,readyfor

implementationandmanufacturingleadstothefinaloutput,thesolution.

Thisiscomplementedbyevaluationaftereachstepintheprocess.

InStudy2,thetwofirststepswerecarriedoutin”thewaterfallmodel”,whichresultedina

specificationofrequirementsforanassistivedevice,whichwouldmakeitpossibleforapersontobe

helpedbacktoastandingpositionfromakneelingposition.

Study3comprisesthethirdstepin”thewaterfallmodel”oftheinclusivedesignprocess,theconcept

creationandevaluation.

3.3.1 Participants

Twentyparticipantswererecruitedfromapanelofolderpeoplewhohaddeclaredtheirinterestin

takingpartinexperimentswithnewtechnologyforbetterlivesforolderpeople.Wemailedthema

letterinvitingthemtoparticipateinthisspecialstudy.Thecriteriawerethattheywerepositive

towardsparticipating,thattheyhadnosymptomsofheartdisease,andthattheywereover75years

old.EthicalapprovalwasgivenbythelocalethicalresearchcommitteeinStockholm,(Dnr

2011/1590Ͳ31/5).Allparticipantstookpartvoluntarily,wereinformedoftheexperiments’content

aheadoftime,andsignedanagreementtoparticipate.

(23)

3.3.2 Observationstudy–testscenario

Instudy2weanalysedhowolderpeopleprefertogetupoffthefloor.Participantswerehelpedtolie

ontheirbacksonthefloor.Whentheywerereadyweaskedthemtorisefromthefloorinanyway

theypreferred.

Instudy3,thetestoftheconcept(theliftingwalker),onepersonhelpedeachparticipant,placing

thewalkerinfrontoftheparticipantsothathe/shecouldcrawlupandlieovertheelevationseat.

Theassistingpersonthenpushedthebuttontoraisetheseat.Theseatwaselevatedtoaposition

wheretheparticipant’slegswerevertical,makingitpossibletoraisetheupperbodytoanupright

standingposition.

3.3.3 Datacollection

Thewholeprocesswasvideofilmed.Onecamerawasused,anditwasplacedinastaticposition

fromwhichthepeoplewerevisibleduringthewholetest.Participants’experiencesofrisingfromthe

floorandbeingliftedwiththeelevationseatwereregisteredwiththeVIDARergonomicassessment

system.VIDARisananalyticalprogramthatwasdevelopedandusedtoanalyseaperson’s

experienceofdiscomfortandpainduringanactivity[42].VIDARmakesitpossibletoevaluatepainor

discomfortinspecificpartsofthebody,andinrelationtocertaintasksonthebasisofits

synchronisationwiththevideofilmofthetask.InVIDARitisalsopossibletocomplementthe

registrationwithpersonalcommentsinfreetext.ThevideoisimportedintotheVIDAR.In

cooperationwiththeparticipant,criticalstagesduringtheriseandtheliftwereselected,andthe

participantevaluatedhowhe/sheexperiencedeachstagewiththehelpoftheVIDARsystem.

Participantswereaskedtodescribeiftheyexperiencedanypain,andwhethertherewasanystage

thatwasmoredifficultormoreofastrainthanothers,oriftheyhadanyothercommentsaboutthe

risingortheliftingprocess.Finallytheparticipantswereaskedtoanswerquestionsabouttheir

opinionsontheuseoftraditionalwalkersascomparedtoawalkerequippedwithanelevationseat,

andwhattheadvantageswere.

3.4 Study4

Thepurposeofthisstudywastoevaluatehowanassistivedevice,theliftingwalker(Innovation(II)),

willoperateandbeadoptedbyhealthcarestaff,whoisconfronteddailywiththetaskofassisting

peoplewhohavefallen.Arethereothercharacteristicstothedeviceortheorganisation,which

governadoption?

Thestudywasconductedwithnursingstaffinanursinghometofindouthowawalkerequipped

withaliftingbeamcouldfacilitatethework.

TheresearchwasconductedatahomeforpeoplewithParkinson'sdisease.Thereasonforthe

choiceofanaccommodationforParkinson'sdiseaseisthattheresidentswiththisdiseaseoftenfall,

whichwouldresultinaqualifiedevaluation.Thestudyfocusedonhowthecarestaffperceivesthe

useofthewalkerfittedwithaliftingbeam.Thestaffwasaskedtocompletea“fallreport”

supplementedwithadescriptionofhowtheassistancewascarriedoutandhowtheyexperienced

thestressontheirownbodyduringthetask.

Inconnectionwitheachfall,areportwaswrittenaboutwhen,whereandhowthefalloccurred.This

reportalsoincludestheresearchperson'sageandgeneralfunctionalstatus.Assistingcarestaffhas

beenfillinginaformabouttheirexperience.Thepersonslistedasresearchpersonsarethosewho

(24)

havefallenduringthetimewhenthestudywasconducted,andthemethodandhelpingaidaswell

asthestaffwhoassistedintherisingwasnoted.Asabackground,recordsofhowfallsnormallywas

handledwereevaluated.

3.5 Study5

Thepurposeofthestudywastoevaluatehowamoreradicalergonomicinnovation,aremote

controlledultrasoundrobotforcardiacexaminations,Medirob,hasbeenadopted.TheMedirobisa

moresystemͲdependentinnovationandrequirestheacceptanceofboththeindividualsonographer

andthehealthcareorganisationinordertobeadopted.SinceMSDisacommonproblemamong

sonographers,youwouldthinkthattheadoptionofthisergonomicsolutionwouldbesubstantial,

particularlyamongthosewithproblemsandalsoforpreventionpurposes.

Thestudywasconductedbyinterviewswithdepartmentheadsandheadsofclinics,responsiblefor

theprocurementoftheequipment.

Theaimwastofindoutwhichaspectsdecidedwhethertheequipmentwasadopted/boughtornot.

Theinterviewswereconductedwithheads,whohadboughttheequipment,headswhohadtried

butnotboughttheequipment,andwithheadswhohadnotyettriedtheequipment.

ThestudieshavebeenconductedinSwedenwheretheMedirobbeenavailableonthemarketsince

2006.

(25)

4 Results

Theresultsbelowaresomeoftheresultsfromeachstudythataffectthehypothesisofthisthesis.

Foracompleteaccountofthestudies,seetherespectiveAppendix.

4.1 Study1–GlueSpreader

ThepurposeoftheinitialprojectwastoworkwithfloorlayerstopromotethedevelopmentoffloorͲ layingworkthroughbothmethodologicalsolutionsandtraining/informationinordertoreduce,first

andforemost,stressͲrelatedinjuriesandMSDwithintheoccupationalgroup.Thechangeinthework

wasintendedtoprovidesolutionsthatwerebetterfortheindividualfloorlayerand,froma

productioneconomystandpoint,forthecompanyandsociety.Inaccordancewiththeories

concerningearlyadoptersandchangeagents[43][44],thoseinvolvedindevelopingtheproduct

includedfloorlayerswithextensiveprofessionalexperience.Thiseffortwascarriedoutvia

developmentseminarsinsoͲcalled“Systemgroups”,Theuseofsystemgroupsinproduct

development,[17].Thisapproachmadeitpossibletoconducttestsandmakeimprovementsduring

thecourseofthedevelopmentprocess.

Theprojectresultedinasimpleaccessoryforgluespreading.Anarticulatedmountingandan

extensionshaftmadeitpossibletodogluingworkstandingup,usingthesameworkingpatternas

whenkneeling.

Figure6. GlueSpreaderDx96Ͳ1

Thefirststepsintheadoptionprocess—information,minortestingand,tosomedegree,purchase—

werecarriedoutinacomprehensivemannerintheprojectdescribedin:“Thefloorlayerproject:

fromkneelingtostanding”[45].

InformationabouttheproductandworkingmethodwasdisseminatedextensivelyviatheSwedish

FlooringTradeAssociation.Atrainingprogrammewasdevelopedtoinformnewfloorlayersin

trainingabouttheworkingmethodandtheproduct,andoftheimportanceofworkinginan

ergonomicallycorrectmanner.

(26)

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compani statistica dividedi compani dividedi regions,

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(27)

EvaluationaccordingtoRogers

Table3.Evaluationofthegluespreader

Negativechange Nochange Positivechange

Relativeadvantage X

Compatibility X

Complexity X

Trialability X

Observability X

Relativeadvantage:

Fromtheergonomicpointofviewitiseasytoseethatthetaskofgluingstandingup,insteadof

crawlingonyourknees,representsaclearadvantage.Sinceneitherthequalityofworkperformed

northeproductiontimeisaffected,therelativeadvantageisstrengthened.

Compatibility:

TheflooringcompaniesarewellawareoftheMSDproblems,mainlytotheknees,andalarge

proportionoftheworkforceexperiencetheseproblems.Thismeansthatthesolutionfulfilsthe

requirementofcompatibility.

Complexity:

Tounderstandandusetheproductisselfevident;theworkisperformedwiththesamematerialand

equipmentasbefore,withtheadditionofanextendedhandleforthetasktobeperformedstanding

up.

Trialability:

Thesolutionhasbeengenerallyavailableandiseasytotryout,evenatrestrictedsurfaces.

Observability:

Thesolutionwaswellknownamongflooringcompaniesandmostcompaniesalsohadtriedthe

product.

Systemdependency

Table4.Thegluespreadersystemdependency

Substantialdependency Limiteddependency

Theinnovation X

Theenduser X

Thesolutionfulfilsthefiveaspectsofpotentialadoption.Thesolutionissystemindependenttothe

enduser,itdoesnotinfluenceotheraspectsofthefloorlayingwork.Inthiscase,theenduser,the

floorlayer,isbothuseranddecisionmaker,sincetheinvestmentcostisnegligible.

4.1.1 Degreeofadoption

Theinnovationhasnotpassedthetippingpoint[26].Inthiscase,thesolutionhasnotbeenadopted

bythemajorityoffloorlayersinspiteoftheproblemsrelatedtoMSDintheoccupation.Thesolution

isusedtoalimiteddegreeandpredominantlyamongthose,whosufferkneeinjuryproblems.

(28)

4.2 Study2,3–Liftingwalker

Studieshaveshownthatonethirdofallpersonsover65yearswholiveathomefallatleastoncea

year[49]20%theseneedmedicalattention[50Ͳ52].Ofthepeoplewhofallanddonotinjure

themselvesseriously,50Ͳ95%cannotgetupbythemselves[53].Toremainlyingonthefloorbecause

onecannotraiseoneselfcanhaveseriousconsequences.Studieshaveshownthatpeoplehavelain

onthefloorforanhourormorebeforetheyreceivedhelp[54].Eventhoughonedoesnotlive

alone,apartnerisnotalwaysabletohelp.Thatpersonmayalsohavefearsaboutthepartnerfalling.

Thismaybethecaseespeciallywhenthepersonfallsoften.

Thetechniquesthathavebeendevelopedforliftingpeoplewhohavefallenhavesofarbeenfocused

onreducingstrainonthecaregivers,whomusthelpthefallvictimsbackupagain.Thishasledtothe

developmentofliftingdevicesthatareadaptedtotheenvironmentwheretheyaremostlyused–

hospitalsandcarefacilities[55],[56],[57].

Thevarioustechniquesthathavebeendevelopedaremeanttohelppeopleupfromthefloorwith

differentdegreesofassistancefromcaregivers/hospitalstaff,andincludemobilelifts,inflatable

liftingdevicesandevenceilingͲmountedlifts.Allofthesedevicesarebasedonthepatientnot

helping.

Developmentofaliftingdevicethatcanhelppeopleraisethemselvesentirelyontheirown,orwith

minimalassistance,wouldbearevolutionarystepfortheindividualascomparedwiththelifting

devicesinusetoday,whichrequireextensiveassistancefromhomehelpersorothers.Itcould

provideapotentialforpeopletostayintheirhomeslonger.

4.2.1 Step1&2–Discover&Translate

Inthestudyweanalyzedhowolderpeopleprefertorisefromlayingonthefloor,andinwhich

stagestheycangainthemostbenefitfromanassistivedeviceforlifting.

Figure8.Thewaysofgettingup.Eacharrowrepresentsthenumberofparticipants

(29)

Figure9.P

Ourresu kneeling stepthat theknee themselv kneeling 4.2.2

Thethird task.Ag retiredp Thewor addinga physicall willbea Theseat fromwh

Figure10.

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(30)

4.2.3 Prototype

TheprototypewasbuiltonthebasisofthemostcommonlymarketedwalkerinSweden,theOno.

Theelevatingconstructionconsistsofaseatthatrunsalongtheverticalsupportsforthewalker’s

handles.Anelectricmotor,abatteryandacontrolpanelhavebeenintegratedintotheelevation

seat.Apositivedrivebelthasbeenmountedalongtheverticalsupportsforthehandles.Inthisway

theelevationseatcanrunalongtheentirelengthofthesupport.

Figure11.Elevatingconstruction

Theconstructionoftheelevationseatislightweightandcopeswithloadsupto125kg.Itisdesigned

toconformtovariouskindsofphysicalconstitutions.

Figure12.Prototypeofthewalkerwithelevatingseat

Participantswerehelpedtolieontheirbacksonthefloor.Weaskedthemtoraisethemselvestoa

kneelingpositioninanywaytheypreferred.Onepersonhelpedeachparticipant,placingthewalker

infrontoftheparticipantsothathe/shecouldcrawlupandlieovertheelevationseat.Theassisting

personthenpushedthebuttontoraisetheseat.Theseatwaselevatedtoapositionwherethe

participant’slegswerevertical,makingitpossibletoraisetheupperbodytoanuprightstanding

position.

(31)

Figure13.

Participa thatwas liftingpr Thediag

Figure14.

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EvaluationaccordingtoRogers

Table5.Evaluationoftheprototypebyprivatecitizengroup

Negativechange Nochange Positivechange

Relativeadvantage X

Compatibility X

Complexity X

Trialability X

Observability X

Relativeadvantage:

Thesolutionhastheadvantagetomakeitpossibletogetupfromthefloor(ifnotseriouslyinjured)

eitheronyourownorwiththehelpofanotherperson.Thesolutionalsocombinesacomplementary

function(liftingaid)withanalreadyexistingandutilizeddevice(thewalker).

Compatibility:

PeopleusingawalkerbelongtoariskͲexposedgrouppronetofallrepeatedly.Thisgroupalso

experiencesintegrityproblemsduetohavingtocallforassistancetogetupafterafall.Thesolution

mightrepresentaconsiderableaddedvalueforthisgroup.

Complexity:

Thesolutioniseasytounderstandanditspositivequalitiesapparent.

Trialability:

Thesolutioniseasytotest.

Observability:

Everyonewhohasseenorreadaboutthesolutionhasclearlyunderstooditspositiveattributes.

Systemdependency

Table6.Systemdependencyaccordingtotheprivatecitizengroup

Substantialdependency Limiteddependency

Theinnovation X

Theenduser X

Thesolutionfulfilsthefivepointsaboveforpotentialadoption.Asaprivatecitizenyourepresent

bothanenduserandadecisionmaker.Thismeansthattheinnovation/solutionisnotsystem

dependent.However,thebehaviouroftheenduserwillberelatedtodecisionsonwhetheryouthink

youneedawalkerornot.Toconvinceolderpeopletouseawalkerpreventativelyrequiresother

relativeadvantages.

4.2.4 Degreeofadoption

Theinnovationhasnotpassed“tippingpoint”[26].Inorderforthistohappen,andfortheproduct

toestablishitselfonthemarket,itwillhavetobeincludedintothehealthcaresubsidyscheme.

4.3 Study4–Theliftingwalkeratwork

Thestudywasconductedwithnursingstaffinanursinghomeinordertoexaminetheconditionsfor

howawalkerequippedwithaliftingbeamcouldfacilitatethetaskofassistingpatientswhohavehad

afall.

The Adoption of Ergonomic Innovations for Injury Prevention: Examples from the building construction and health care industries

The adoption of

Ergonomic Innovations for Injury Prevention

Examples from the building construction and health care industries

BO GLIMSKÄR

DOCTORAL THESIS IN TECHNOLOGY AND HEALTH STOCKHOLM, SWEDEN 2014

KTH ROYAL INSTITUTE OF TECHNOLOGY

SCHOOL OF TECHNOLOGY AND HEALTH

www.kth.se

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Abstract

Sammanfattning

Acknowledgements

Listofpublications

Authorcontributions

Contents

1 Introduction

2 Scopeofthestudy

3 Methodsandmaterial

4 Results