Abstract
I appreciate the offer of JDMS’s Editor-in-Chief, Dr. Kevin Evans, to provide a guest editorial on my perspective on the next steps for ergonomics research in sonography. Dr. Evans is a visionary in education and research in the world of sonography, and I feel fortunate to have the pleasure and gain the intellectual benefits of working with him for more than a decade on research to address the multifaceted and persistent problem of work-related musculoskeletal disorders (WRMSDs) in sonographers and other imaging professionals.1–3
My approach to ergonomics research and practice is participatory and collaborative. Successful ergonomics intervention begins with ergonomics education so that workers who are exposed to risk factors for WRMSDs can fully participate in a sustainable solution process and recognize the full complement of benefits to embracing ergonomics and making it “how we work.” Those benefits include reduced discomfort/improved comfort, reduced fatigue, improved efficiency, and error reduction, among others. For example, sonographers who understand the value of using computer workstations in which all components (chair, displays, and input devices) can be adjusted to match their personal anthropometry and that provide sit and stand options are more likely to use that adjustability. Workers with some knowledge of ergonomics should be involved in evaluating the usability of new equipment before it is purchased. They can also provide input on room design and equipment layout. This level of knowledge and involvement is more likely to result in satisfaction and utilization of new equipment and other interventions.4,5
Health care workers cannot protect themselves from WRMSDs without the support and actions of managers and administrators. This is because the primary goal of health care workers is providing the best care possible for their patients, in a timely fashion. Imaging professionals who perceive that their health is a lesser priority to their employer than patient outcomes and productivity will obtain the best image they can as fast as they can, which can pose risk of injury to the worker. Alternatively, when administrators prioritize the health outcomes of patients and the health of staff, through word and deed (e.g., budget allocation for personnel and equipment, injury report review and follow-up, active inquiry regarding interventions initiated within departments), then managers can more effectively work with the members of their staff to develop plans for addressing WRMSD risk factors encountered by staff. A health care organization’s safety culture should encompass the occupational safety of its workers, as well as the safety of its patients. Organization-level interventions could include a daily review of schedules to identify patients with mobility limitations or other factors that should require the presence of two sonographers, a limit on the number of difficult scans performed in a single day by any one sonographer, or the decision that all portable radiographs will be performed with two radiographers to reduce risk of injury during patient handling and receptor positioning activities. 6
In common with most ergonomics researchers, my desire is to document and analyze interventions and their effects, at both the micro- and macro-level of the health care workspace, to be able to disseminate information about what works in what context. Goldenhar et al. 7 wrote about the necessity of and challenges to the conduct, dissemination, and diffusion of occupational safety and health intervention research. The authors named “developing partnerships” as one of five key elements in the intervention research process and emphasized the importance of stakeholder involvement and multidisciplinary teams to tackle the challenges of intervention research. Developing partnerships within and between all levels is vital to the success of micro- and macro-level changes in the health care workspace. For example, sonographers can partner with patients to ask those patients who are able to move closer to the sonographer, rather than scanning in awkward postures that put excessive loads on shoulder muscles and tendons. Managers can partner with their staff by involving staff in decision making concerning equipment purchases. Managers and sonographers can partner with ergonomists and researchers to ideate new solutions to address ongoing risks and document ways of working that have been successful in reducing injuries in their department to share their experience with others. Collaboration is needed to produce the empirical evidence that changes can be beneficial for patient throughput, employee health, and department productivity. As stated by Goldenhar et al., 7 “interventions are difficult to implement,” and implementation documentation (including what to measure and document) and analysis may be difficult for health care workers and managers who are already busy providing patient care. So, collaborating with researchers with experience in implementation research can be beneficial to health care professionals (HCPs) interested in exploring and documenting changes in work methods or equipment that could be effective in reducing worker exposure to risk factors for WRMSDs.
Quoting from the recently published Industry Standards for the Prevention of Work Related Musculoskeletal Disorders in Sonography, 8 “The risks for WRMSDs among sonographers include a broad range of contributing factors. Therefore, the employer, manufacturer, sonographer/user, industry organizations, and educational programs all have the responsibility to do their part to educate, train, exercise best practices, and provide equipment and working conditions to prevent health and safety problems that cause WRMSDs.” While the standard calls for each group to contribute, comprehensive collaboration, where representatives from all of the groups are involved in an intervention project, is rare, so progress is often piecemeal. The term interprofessional practice is commonly used to refer to interaction between different health care disciplines when they work collaboratively to care for patients. The end goal is improved outcomes for patients. However, the benefits of adopting a holistic interprofessional practice mind-set could extend beyond benefits to patients, to include all stakeholders, including HCPs. For example, a holistic interprofessional practice mind-set would look at health care tasks that are common to different HCPs to determine methods that are best for all who perform the task, such as patient-handling activities. Nurses have been at the forefront of efforts to reduce unassisted manual patient handling performed by nurses and nursing assistants. Other HCPs, including sonographers and radiographers, also position patients in patient rooms, yet they often perform these tasks alone and unaided by equipment, risking injury to themselves. In a setting with a holistic interprofessional mind-set, nursing staff would assist imaging technologists to position patients, and all, nursing staff and imaging technologists, would be trained and proficient in using the appropriate patient-handling equipment that is readily accessible and ready for use. A holistic interprofessional practice mind-set would include engagement with non-HCPs from outside and inside the health care setting, such as ergonomists, industrial hygienists, and other occupational safety professionals; equipment manufacturers’ designers and engineers; and hospital purchasing decision makers. Collaborative engagement of the spectrum of stakeholders is needed in intervention research to address longstanding challenges to reducing WRMSDs in sonographers and other HCPs, in order to develop novel, sustainable innovations to delivery of health care services that benefit patients and are safe for HCPs.
