Dermatology World

Office ergonomics

By Allison Evans, staff editor, March 1, 2012

The height of arm rests on chairs. The type of keyboards used for computing. Patient positioning. Why should dermatologists pay special attention to these seemingly simple decisions? Because they can have a substantial effect on a practice’s morale, productivity, and revenue. According to the Occupational Safety and Health Administration (OSHA), businesses spend $170 billion a year on costs associated with occupational injuries and illnesses, and these costs are taken directly from a company’s profit. But when businesses start to tend to the health and safety needs of their employees, these costs can be reduced by 20 to 40 percent, increasing a practice’s bottom line.

It’s a science

Jonathan Puleio, director of consulting for Humanscale, a company that specializes in designing ergonomic work tools for computer users, defined ergonomics as “the science of fitting tasks to workers based on the known capabilities and limitations of the human body.”

It’s a science not covered in one’s basic dermatology training; nonetheless, many medical practices are faced with tasks and situations that could cause both physicians and their employees harm, ranging from computer station setup to the way dermatologists perform surgical procedures.

According to the Cornell University Ergonomics Web (CUErgo) at, ergonomics is a benefit for companies, not a cost, because employees are one of the largest costs to modern businesses. Companies spend a lot of time and effort hiring the right person for the job, and if employees are injured and no longer able to work, then companies may lose valuable resources replacing lost candidates and money from worker compensation claims.

Hire a consultant

Puleio recommends that businesses start addressing ergonomic concerns by inviting a consultant to the practice. “The best starting point is observation because it allows the ergonomist to better understand existing postural challenges. From there, improvement strategies can be formulated and implemented,” he said.[pagebreak]

Ergonomists are trained to identify workplace hazards and make recommendations to improve the health and safety of the workers. “An ergonomic consultant should have formal training in ergonomics from an accredited university and hold a certification in ergonomics from the Board of Certified Professional Ergonomists,” Puleio said. While most ergonomic consultants have training in related fields, few actually have training in ergonomics, so it’s important to screen for proper qualifications up front, he said.

Puleio, a certified ergonomist for 10 years, finds that the most common ergonomic concerns in medical practices are awkward postures, poor equipment layout, inefficient workflow practices, and improper lighting. “The good news is that there are cost-effective solutions to addressing the majority of these issues,” he said.

A medical staff with medical problems

OSHA defines musculoskeletal disorders (MSDs) as injuries and disorders of the soft tissues (muscles, tendons, ligaments, joints, cartilage) and nervous system. “Musculoskeletal disorders due to repetitive use are a leading cause of injury in the workplace, including health care settings,” said Christine Liang, MD, a dermatologist practicing at Brigham and Women’s Hospital in Boston, who will also present on the topic of ergonomics at the Academy’s 70th Annual Meeting in March 2012.

Dr. Liang led a survey in 2010, recently published in Dermatologic Surgery, in which 354 members of the American College of Mohs Surgery (ACMS) answered questions about ergonomic office practices and physical pain experienced as a result of dermatologic surgery practices (2011;38(1):1-9). According to the study, 90 percent of the respondents reported some type of musculoskeletal symptoms or injuries. The most common complaints involved the neck, shoulders, and back, Dr. Liang said.

“Unfortunately, ergonomic modifications are not always utilized, thus dermatologists may not be optimizing their work habits to prevent injury,” Dr. Liang said. In fact, the survey found that 64 percent of the ACMS respondents did not teach ergonomic practices to staff, residents, or fellows. Ninety-one percent had not had an ergonomic evaluation of their workspace and habits.

The primary reason Mohs surgeons did not use or purchase ergonomic equipment wasn’t cost, but rather a lack of awareness, according to the survey.

Dermatologists perform numerous procedures that involve repetitive motion and awkward static postures, putting them at risk of MSDs, including repetitive strain injury, she said.

“From a health and safety perspective, poorly designed work environments can cause general discomfort, body aches, muscle fatigue, and even injury,” Puleio said. “If nothing is done, these ailments can start to impact the efficiency of the practice,” he continued. Dermatologists may not be able to see as many patients, the staff may not be able to process as many insurance claims, and error rates may rise. Mistakes are more likely to occur when individuals are experiencing discomfort, Puleio added.[pagebreak]

You have to spend to save

Often ergonomic concerns are not addressed because a lack of awareness about how to modify a work environment and the upfront cost to implementing the changes, Dr. Liang said. However, ergonomics should be an integral part of any job and workplace design, not an afterthought, according to CUErgo. “It’s no more expensive to choose a bad design — the difference isn’t economics, it’s education!”

The thought of purchasing new furniture for an entire office can be daunting, but it’s an investment in the most literal sense. “Uncomfortable workers are less productive workers. In contrast, comfortable workers are less likely to be absent from work, file a worker compensation claim, and become injured,” Puleio said. Greater efficiency and improved workflow in medical settings enable dermatologists to treat more patients, which translates directly into increased revenue growth. Fewer mistakes can also be used to negotiate reduced insurance premiums, saving practices even more money.

Ergonomics can also enhance the patient experience. “While few [patients] have the skill set to design truly functional spaces, most can recognize poorly-designed spaces,” Puleio said. “Spaces that are clearly performing poorly can impact the patient’s experience and his or her overall impression of the physician.”

“Positioning” your workforce

Office staff and practitioners spend many hours per week at computers, so it is important to optimize the workstation. Dr. Liang shared tips on how people can be more ergonomically correct at computer workstations. “The computer monitor should be directly in front of you at eye-level height, about an arm’s-length distance away,” she said. “The keyboard should be at elbow-height or just below elbow height. The mouse should be at the same level and immediately next to the keyboard.”

“If multiple people are using a station, an adjustable keyboard tray and chair should be used so individual users can make adjustments as needed. You should be seated all the way back in your chair and the backrest should be adjusted to support both the lower and upper back. When in this position, the seat should be tilted so that your thighs are parallel to the floor, or your knees slightly below the hips and feet well supported by the floor or a foot rest,” Dr. Liang advised.

Computer workstations in health care facilities should be designed to accommodate a range of population sizes. “Keyboard and monitor position both drive posture. Chair design is critical for those sitting all day, and illumination levels are important for those referencing documents or performing inspection tasks,” Puleio said.

A common MSD for office employees whose workstation is not correctly set up is carpal tunnel syndrome. On average, it takes employees 28 days to recover, which is longer than the time it takes to recover from amputation or fractures, according to OSHA. While some options to make an office more ergonomically correct can be costly and take time to implement, there are many inexpensive, “quick win” options available, such as adjusting the height of working surfaces, adding more short breaks to an employee’s work day, providing ergonomic chairs or stools, and making sure all supplies and equipment are within easy reach of the worker.

Other common ailments include eye strain, headaches, backaches, and shoulder tension. Over a short period of time these may not cause employees many problems, and may seem part and parcel of a “hard day’s work,” but these small injuries can quickly accumulate over time and cause serious damage and thus must be addressed before they become problems.

Once ergonomic principles have been integrated into a workspace, education becomes essential. “Ergonomic work tools are ineffective if those using them are unaware of their benefits, or do not know how to make proper adjustments,” Puleio said.[pagebreak]

Keeping derms healthy

Besides ensuring office staff have a safe and comfortable space, it’s also important that dermatologists take care to address ergonomic concerns for themselves that could cause physical pain and may result in missed days of work.

Dermatologists should always use adjustable examination tables and stools, Dr. Liang said. This way, patients can be brought to the proper height so that the physician doesn’t have to strain to treat and examine the patient.

“For procedures, the patient should be brought as close to the side of the table that the dermatologist is on. The height of the table should be adjusted such that the physician’s forearms are about parallel to the floor,” she said.

Since physicians spend a lot of time on their feet, wearing compression stockings, foot gel insoles, or using anti-fatigue floor mats can lessen the pressure placed on the lower legs, Dr. Liang advised.

For dermatologists who perform surgical procedures, the use of operating telescopes or magnifying loupes create a safer neck angle while viewing the same working field detail. “For those who do Mohs surgery, an ergonomically designed microscope headpiece allows the physician to maintain a safe, neutral neck position by looking straight ahead instead of downwards,” Dr. Liang noted.

“Discomfort indicators”

“It’s also important to look for what we call discomfort indicators,’” Puleio said. He suggests employers observe actions like employees holding wrists, squinting, and putting pressure on their backs. If visual signs of discomfort are observed, there is likely a problem. Another tell-tale sign of ergonomic issues is if employees have tried to modify their workspace with wrist supports, monitor stands, or lumbar cushions. These indicators mean that employees are likely experiencing discomfort, which may become problematic if left untended.

Be proactive

The Bureau of Labor Statistics reported that, on average, 32 percent of missed days of work are due to overexertion and repetitive-use injuries. With staggering statistics showing how much a business’s profit margin is decreased because of inadequate workplace conditions, it benefits employers to be proactive in making a workspace safe and comfortable.

“Implementing ergonomics into a dermatology practice minimizes the chance of injury to the dermatologist, staff, and trainees. Musculoskeletal symptoms can present early and persist throughout a career; therefore, it is wise to invest early in ergonomic modifications to prolong productivity and prevent injury,” Dr. Liang said.