2018 GLOBAL MEDICAL ENGINEERING PHYSICS EXCHANGES/PAN AMERICAN HEALTH CARE EXCHANGES (GMEPE / PAHCE)

The Role of Clinical Engineering in the Promotion of Hospital Ergonomics

B. M. Giordani1, F. S. Barros2, P. Nohama3, M. M. Gusso3
1
Graduate Program in Design, Santa Catarina State University, Brazil
2
Graduate Program in Biomedical Engineering, Federal University of Technology - Paraná, Brazil
3
Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná, Brazil
Email: giordanibianca@gmail.com;
Abstract –– The clinical engineer is the professional inside
the hospitals that uses the knowledge of engineering in favor
the resolutions of questions from the health environment. In
addition to equipment management, clinical engineers have a
number of diversified assignments and they need ensure the
safety and satisfaction of human beings during them. One way
to promote this is through hospital ergonomics, the observation
of ergonomic parameters can help identify ergonomic
problems that can be solved, promoting health, satisfaction and
safety in the health units. Methods: The present study intended
to establish a relationship between the attributions of clinical
engineering and ergonomics, in order to demonstrate the
ability of promoting ergonomics that clinical engineers possess,
using bibliographic research as a method to provide
information and data for the development of the research.
Results: Comparing ergonomics parameters and clinical
engineering attributions found in the literature it was possible
to identify several convergences between them. Discussion:
With the comparison, this relationship was perceptible,
demonstrating the opportunity that clinical engineers have in
ergonomics of offering better health services.
Keywords –– clinical engineering, ergonomic parameters,
hospital ergonomics.
I. INTRODUCTION
The technological advances of the last decades are
imposing the modernization of many sectors in society, in
health units is no different. Innovations in electronics,
nuclear medicine, computers and diagnostic by imaging are
some of the examples that illustrate the evolution of health
systems over the last century [1]. Each day that passes new
high technology devices are created and they are used to
promote better diagnostics and treatments for patients in
hospitals and clinics. As a result, in addition to the
improvement in services provided to users, it also increases
the need of professionals who are able to deal correctly with
those equipment that are increasingly complexes and need
attention. Thus, the figure of the clinical engineer,
professional equipped with the necessary knowledge to
perform such activities, becomes increasingly essential for
the management of those resources.
The Clinical Engineer provides support and enhances
patient care through the application of engineering and
management skills into health technologies [2]. In this way,
these professionals are responsible for efforts related to the
use of technologies in hospitals. However, clinical
engineering goes far beyond equipments, nowadays they are
deeply involved in activities like quality improvement and
risk management. Thus, in its various functions, the clinical
engineer is also concerned with the risks involved in using
these devices in order to avoid accidents [2]. In this way, the
concern of the clinical engineering in the improvement of
the safety of the hospital services is perceived, making this
professional responsible for the ergonomics in hospitals.
Ergonomics - or human factors - is centered in study the
adaptation of work to man [3], work being understood here
in its broadest definition, all situations arising from the
interaction between a human being and a productive
activity. Ergonomics is concerned with understanding the
worker's skills and limitations in order to adapt the work to
its needs, avoiding failures and thereby preserving the health
of the individual. It is divided into three domains - physical,
cognitive and organizational - to analyze the work in an
integral way and to achieve its goal of promoting health,
safety and people satisfaction, resulting in efficiency in the
functions performed [3]. Knowing the domains of
ergonomics and its scope, it is possible to affirm that it can
be applied to many activities and responsibilities of the
clinical engineer, going beyond the study of man-machine
interfaces, being applied for the planning of clinical spaces,
working hours and among other diverse interactions studied
by the ergonomics that are verified in the routine of a
clinical engineer.
Ergonomic knowledge can be a potential ally to clinical
engineers in improving the safety of hospital services. The
present study was devoted to present how clinical
engineering professionals, in their daily assignments, can
assist in the promotion of hospital ergonomics, according
ergonomics domains and parameters.
II. METHODOLOGY
The present work was dedicated to perform a research
of applied nature, with the purpose of producing practical
knowledge in order to help solving specific problems. The
approach used was qualitative, since it was emphasized by
the understanding of the phenomena and their respective
meanings [4]. The research executed was exploratory, using
a bibliographical survey to understand the topics addressed
to better relate them. Therefore, the technical procedure
used was a bibliographic research that provided the
information and data for the development of the research.

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978-1-5386-5475-0/18/$31.00 ©2018 IEEE IEEE CATALOG NUMBER: CFP1818G-ART
 2018 GLOBAL MEDICAL ENGINEERING PHYSICS EXCHANGES/PAN AMERICAN HEALTH CARE EXCHANGES (GMEPE / PAHCE)
III. RESULTS
A. Clinical Engineering
Clinical engineering, an arm of biomedical engineering,
is a very important sector in health units. But it has not
always been that way, the establishment of these sectors
and, consequently, of professionals called clinical engineers
is relatively recent.
The emergence and implementation of clinical
engineering was very important for the improvement of
hospital practices. Clinical engineering departments have
become the support center for all medical technologies.
They became responsible for all the biomedical instruments,
systems used in hospitals and the training of doctors on the
safe use of equipment [5].
Studies have shown a substantial contribution of these
sectors in hospitals and clinics, since this professional
interacts with several actors within the hospital
configuration. Their assignments are not limited to the
maintenance of equipment. In fact, clinical engineers are
responsible for several activities. Some authors [6]
categorized the activities into three main tasks (Table 1).
TABLE I
FUNCTIONS OF CLINICAL ENGINEERS.
- Plan: determine objectives, goals, policies, programs,
resources and establish procedures.
- Organize: organizational structures, outline
relationships, describe positions and profiles, and
generate organizational manuals and procedures.
Administrative
Integrate: select, guide, train and develop areas of
tasks
performance.
- Lead: delegate responsibilities, motivate, coordinate,
overcome differences, anticipate and promote change.
- Evaluate: establish the information system, determine
efficiency standards, measure and feedback the other
results.
- Collaborate in the implementation of new techniques
and medical procedures that involve engineering
aspects.
- Collaborate in medical or clinical research related to
Research and engineering.
development - Design and supervise the construction and testing of
tasks special purpose equipment.
- Carry out continuous study, research, development
and design of methods used in health care.
- Develop methods of calibration, adjustment and
testing of instruments.
- Keep biomedical instruments in optimum working
condition, ensuring patient and operator safety.
- Plan the acquisition of medical-hospital equipment,
aiming at the incorporation of technology.
- Coordinate the acquisition process.
- Manage the maintenance of medical-hospital
Service tasks equipment from acquisition to disposal.
- Plan and monitor changes in the physical structure of
the health spaces.
- Interact with medical and paramedical staff to identify
problems and generate solutions.
- Assist clinicians and researchers in defining problems
by analyzing and proposing solutions.
PORTO, PORTUGAL; MARCH 19–24, 2018
- Act as technical part in committees.
- Collaborate in the improvement and maintenance of
the quality control of methods and instruments.
- Represent the institution outside the walls in aspects
related to engineering.
- Collaborate in the investigation of accidents involving
equipment in the hospital unit.
- Train human resources and instruct the technical staff
for the maximum use of resources.
In order to execute those activities, in addition to the
specific training in clinical engineering that is required of
these professionals, the clinical engineering associations -
for example ABEClin - expects its members to perform their
functions taking ethical principles into account. Among the
principles, two stand out: Maintain, as a priority, the safety,
health and welfare of the public; Make the health area a safe
and effective environment for the responsible and effective
use of the resources made available to it [7].
The mentioned principles refer to the concern that this
professional must have with the promotion of the physical
integrity of the people during their professional activities.
These principles closely resemble the objectives of
ergonomics: safety, satisfaction and health [3]. This fact
demonstrates how clinical engineers are also responsible for
ergonomics in hospital environments, as in their daily
assignments they should seek to promote this.
B. Hospital Ergonomics
Ergonomics is a science related to understanding the
interactions between humans and other elements or systems,
and applying theories, principles, data and methods to
projects in order to optimize human well-being and
performance of the system [8]. It is understood that the
object of study of ergonomics is the man and all that he
interacts and interferes in the execution of a certain activity.
From this, it is possible to develop projects, plans spaces,
artifacts, systems, workstations to make them adequate for
the capacities and restrictions of people [3], according three
different domains (Table 2).
TABLE II
ERGONOMIC DOMAINS.
PHYSICAL ERGONOMICS
It deals with the characteristics of human anatomy, anthropometry,
physiology and biomechanics, related to physical activity. It includes
posture at work, material handling, repetitive movements, work-related
musculoskeletal disorders, job design, worker safety and health;
COGNITIVE ERGONOMICS
It deals with mental processes, such as perception, memory, reasoning
and motor response, related to the interactions between people and other
elements of a system. It includes mental burden, decision making,
human-computer interaction, stress, and training;
ORGANIZATIONAL ERGONOMICS
It deals with the optimization of socio-technical systems, covering the
organizational structures, policies and processes. It includes
communications, work project, group work scheduling, participatory
project, cooperative work, organizational culture, networked
organizations, telecommuting, and quality management .
ISBN: 978-1-5386-5475-0
IEEE CATALOG NUMBER: CFP1818G-ART
 2018 GLOBAL MEDICAL ENGINEERING PHYSICS EXCHANGES/PAN AMERICAN HEALTH CARE EXCHANGES (GMEPE / PAHCE)

It is known that the assessment of the ergonomic aspects Knowing the parameters to be observed, it is possible to
of a system should be examined comprehensively in order to identify problems and plan ergonomic interventions to be
identify the nature of problems and their solutions. Some promoted. It should be made in all circumstances where
authors [9] described parameters to be used for this humans perform activities, including health care
identification (Table 3). establishments, where it is called Hospital Ergonomics.
Hospital Ergonomics aims to improve working
TABLE III conditions, comfort and safety of health workers and
ERGONOMIC PARAMETERS. patients [10]. Ergonomics differs when inserted in health
spaces, since the hospital environment presents very unique
Interfaces
configuration, morphology, physical arrangement, dimensions, reaches,
configurations, presenting peculiarities because it is a place
machines, equipment, consoles, benches, panels and furniture; of high complexity (physical, technological, instrumental),
Instrumental with constant temporal pressure and tension related with the
configuration, conformation, physical arrangement, topology, best possible care. This includes, among others, human
prioritization, ordering, standardization, compatibly and consistency, diversity, female prevalence, high physical demands and
supervision panels (synoptic, dials) or commands;
Informational
shift work. In addition, it is also important to highlight the
visibility, readability, comprehensibility and quantity of information, organizational aspects of the work, particularly hierarchical
prioritization, ordering; signal components - characters and symbols -, and relational aspects among health professionals [11].
security or guidance signaling systems, synoptic panels, video monitors Ergonomics is interdisciplinary and, therefore, it has the
and displays, operational manuals and instructional supports;
Ational
involvement of professionals from several areas for its
configuration, shape, apprehensibility, dimensions, movement and accomplishment [3]. It is observed that many professionals
resistance of manual and pedestrian controls; can assist in the promotion of hospital ergonomics. Among
Communications the areas, engineering plays an important role, having a
articulation and standardization of verbal messages by loudspeakers, critical view of the systems, acting on the technical aspects
microphones and telephony: quantity of oral communication equipment;
Cognitive
of environments and machinery, on the organization of jobs
comprehensibility, logical consistency of coding, compatibility of and flows of materials, among other functions [3]. In this
repertoires, coherence of stimuli, instructions, actions and decisions case, the performance of the engineers, especially clinical
involved in the task, compatibility with the amount of information, engineers, is highlighted, since they face many aspects that
complexity and/or risks involved in the task; qualification, competence deserve ergonomic attention in their daily functions.
and proficiency of the operator;
Motional
weight limits for lifting and manual transport of loads according to the
horizontal distance of the load in relation to the lumbar region of the IV. DISCUSSION
spine, the vertical course of lifting or lowering of the load, the
conformation of the load, the frequency of manipulation of the load;
Spatial/architectural
From the previous assessment, it is possible to identify
aeration, sunshine and ambient lighting; Acoustic and thermal insulation; several convergences between the occupations and
Circulation areas and installation layout of workstations; Graphic objectives of clinical engineering with the aspects of
ambience, colors of the environment and architectural elements; ergonomics. To make it more evident, this relationship was
Physical-environmental explained by converging the attributions of clinical
lighting, noise, temperature, vibration, radiation, pressure, limits of
hygiene and safety at work, and considering the specificities of the task; engineering with the ergonomic parameters in Table 4.
Chemical-environmental
toxicity and vapor; biological agents (micro-organisms, bacteria, fungi TABLE IV
and viruses) that respect standards of asepsis, hygiene and health; RELATION BETWEEN THE ASSIGNMENTS OF THE CLINICAL
Security ENGINEERING AND THE DOMAINS AND ERGONOMIC PARAMETERS .
risk and accident control, maintenance of machinery and equipment, use
of collective protection devices and personal protective equipment, Ergonomic Ergonomic
constant supervision of ducts, alarms and industrial plant in general; Clinical Engineering Tasks
Domains Parameters
Operational Plan: determine objectives, goals, Operational
task scheduling, formal and informal interactions, rhythm, repetitiveness, policies, programs, resources and Organizational Organizational
autonomy, pauses, supervision, precision and tolerance of task activities, establish procedures. Instructional
quality controls, team dimensioning; Organize: organizational
Organizational structures, outline relationships, Informational
Cognitive
splitting, isolation, participation, management, evaluation, day, hours, describe positions and profiles, Cognitive
organizational
shifts and work schedules, selection and training for work; and generate organizational Instructional
Instructional manuals and procedures.
training programs, task execution procedures; recycling and evaluation; Integrate: select, guide, train and Organizational
Urban Organizational
develop areas of performance. Instructional
planning of city space, urban signage and transportation, road, rail and Lead: delegate responsibilities,
subway terminals, circulation and integrationareas, rest and leisure areas; motivate, coordinate, overcome Cognitive Communicatios
Psychosocial differences, anticipate and Organizational Instructional
conflicts between individuals andngroups; communication difficulties and promote change.
interpersonal interactions; lack of options for relaxation and leisure.

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IEEE CATALOG NUMBER: CFP1818G-ART
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Evaluate: establish the

Informational modify a system according to the particularities, abilities
information system, determine Cognitive and restrictions of human beings, analyzing all systems that
Cognitive
efficiency standards, measure and Organizational
feedback the other results.
Operational interact with each other in a work situation, confronting the
Collaborate in the implementation prescribed work with what is actually performed [11].
of new techniques and medical
Organizational Instructional Thus, it is understood that there is a large space for
procedures that involve clinical engineering to contribute to the promotion of
engineering aspects.
Design and supervise the Interfaces
hospital ergonomics. By the amount of parameters that can
Physical be associated with the functions of these professionals, this
construction and testing of special Instrumental
Cognitive
purpose equipment. Ational may even be seen as a necessity. Reference [11] highlights
Carry out continuous study, that some ergonomic contributions that can easily be
Operational
research, development and design Organizational
of methods used in health care.
Instructional promoted with the help of clinical engineering: Distribution
Develop methods of calibration, of the respective services in the space, according to
adjustment and testing of Organizational Instructional parameters of functionality, communication and transfer
instruments. and/or movement of patients in the hospital; Selection and
Keep biomedical instruments in deployment of equipment and functional organization of
Security
optimum working condition,
ensuring patient and operator
Physical Interfaces services and workplaces; Organization of hospital
Instrumental information flows and systems that improve communication
safety.
Manage the maintenance of between services where there is high patient transfer or
Physical Security
medical-hospital equipment from frequent communication; Use of equipment, utensils and
Organizational Operational
acquisition to disposal. devices of clinical practice; Organization and distribution of
Plan and monitor changes in the
Architecture working time of health professionals, based on
Physical-envir. organizational requirements, actual workloads (physical and
physical structure of the health Physical
Chemical-envir.
spaces.
Security
mental) and the reliability and human resilience of these
Assist clinicians and researchers professionals; Patient Safety, namely in the identification,
Physical
in defining problems in clinical All recording and analysis of clinical error, medical error and in
Cognitive
and service areas by analyzing (Except Urban) the prevention of adverse events (or events) arising from the
Organizational
and proposing solutions.
provision of health care.
Interfaces
Collaborate in the improvement
Instrumental
and maintenance of the quality Physical
Ational
control of methods and Organizational
instruments.
Operational V. CONCLUSION
Instructional
Operational
Organizational A hospital is an environment that integrates many
Train human resources. Organizational complex relationships, being a necessity the creation of an
Instructional
Psychosocial ergonomically appropriate system for the functions
Collaborate in the investigation of performed there [11]. Therefore, there is a growing demand
Physical Security
accidents involving equipment in
the hospital unit.
Cognitive Cognitive for professionals committed to promoting these ergonomic
Instruct the technical staff for the aspects in their daily work, so that they can help in
Organizational Instructional
maximum use of resources. stimulating the quality of life and well-being in these spaces.
The clinical engineering professional is more than
Observing Table 4, it can be seen that from the capable of collaborating with hospital ergonomics, as well
assignments described [6], in only six ergonomic concepts as having many opportunities to exercise it in their
could not be used in the routine of clinical engineering, assignments.
while in the other 19 assignments several parameters could The present study demonstrated some ergonomic
be useful, improving equipment, spaces and services in parameters that can be observed from the point of view of
general. Then, it is observed how ergonomics can be the clinical engineer and when they are diagnosed can be
inserted in the hospital environments through the clinical easily solved, demonstrating where the professional can
engineer, reinforcing the importance of such professional in interfere and evidencing how valuable it is for the health,
the provision of health services more safe and satisfactory. safety and satisfaction of people in medical-hospital
Knowing the parameters to be observed in each function environments.
gives to the clinical engineer the sensibility to identify faulty However, it was only presented the opportunity for
items or elements to be improved in their daily activities. intervention by these professionals, tools and protocols that
In addition to the parameters, ergonomics provides a could be used for ergonomic diagnoses and corrections were
series of protocols to diagnose problems and tools to solve not explored at this time. It is recommended for future
them. It is up to the professionals to seek the aid to solve studies that ergonomic instruments that could be used by
each problem. A widely used protocol is the Ergonomic clinical engineering in the solution of ergonomic problems
Work Analysis, it is defended that this analysis allows to in the health units are listed.

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