Current Directions in Biomedical Engineering 2019;5(1): 141-144
Lorenz Müller*, Saskia Sobkowicz, Elisabeth Ibenthal and Claus Backhaus
Usability assessment of patient hoists as a
purchasing guide for health facilities
Abstract: Nurses suffer from musculoskeletal strains because
of frequent patient mobilizations. Therefore, mobile patient
hoists were developed. However, patient hoists are rarely used.
A possible reason is a low user acceptance due to poor
usability of available products. To increase the user acceptance
in health facilities and thus the frequency of use, a comparative
usability assessment was conducted. The goal is to support
health facilities in future purchasing decisions. 12 hoists were
tested by 40 nurses in three everyday scenarios. Every nurse
tested three hoists in randomized order. In total, each hoist was
tested ten times. The success rate was used to measure the
effectiveness. To identify poorly designed components,
success rates were clustered into categories, which describe
different hoist parts. User acceptance was quantified in the
range of 0 to 100 using a standardized questionnaire. The
success rate over all hoists was high and ranges from 88 % to
95 % (M = 92 %, SD = 2 %). However, serious use errors
occurred in 24 % of the scenarios. The slingbars of the hoists
showed the lowest effectiveness (M = 82 %, SD = 6 %). The
user acceptance of the hoists ranges from 49 to 86 (M = 68, SD
= 10). Besides structural problems like limited space or
product availability, design deficits are a possible reason, why
hoists are not used. All in all, the study identifies
ergonomically better-designed hoists. Based on the results,
health facilities can take usability aspects into account when
making purchasing decisions.
Keywords: usability, medical devices, procurement
https://doi.org/10.1515/cdbme-2019-0036
1 Introduction
Nurses suffer more often from musculoskeletal injuries like
low back pain (LBP) than other professions [1].
______
*Lorenz Müller: FH Münster, Bürgerkamp 3, Steinfurt, Germany,
e-mail: lorenz.mueller@fh-muenster.de
Saskia Sobkowicz, Elisabeth Ibenthal, Claus Backhaus: FH
Münster, Steinfurt, Germany
Open Access. © 2019 Lorenz Müller et al., published by De Gruyter.
The frequent mobilizations of patients without assistive
devices is one reason for this [2]. On average, nurses lift and
carry patients up to 38 times a day and 8860 times a year [3].
To reduce the risk of back injuries different methods like
the biomechanically substantiated instructions for back-
friendly patient handling or assistive devices can be applied,
like transfer slings or belts with various transfer techniques or
a bridgeboard [4-6]. Besides these options, mobile patient
hoists were developed to reduce physical strains. However,
mobile hoists are rarely used. Some reasons are the lack of the
perceived need, insufficient product training and short time
slots for patient care [7]. Another possible factor is a low user
acceptance due to a poor usability of available hoists [8].
To support health facilities in purchasing well-designed
hoists a comparative usability evaluation is needed. Based on
the results, health facilities can consider the product usability
as a buying criterion to increase the user acceptance and thus
the rate of use.
2 Material and Methods
2.1 Selected patient hoists
12 patient hoists were selected. The selection was based on a
market research and represents the most common hoists in
German health facilities [9].
2.2 Usability assessment
The usability assessment was carried out according to DIN EN
62366 by performing a user test and a user survey [10].
Subjects
40 nurses were recruited from different hospitals and nursing
homes (see Table 1). Allowed to participate were nurses with
at least one-year work experience and knowledge in handling
patient hoists. Participating nurses received a salary of 125 €.
This work is licensed under the Creative Commons Attribution 4.0 License.
Unauthenticated
Download Date | 9/20/19 2:51 PM
L. Müller et al., Usability assessment of patient hoists as a purchasing guide for health facilities — 142

Table 1: Demographic characteristics of subjects (n = 40) Each hoist was tested ten times in the three scenarios. Every
Nurses Work nurse performed the test with three unfamiliar hoists in
Age in Years
(n = 40) experience in Years randomized order. After performing the scenarios with one
hoist, a user survey was conducted (see Figure 2).
Gender n M (SD) Min/Max M (SD) Min/Max
Before the test was carried out, the nurses received a
Female 29 product-neutral instruction in the handling of the hoists and the
34 (11) 22/61 12 (11) 1/44
Male 11 test procedure. During the test, the hoist’s product manual was
in reach.
Test environment
The test took place in a simulated patient room equipped with The scenarios included 12-14 tasks. The tasks were
a one-way mirror, a care bed, a wheelchair, a toilet and three unknown to the nurses and did not have to be completed step
cameras (see Figure 1). A dummy (167 cm, 47 kg) with a by step. Figure 3 illustrates the tasks of scenario 1 as an
realistic mass distribution was used to simulate a patient. example.
To identify poorly designed components, tasks were
clustered into categories, which describe relevant hoist
components (see Figure 3). Relevant components are the sling,
brakes, boom, slingbar, legs and the hoist mobility.
Figure 3: Tasks of Scenario 1 and the related hoist components

Figure 1: Test scenario and observation room for the usability test

Test procedure
The test consisted three everyday scenarios (see Figure 2):
- Scenario 1: Transport from care bed to wheelchair
- Scenario 2: Transport from wheelchair to toilet
- Scenario 3: Transport from floor into care bed
Figure 2: Test procedure
Start

Get patient
hoist

Patient transport
Repeat two times

Scenario 1

User test
Scenario 2

Scenario 3

Evaluate
patient hoist User survey

Unauthenticated
Download Date | 9/20/19 2:51 PM
L. Müller et al., Usability assessment of patient hoists as a purchasing guide for health facilities — 143

2.2.1 Usability metrics Table 3: Results of the usability assessment

Worst Best
Effectiveness M (SD) tested tested
To measure the effectiveness, the investigator rated the hoist hoist
fulfilment of the tasks using the criteria shown in Table 2.
Total 92 (2) 88 95

Bed - Wheelchair 90 (2) 85 94

Table 2: Criteria for rating effectiveness
Wheelchair - Toilet 94 (3) 87 98
Score Description

Success Rate in %
Floor - Bed 93 (3) 88 97
1 (good) - Task was completed without use error
- No help was needed (manual or investigator) Sling 91 (4) 84 97
2 (medium) - A lot of time was needed to complete the task Brakes 95 (9) 72 100
- Help from the manual was needed Boom 94 (2) 91 96
- Use error did occur, but was corrected without
Slingbar 82 (6) 68 88
external help
Legs 96 (5) 85 100
3 (bad) - Help of the instructor was needed
- Task could not be completed Hoist mobility 93 (3) 88 98
- User error did occur and was not corrected Use of Manual in % 26 (17) 70 10
Total 23:31 (02:48) 28:41 19:44
Based on the ratings the success rate was calculated for each minutes
Time in
Bed - Wheelchair 09:37 (01:19) 11:56 07:55
hoist, scenario and hoist component (see eq 1) [11].
Wheelchair - Toilet 06:29 (01:25) 09:21 04:47
Floor - Bed 07:25 (00:55) 08:43 06:06
(1)
∑ 𝑮𝒐𝒐𝒅 𝑻𝒂𝒔𝒌𝒔 + (∑ 𝑴𝒆𝒅𝒊𝒖𝒎 𝑻𝒂𝒔𝒌𝒔 ) × 𝟎,𝟓
𝑺𝒖𝒄𝒆𝒔𝒔 𝑹𝒂𝒕𝒆 = × 𝟏𝟎𝟎
𝑷𝒂𝒓𝒕𝒊𝒄𝒊𝒑𝒂𝒏𝒕𝒔 ∗𝑻𝒂𝒔𝒌𝒔
User Acceptance 68 (11) 49 86
Use of manual
The number of nurses who needed the user manual to proceed Lifting the “patient” from the floor led to discomfort. That
the tasks was noted. was due to general difficulties in attaching the slings on the
Time slingbar. Furthermore, the hoist’s boom could not be lowered
The completion time was measured for each scenario. The enough.
times per scenario were summed up to a total time. The spreading of the hoist legs did not lead to many
problems, especially with electrically adjustable legs. But the
User acceptance hoists legs often got stuck under the care bed.
To determine the user acceptance a standardized questionnaire In the case of three hoists, poorly placed emergency stops were
was used [12]. The questionnaire rates 16 statements on a 5- unknowingly actuated, which led to a process interruption and
point rating scale. The result represents the user acceptance in helplessness among the nurses.
the range of 0 to 100. In addition, the nurses could write down On average, 26 % (SD = 17 %) of the nurses needed the
what they liked and what they did not like about the hoist. product manual. Some hoists were more self-explanatory than
others. For one hoist, 70 % of the nurses used the manual to
proceed the tasks.
3 Results The completion times show large differences between the
hoists. In average nurses needed 19:44 minutes to complete the
Table 3 shows the results of the usability assessment. three scenarios with the fastest hoist and 28:41 minutes with
Illustrated are the means, standard deviation as well as the the slowest hoist.
worst and the best results. The user acceptance differs strongly between the 12 hoists
The overall effectiveness of the 12 hoists ranges from 88 % to (see Table 4).
95 % (M = 92 %, SD = 2 %). In 24 % of the scenarios at least
one “bad” use error, according to Table 2, occurred. Table 4: User acceptance
The effectiveness of the hoist’s brakes (M = 95 %, SD = 9 User acceptance per hoist M (SD)
%) and slingbars (M = 82 %, SD = 6 %) differ the most. In H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12
addition, the slingbars caused the most handling difficulties. 74 62 64 68 54 80 49 69 60 86 73 73
One hoists slingbar only reached a success rate of 68 %. (21) (15) (20) (14) (21) (13) (18) (14) (18) (11) (8) (12)

Unauthenticated
Download Date | 9/20/19 2:51 PM
L. Müller et al., Usability assessment of patient hoists as a purchasing guide for health facilities — 144
The best rated hoist scored in average a very good value of
86 (SD = 11, n = 10). The hoist with the lowest user acceptance
reached in average a value of 49 (SD = 18, n = 10), which is
considered a bad rating [12].
4 Discussion
The aim of this study was to identify usability differences of
the 12 most common patient hoists in German health facilities
and to provide a guide to take usability aspects into account
when purchasing hoists.
Although hoists do not offer complex functions, the study
shows that hoists differ in the amount of their usability. While
each hoist was suited to fulfil the requirement to transport a
patient, hoists with higher user acceptance and effectiveness
could be identified. Especially the attachment of the sling on
the slingbar showed design weaknesses which led to stress the
nurses. A correlation between the usability metrics must be
examined in further studies.
The identified design weaknesses of the hoists can explain
the low usage rate in everyday practice. But, these are not the
only reasons why nurses do not use them. The feedback of the
participating nurses about the research aim was very positive.
The nurses mentioned that they would like to use hoists more
often to reduce physical stress but pointed out that there is a
lack of hoists in health facilities and organisational hurdles.
For example, hoists borrowed from other stations will not be
returned or slings get lost after getting cleaned.
Based on the results, there may be possible developments.
At first, health facilities can make purchasing decisions in
favour of user acceptance, effectiveness and time which may
increase the user acceptance in health facilities and the usage
rate of hoists. Secondly, an increased hoist usage rate can be a
reason to buy more hoists and slings. This way, strains caused
by lifting and carrying patients can be reduced sustainably.
Due to the fact, that even products that appear simple at
first glance, show large differences in effectiveness, time and
user acceptance, the usability of medical devices should be
considered in purchasing decisions in health facilities to
increase patient- and user safety.
Author Statement
Research funding: This research has been funded by the
insurance association for health and welfare (BGW). Conflict
of interest: Authors state no conflict of interest. Informed
consent: Informed consent has been obtained from all
individuals included in this study
References
[1] Vieira ER, Kumar S, Coury HJ, Narayan Y. Low back
problems and possible improvements in nursing jobs. J Adv
Nurs 2006;55(1):79-89.
[2] Elford W, Straker L, Strauss G. Patient handling with and
without slings: an analysis of the risk of injury to the lumbar
spine. Applied Ergonomics 2000;31(2):185-200.
[3] Hofmann F, Michaelis M, Stößel U, Siegel A. Die Freiburger
Wirbelsäulenstudie: Epidemiologie arbeitsbedingter
Wirbelsäulenerkrankungen bei Beschäftigten im
Gesundheitsdienst in Deutschland. Das Gesundheitswesen
1995;57:467-475.
[4] Jäger M, Jordan C, Kuhn S, Beck B, Nerenhaus A. Ableitung
tätigkeitsspezifischer biomechanisch begründeter
Handlungsanleitungen für rückengerechtes Bewegen von
Patienten. Applied ASU Arbeitsmedizin 2015;50:738-749.
[5] Hess JA, Kincl LD, Mandeville DS. Comparison of three
single-person manual patient techniques for bed-to-
wheelchair transfers. Home healthcare nurse
2007;25(9):577-579.
[6] Conrad KM, Reichelt PA, Lavender SA, Gacki-Smith J, Hattle
S. Designing ergonomic interventions for EMS workers:
Concept generation of patient-handling devices. Applied
Ergonomics 2008;39(6):792-802.
[7] Evanoff B, Wolf L, Aton E, Canos J, Collins J. Reduction in
injury rates in nursing personnel through introduction of
mechanical lifts in the workplace. American Journal of
Industrial Medicine 2003;44:451-457.
[8] Hignett S. Ergonomic Evaluation of Electric Mobile Hoists.
British Journal of Occupational Therapy 1998;61(11):509-
516.
[9] Berufsgenossenschaft für Gesundheitsdienst und
Wohlfahrtspflege (BGW). BGWtest Marktrecherche –
Vergleichende Tests von mobilen Hebeliftern für
Patientinnen und Patienten 2018. Internal report:
unpublished.
[10] DIN EN 62366:2016. Medizinprodukte - Anwendung der
Gebrauchstauglichkeit auf Medizinprodukte.
[11] Nielsen J. Success Rate: The Simplest Usability Metric 2001,
February 18. URL: www.nngroup.com/articles/success-rate-
the-simplest-usability-metric/, last access 31.07.2019.
[12] Müller L, Backhaus C. Entwicklung eines Fragebogens zur
ergonomischen Bewertung von Medizinprodukten innerhalb
des Beschaffungsprozesses in Gesundheitseinrichtungen.
Dokumentation zum 65. Kongress der Gesellschaft für
Arbeitswissenschaft in Dresden. Dortmund: GfA-Press.
B.2.8. 2019.
Unauthenticated
Download Date | 9/20/19 2:51 PM