Mobility Minute: Guy Fragala on the impact of human factors with in-hospital mobility
I’ve always been fascinated with the concept of human-centered design and how many times users are failed by the missteps of product designers in every industry. ‘Human-centered’ is a concept that is often overlooked by those who develop interfaces and tools that we interact with daily. Dr. Guy Fragala has over 45 years of experience as a healthcare professional and is recognized as one of the pioneers of Safe Patient Handling and Mobility efforts in the United States. He has lectured throughout the world and is a recognized international expert in the application of ergonomics to the healthcare setting. Currently he helps and supports a number of organizations, vendors and facilities with their safe patient handling and mobility efforts. In 2012 he was awarded the National Advocacy Award for Improved Caregiver Safety and in 2017 awarded the Bernice Owen Safe Patient Handling and Mobility Research Award. His book entitled, Ergonomics: How to Contain On-the-Job Injuries in Healthcare, published by the Joint Commission on Accreditation of Healthcare Organizations, has influenced much of the work today related to healthcare ergonomics and safe patient handling and mobility programs.
“If we can take technology and improve a process or a task, we can make it easier for a caregiver to benefit themselves and the patient ”
Listen to the full podcast here.
Note: Podcast transcript below is generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio before quoting in print.
Tell us about your background, that is what you consider as your areas of expertise and where you have worked and what you have done.
My educational background has been in mechanical and industrial engineering, specializing in ergonomics and human factors. I started at an insurance company doing loss prevention and risk management work and went on to work at the Dupont corporation where I learned a lot about corporate cultures and safety. I was approached by the University of Wisconsin and asked to come teach in an occupational safety and health program. While I was on a leave of absence from the school, I was approached by the University of Massachusetts Medical Center. They wanted a Director of Environmental Health & Safety and I wondered, “Why in the world would a healthcare organization want someone to deal with occupational safety and health?” I realized that caregivers in healthcare are some of the most at-risk groups for injury. I’ve worked in healthcare most of my professional career, yet I’m not a clinician. But, I’ve interfaced with many clinicians and together we’ve pursued some pretty good solutions!
You mentioned the terms Human Factors and Ergonomics, what is Human Factors or Ergonomics and why is it Important?
Some folks use the terms synonymously and they are quite similar. Basically what ergonomics and human factors tries to do is optimize the match between the interface of the person doing a job and the actual task at hand. We’re trying to design jobs that fit the capabilities of people and not expect people to adapt to poor designs. In theory it makes a lot of sense, but if you go out there and you look at a lot of the systems people are dealing with and tasks they need to perform in their day-to-day work, we find very often that we really don’t see these optimal interfaces. One of the areas where ergonomics has been very helpful in terms of occupational safety is prevention of musculoskeletal injuries.
Well respected in his field, Dr. Guy Fragala has been a pioneer in the world of Safe Patient Handling & Mobility. In this video he speaks at Occupational Safety and Health Administration (OSHA) Press Conference [1999].
How have you tried to integrate the concepts of human factors or ergonomics into the hospital environment? (coordination of care)
People delivering care are one of the most at-risk groups for occupational back injuries. We’re concerned with lifting loads, but when people are bending the trunk of the body is quite heavy, and the musculoskeletal structure must support the body in that bending posture. Ergonomics and human factors practitioners have found that repeated bending is a very high-risk activity. If we can reduce the frequency of what’s been determined as a high-risk activity, we can really make some impact into reducing the risk to that person and the jobs that they do day in, day day out.
Based on your efforts and experience with safe patient handling, how do you see these efforts evolving into safe patient handling and mobility and how would you define mobility as applied to the hospital patient?
While at UMass Medical Center, I recognized that nurses were the group suffering the most occupational injuries. I looked at the way this work was being done and how we were trying to prevent and reduce the impact of these injuries. For years, we taught people how to lift properly. Research has since showed that properly lifting doesn’t reduce occupational injuries. Because of the loads involved, no matter how biomechanically correct we perform these lifts we weren’t reducing risk for the caregiver.
Mobility is becoming a more important part of the practice of delivering care. We don’t want to keep people in bed or make them inactive because there are so many downsides to this. Research is showing today that if we mobilize patients early and often we can dramatically improve outcomes. If you look at the tasks involved with mobilizing patients, many of them are tasks of the caregiver that we consider ‘high-risk activities’ from an occupational risk perspective. We need to use technology to develop new ways to do this work.
Let’s talk measurement. Do you think measuring some aspects of patient mobilization is important and how do you think we might effectively begin to measure patient mobilization in the hospital?
When we look at how we make improvements and gain additional evidence, we need measurement and data collection. Right now we know mobilization is good. Research has showed us that we need to mobilize patients early and often, but how often? I think that’s data we need to collect and evaluate to help us better understand what is required in these mobility programs. In the past, we’ve depended on the caregiver to record in charts, but that’s not a good use of the caregivers time. If we can develop better means to collect mobility data, we are going to be much better off because we can let the caregivers do what they do best; be at the bedside and deliver care. I think we can interface with Electronic Medical Records new ways to capture data. Once you have this new data, it can be evaluated to influence mobility programs and motivate patients to recover.
Measurement is a good motivator.
Do you have any thoughts on who has ownership of mobility efforts in the hospital setting and how important is ownership when considering the potential success of any program or effort?
That’s going to be really important to the future of mobilization in healthcare. Let’s consider where we are right now and where it might end up. When we think of mobilization right now of course we are going to think of the physical therapist. A therapist gets a prescription to come and do rehabilitation activities with a patient. This might only be three times a week for a half hour. I’m not a clinician, but I recognize that this isn’t enough. When a PT isn’t there, some people might think mobility becomes the nurses responsibility now. To ask the nurse to mobilize the patient, especially in today’s environment, might be somewhat impractical. I think right now we are a sort of conflict; who owns mobility? Is it a nursing function or a rehab function? I think mobilization has to be something that we do across the entire spectrum of that patient’s care and so interdisciplinary communication is essential.
ABOUT THE AUTHOR
DREW MARTIN
Drew works as marketing manager and takes care of digital and content marketing efforts for Recovery Force Health. He enjoys learning about and discussing newer medical technologies and adopting them into everyday marketing practices.
