Examining the relationship between human factors related quality risk factors and work related musculoskeletal disorder risk factors in manufacturing.

This study addresses the relationship between human factors (HF) related quality deficits in manufacturing and work-related musculoskeletal disorder (WMSD) risk factors in production staff. A recent systematic review identified 60 HF-related quality risk factors (QRFs) in manufacturing related to product, process and workstation design stages. We investigate the extent to which these identified QRFs are also WMSD risk factors. Each QRF was examined for its relationship with WMSD using a 0 (no relationship) to 10 (strong relationship) scale rubric. The authors rated each QRF separately and then discussed and adjusted their ratings in a review session. Results showed that average median ratings were the highest for QRFs related to product design (8/10), intermediate for QRFs related to workstation design (7/10) and the lowest for QRFs related to process design (5/10). This emphasises the significant role of HF in system design in reducing both quality deficits and risk of developing WMSDs for manufacturing personnel.Practitioner summary: This study investigates whether human-related risk factors for product quality are also risk factors for work-related musculoskeletal disorders in manufacturing. Results showed a substantial relationship between quality risk factors and WMSD risk factors. This indicates the significant role of human factors in operations design in improving both system performance and human wellbeing.

Is there a u-shaped relationship between load levels and fatigue and recovery? An examination of possible mechanisms.

In a previous study, an unexpected u-shaped relationship was observed between load level and fatigue/recovery responses. Moderate load levels resulted in lower perceived discomfort, pain, and fatigue, and shorter recovery times compared to either low or high load levels. This phenomenon has been reported in other studies, but no article has examined the possible mechanisms that might explain this u-shaped relationship. In this paper, we re-examined the previously published data and found that the phenomenon does not appear to be due to the experimental artefact; the u-shape may be due to unexpectedly lower fatigue effects at moderate loads, and higher fatigue effects at lower loads. We then conducted a literature review and identified several possible physiological, perceptual, and biomechanical explanatory mechanisms. No single mechanism explains the entirety of the phenomenon. Further research is needed on the relationship between work exposures, fatigue, and recovery, and the mechanisms related to the u-shaped relationship.Practitioner summary: We examine a previously observed u-shaped relationship between load level and fatigue/recovery, where moderate force resulted in lower perceived fatigue and shorter recovery times. A u-shaped fatigue response suggests that simply minimising load levels might not be an optimal approach to reduce the risk of workplace injuries.

Examining human factors and ergonomics aspects in a manufacturing organisation's metrics system: measuring up to stakeholder needs.

This research examines the status of human factors and ergonomics (HF/E) metrics in the case context of product realisation in an electronics manufacturing company. Interactions with 100+ stakeholders over a five year period were thematically analysed for metrics-related views and content. A disconnect between engineering metrics and HF/E metrics was evident. Engineers and HF/E specialists expressed different understandings of the gap between the disciplines and how to generate HF/E metrics that would fit the organisation. Other emerging themes provided insight for metrics development including improving indicator relatability, considerations for communication of information, and barriers to implementation of metrics. The results led to seven recommendations to help guide practitioners in developing and refining HF/E metrics as part of an organisation's metrics system. This macroergonomic case study provides key points for consideration when developing HF/E focussed metrics to support organisations being more proactive with HF/E in work system design. Practitioner summary: Metrics' presence, stakeholder views on metrics, and metrics-related content in a case organisation were thematically analysed with a macroergonomics focus. Human factors and ergonomics metrics (HF/E) were disconnected from engineering metrics thus limiting the design team's ability to handle human factors in design. Factors influencing HF/E metrics creation and integration were identified, resulting in seven recommendations for developing HF/E metrics.

Developing a simulation tool to quantify biomechanical load and quality of care in nursing.

Nursing is a high musculoskeletal disorder (MSD) risk job with high workload demands. This study combines Digital Human Modelling (DHM) and Discrete Event Simulation (DES) to address the need for tools to better manage MSD risk. This novel approach quantifies physical-workload, work-performance, and quality-of-care, in response to varying geographical patient-bed assignments, patient-acuity levels, and nurse-patient ratios. Lumbar loads for 86 care-delivery tasks in an acute care hospital unit were used as inputs in a DES model of the care-delivery process, creating a shift-long time trace of the biomechanical load. Peak L4/L5 compression and moment were 3574 N and 111.58 Nm, respectively. This study reports trade-offs in all three experiments: (i) increasing geographical patient-bed assignment distance decreased L4/L5 compression (8.8%); (ii) increased patient-acuity decreased L4/L5 moment (4%); (iii) Increased nurse-patient ratio decreased L4/L5 compression (10%) and moment (17%). However, in all experiments, Quality of care indicators deteriorated (20, 19, and 29%, respectively).Practitioner Summary: This research has the potential to support decision-makers by developing a simulation tool that quantifies the impact of varying operational and design-policies in terms of biomechanical-load and quality of care. The demonstrator-model reports: as geographical patient-bed distance, patient-acuity levels, and nurse-patient ratios increase, biomechanical-load reduces, and quality of care deteriorates.

Movement disorders after hypoxic brain injury following cardiac arrest in adults.

BACKGROUND AND PURPOSE: Post-hypoxic movement disorders and chronic post-hypoxic myoclonus are rare complications after cardiac arrest in adults. Our study investigates the clinical spectrum, neuroimaging results, therapy and prognosis of these debilitating post-hypoxic sequelae. METHODS: This retrospective study included 72 patients from the neurological intensive care unit at a university hospital, who were diagnosed with hypoxic-ischaemic encephalopathy after cardiac arrest between January 2007 and September 2018. Clinical records were screened for occurrence of post-hypoxic movement disorders and chronic post-hypoxic myoclonus. Affected patients were further analysed for applied neuroprognostic tests, administered therapy and treatment response, and the outcome of these movement disorders and neurological function. RESULTS: Nineteen out of 72 screened patients exhibited post-hypoxic motor symptoms. Basal ganglia injury was the most likely neuroanatomical correlate of movement disorders as indicated by T1 hyperintensities and hypometabolism of this region in magnetic resonance imaging and positron emission tomography computed tomography. Levomepromazine and intrathecal baclofen showed first promising and mostly prompt responses to control these post-hypoxic movement disorders and even hyperkinetic storms. In contrast, chronic post-hypoxic myoclonus best responded to co-application of clonazepam, levetiracetam and primidone. Remission rates of post-hypoxic movement disorders and chronic post-hypoxic myoclonus were 58% and 50%, respectively. Affected patients seemed to present a rather good recovery of cognitive functions in contrast to the often more severe physical deficits. CONCLUSIONS: Post-hypoxic movement disorders associated with pronounced basal ganglia dysfunction might be efficiently controlled by levomepromazine or intrathecal baclofen. Their occurrence might be an indicator for a more unfavourable, but often not devastating, neurological outcome.

Using system dynamics modelling to show the effect of nurse workload on nurses' health and quality of care.

The objective of the current study is to explore System Dynamics modelling to quantify and understand the effects of nursing workload on nurse burnout, absenteeism, and quality of patient care. A literature search was performed to identify the causal relationships between factors related to the problem and build a conceptual causal loop diagram. Each of these factors was then operationalised and a simulation model was built using quantitative empirical data from the literature, supplemented with expert input. The model results showed that long nurse shifts and work weeks double nurse fatigue levels, while increasing burnout by up to 6 times, absenteeism by up to 5 times, and medical errors for the patients increasing by up to 150%. The study demonstrates a novel application of System Dynamics in healthcare to examine the impact of management strategies and healthcare system design on nurses' wellbeing and on care quality. Practitioner summary: System Dynamics Modelling allows for the integration of available scientific evidence and expertise to reveal the relationship between nurse workload, burnout and care quality in terms of medical errors. Such models can reveal possible responses from proposed policy or system design changes that could not be quantified with conventional approaches. Abbreviations: HF: human factors; SD: system dynamics; CLD: causal loop diagram; OFAT: one factor at a time.

Assessing human factors and ergonomics capability in organisations - the Human Factors Integration Toolset.

This paper presents the development of a tool that allows an organisation to assess its level of human factors (HF) and ergonomics integration and maturity within the organisation. The Human Factors Integration Toolset (available at: https://www.researchgate.net/project/Human-Factors-Integration-Toolset ) has been developed and validated through a series of workshops with 45 participants from industry and academia and through industry partnered field-testing. HF maturity is assessed across five levels in 16 organisational functions based on any of 31 discrete elements contributing to HF. Summing element scores in a function determines a percent of ideal HF for the function. Industry stakeholders engaged in field-testing found the tool helped to establish the status of HF in the organisation, plan projects to further develop HF capabilities, and initiate discussions on HF for performance and well-being. Improvement suggestions included adding an IT function, refining the language for non-HF specialists, including knowledge work and creating a digital version to improve usability. Practitioner summary: A tool scoring HF capability in 16 organisation functions has been developed collaboratively. Industry stakeholders expressed a need for the tool and provided validation of tool design decisions. Field-testing improved tool usability and showed that beyond scoring HF capability, the tool created opportunities for discussions of HF-related improvement possibilities. Abbreviations: HF: human factors; HFIT: Human Factors Integration Toolset.

Predicting the effect of nurse-patient ratio on nurse workload and care quality using discrete event simulation.

AIM: A novel nurse-focused discrete event simulation modelling approach was tested to predict nurse workload and care quality. BACKGROUND: It can be challenging for hospital managers to quantify the impact of changing operational policy and technical design such as nurse-patient ratios on nurse workload and care quality. Planning tools are needed-discrete event simulation is a potential solution. METHOD: Using discrete event simulation, a demonstrator "Simulated Care Delivery Unit" model was created to predict the effects of varying nurse-patient ratios. Modelling inputs included the following: patient care data (GRASP systems data), inpatient unit floor plan and operating logic. Model outputs included the following: nurse workload in terms of task-in-queue, cumulative distance walked and Care quality in terms of task in queue time, missed care. RESULTS: The model demonstrated that as NPR increases, care quality deteriorated (120% missed care; 20% task-in-queue time) and nursing workload increased (120% task-in-queue; 110% cumulative walking distance). CONCLUSIONS: DES has the potential to be used to inform operational policy and technical design decisions, in terms of impacts on nurse workload and care quality. IMPLICATIONS FOR NURSING MANAGEMENT: This research offers the ability to quantify the impacts of proposed policy changes and technical design decisions, and provide a more cost-effective and safe alternative to the current trial and error methodologies.

Modelling endurance and resumption times for repetitive one-hand pushing.

This study's objective was to develop models of endurance time (ET), as a function of load level (LL), and of resumption time (RT) after loading as a function of both LL and loading time (LT) for repeated loadings. Ten male participants with experience in construction work each performed 15 different one-handed repetaed pushing tasks at shoulder height with varied exerted force and duration. These data were used to create regression models predicting ET and RT. It is concluded that power law relationships are most appropriate to use when modelling ET and RT. While the data the equations are based on are limited regarding number of participants, gender, postures, magnitude and type of exerted force, the paper suggests how this kind of modelling can be used in job design and in further research. Practitioner Summary: Adequate muscular recovery during work-shifts is important to create sustainable jobs. This paper describes mathematical modelling and presents models for endurance times and resumption times (an aspect of recovery need), based on data from an empirical study. The models can be used to help manage fatigue levels in job design.

Young consumers' considerations of healthy working conditions in purchasing decisions: a qualitative examination.

Research has suggested that products manufactured under healthy work conditions (HWC) may provide a marketing advantage to companies. This paper explores young consumers' considerations of HWC in purchasing decisions using data from qualitative interviews with a sample of 21 university students. The results suggest that interviewees frequently considered the working conditions of those who produced the products they purchased. Participants reported a willingness to pay 17.5% more on a $100 product if it were produced under HWC compared to not. Their ability and willingness to act on this issue was, however, hampered by  a lack of credible information about working conditions in production, the limited availability of HWC goods and a presumed higher price of HWC goods. While caution should be applied when generalising from this targetable market segment to a general population, these results provide actionable direction for companies interested in using a HWC brand image to gain a strategic sales advantage. Practitioner Summary: This interview study shows that young consumers are interested in, and willing to pay a premium for, goods made under healthy working conditions (HWC). Reported barriers to acting on this impulse include a lack of credible information on working conditions. Ergonomics can help provide a strategic marketing advantage for companies.

'Power base' tactics for workplace change - an interview study with industrial engineers and ergonomists.

The work activities of industrial engineers (IEs) and ergonomists drive workplace changes. The purpose of this study is to compare the work practices of the two professions and examine (1) how IEs and ergonomists gain influence over workplace changes and (2) whether there are prevailing types of intentional interaction behaviours called Power bases (PB) present in the interaction tactics they employ. The study identified key behavioural strategies used by the interviewees to successfully influence workplace changes; these were then mapped to their corresponding PB. Results showed that IEs and ergonomists were successfully influencing workplace changes using several tactics across the spectrum of PB, with the exception of Reward and Coercion. The study concludes with a list of recommended workplace change agent tactics, and proposes that a PB 'analytical lens' can serve to increase the budding ergonomists' critical and analytical skills when considering possible workplace change tactics. Practitioner Summary: This interview study examines how workplace ergonomics change agents, represented by the two professions: industrial engineers and ergonomists, perceive and exercise their capacity to influence workplace change. Key behavioural tactics that interviewees have found successful are reported, alongside effects on short- and long-term relations with other workplace-influencing stakeholders.

PLANET TOPERS: Planets, Tracing the Transfer, Origin, Preservation, and Evolution of their ReservoirS.

The Interuniversity Attraction Pole (IAP) 'PLANET TOPERS' (Planets: Tracing the Transfer, Origin, Preservation, and Evolution of their Reservoirs) addresses the fundamental understanding of the thermal and compositional evolution of the different reservoirs of planetary bodies (core, mantle, crust, atmosphere, hydrosphere, cryosphere, and space) considering interactions and feedback mechanisms. Here we present the first results after 2 years of project work.

Different patterns of local field potentials from limbic DBS targets in patients with major depressive and obsessive compulsive disorder.

The role of distinct limbic areas in emotion regulation has been largely inferred from neuroimaging studies. Recently, the opportunity for intracranial recordings from limbic areas has arisen in patients undergoing deep brain stimulation (DBS) for neuropsychiatric disorders including major depressive disorder (MDD) and obsessive compulsive disorder (OCD). Here we test the hypothesis that distinct temporal patterns of local field potential (LFP) activity in the human limbic system reflect disease state and symptom severity in MDD and OCD patients. To this end, we recorded LFPs via implanted DBS electrodes from the bed nucleus of stria terminalis (BNST area) in 12 patients (5 OCD, 7 MDD) and from the subgenual cingulate cortex in 7 MDD patients (CG25 area). We found a distinct pattern of oscillatory activity with significantly higher α-power in MDD compared with OCD in the BNST area (broad α-band 8-14 Hz; P<0.01) and a similar level of α-activity in the CG25 area as in the BNST area in MDD patients. The mean α-power correlated with severity of depressive symptoms as assessed by the Beck depression inventory in MDD (n=14, r=0.55, P=0.042) but not with severity of obsessive compulsive symptoms in OCD. Here we show larger α-band activity in MDD patients compared with OCD recorded from intracranial DBS targets. Our results suggest that α-activity in the limbic system may be a signature of symptom severity in MDD and may serve as a potential state biomarker for closed loop DBS in MDD.

Design for human factors (DfHF): a grounded theory for integrating human factors into production design processes.

The 'design for human factors' grounded theory explains 'how' human factors (HF) went from a reactive, after-injury programme in safety, to being proactively integrated into each step of the production design process. In this longitudinal case study collaboration with engineers and HF Specialists in a large electronics manufacturer, qualitative data (e.g. meetings, interviews, observations and reflections) were analysed using a grounded theory methodology. The central tenet in the theory is that when HF Specialists acclimated to the engineering process, language and tools, and strategically aligned HF to the design and business goals of the organisation, HF became a means to improve business performance. This led to engineers 'pulling' HF Specialists onto their team. HF targets were adopted into engineering tools to communicate HF concerns quantitatively, drive continuous improvement, visibly demonstrate change and lead to benchmarking. Senior management held engineers accountable for HF as a key performance indicator, thus integrating HF into the production design process. Practitioner Summary: Research and practice lack explanations about how HF can be integrated early in design of production systems. This three-year case study and the theory derived demonstrate how ergonomists changed their focus to align with design and business goals to integrate HF into the design process.

Consumer demand as a driver of improved working conditions: the 'Ergo-Brand' proposition.

This article develops and explores the 'Ergo-Brand' proposition, which posits that consumers may prefer to buy goods that are made under good working conditions (GWCs). This preference would enhance a differentiation strategy for companies, thereby fostering the application of ergonomics in production. This proposition is developed in the context of a narrative review of the literature on 'ethical consumerism'. This is supplemented with a survey study, conducted in both Canada and Sweden (n = 141) to explore this proposition. Results indicate that consumers would prefer goods made under GWCs, but not unconditionally as quality and price concerns were ranked higher. Access to information on the working conditions in production was seen as a barrier. Nevertheless, the Ergo-Brand concept may be a viable avenue in promoting attention towards ergonomics in companies - particularly if consumer habits are subject to intervention by advertising. Further research on this strategy is warranted.

An ergonomics action research demonstration: integrating human factors into assembly design processes.

In action research (AR), the researcher participates 'in' the actions in an organisation, while simultaneously reflecting 'on' the actions to promote learning for both the organisation and the researchers. This paper demonstrates a longitudinal AR collaboration with an electronics manufacturing firm where the goal was to improve the organisation's ability to integrate human factors (HF) proactively into their design processes. During the three-year collaboration, all meetings, workshops, interviews and reflections were digitally recorded and qualitatively analysed to inform new 'actions'. By the end of the collaboration, HF tools with targets and sign-off by the HF specialist were integrated into several stages of the design process, and engineers were held accountable for meeting the HF targets. We conclude that the AR approach combined with targeting multiple initiatives at different stages of the design process helped the organisation find ways to integrate HF into their processes in a sustainable way. PRACTITIONER SUMMARY: Researchers acted as a catalyst to help integrate HF into the engineering design process in a sustainable way. This paper demonstrates how an AR approach can help achieve HF integration, the benefits of using a reflective stance and one method for reporting an AR study.

Fatigue and recovery during and after static loading.

Subjectively assessed endurance time (ET), resumption time (RT) and perceived discomfort, pain or fatigue (PD), and objectively measured maximum force-exerting capacity were investigated for varying loads and durations of a pushing task with two repeated trials. Beyond the main results quantifying how the load scenario affected ET, RT and PD, three additional results are of note: (1) although the maximum pushing force did not change between trials, shorter ET, longer RT and higher PD indicated accumulation of fatigue in Trial 2; (2) the PD ratings showed a trend with a linear increase during loading and a curvilinear decrease during recovery; and (3) the RT and the load level for different relative loading times were found to have an unexpected U-shaped relationship, indicating lowest fatigue at the intermediate load level. These results can be used to model a more sustainable and productive work-recovery ratio.

The better work, better care framework: 7 strategies for sustainable healthcare system process improvement.

Healthcare systems are under pressure to control costs and improve performance. Efforts to apply improvement trends such as "Lean" and other industrial engineering approaches have led to degradation of the working environment for healthcare professionals. Research is increasingly demonstrating how poor working environments contribute to declines in care quality and has led to calls for a "quadruple aim" with a focus on the working environment alongside quality, cost, and patient experience factors. This paper contributes to the debate by using a "systems" perspective to propose seven strategies by which healthcare systems might be improved without compromising the working environment. This article presents a rationale for these strategies based on current organisational psychology and human factors research and how these strategies might be deployed in practice. The authors argue that better working conditions leads to better care for patients and presents a viable approach for both practitioners and researchers to pursue the "Better Work, Better Care" agenda.

Applying ergonomics and human factors to congress organization in uncertain times.

Organizational Design and Management (ODAM) elements of Ergonomics and Human Factors (E/HF) apply to congress organization. Exemplary delegate and organizer E/HF experience is constrained by shifting requirements, time pressures and financial constraints. E/HF application while organizing the International Ergonomics Association's Triennial Congress in 2021 (IEA2021) is described focusing on delivery platforms considering typical and exceptional (pandemic) constraints, emphasizing ODAM E/HF principles and generalizable lessons. Post-Congress feedback from delegates, session chairs and Congress organizers reveal the Congress as experienced. Presenting virtually allowed on-demand recording access following live sessions and increased question-and-answer flexibility. Frustrations included navigating multiple platforms and insufficient communications. Stakeholders' differing expectations increased organizer workloads and delegate frustration. Maximum virtual presentation benefits require efforts to ensure integrated, human-centered platform development. Simply digitizing traditional Congress sessions ignores potential enhancements. Embracing innovations would help meet delegate communication needs via careful selection and deployment of evolving virtual meeting technologies. Organizational learning strategies can support these efforts.