Dr. Richard Holden Discusses the Science of Patient Ergonomics

Patient ergonomics is, as defined by Dr. Richard Holden, “the application of human factors or related disciplines to study and improve patients’ and other non-professionals’ performance of effortful work activities in pursuit of health goals.”

DocWire News spoke with Dr. Holden, who is a Regenstrief Institute scientist, Professor, Dean’s Eminent Scholar, and Chair of Health & Wellness Design at the Indiana University School of Public Health-Bloomington, to further discuss this burgeoning field in health care.

See what he had to say.

DocWire News: What exactly is patient ergonomics and why is it important?

Dr. Richard Holden: Yeah. So we have a simple way of describing it as the science and engineering (of patient work). So there’s several things inside of that, that people might be hearing for the first time, the idea of patient work. So, that’s the effortful, consequential, goal-directed activity that all of us take part in. Whether we’re going grocery shopping to enhance our nutrition or whether we are taking our medication that’s been prescribed by a physician, that is patient work.

And the study of that patient work the scientific investigation of how do people do it, where to failures occur, how can we help them, that’s the science of ergonomics and the engineering part of ergonomics is trying to find ways to improve the way that people perform either their day-to-day activity or their self-care of their health conditions or their management of acute disease conditions, including over the last year and a half viral infection. So the reason it’s important is that there are deficiencies in patient work that lead to really consequential, poor outcomes for people, for their families and for society. And we as engineers, the people trying to improve that work, think that the more we understand what people do, the better we can help them.

DocWire News: Can you talk to us about the two-volume set that you co-authored?

Dr. Richard Holden: Yeah. So the credit really goes to a number of people. It’s not just myself. I had a co-editor, Rupa Valdez at the University of Virginia. And then we had a lot of contributors. We had contributors from, I want to say four different countries, maybe five different countries all over the United States. And these are amazing scientists and scholars and physicians and nurses who are studying patient work. We put this together over the last year and a half, two years, and I believe there are a total of 26, 27 chapters. So each one of them deals with a particular segment of patient ergonomics. In the first volume, it’s all about the foundation. So it’s the physical aspects of patient ergonomics, the cognitive aspects of patient ergonomics, the organizational aspects. And then a lot about methods, as well as specific topics such as self-care, so managing chronic illness, for example. Patient professional communication, so going and having that conversation with your physician or your healthcare professional. Health information technology, and patient’s roles and family roles in patient safety. So ensuring safe care.

And then the second volume is all about applications. So that’s where we look across settings and populations. We look at populations that are underserved. We look at pediatric, we look at older adults, and then we look at a number of settings, including retail pharmacies, the emergency department, and transitions between locations as well. So the whole two-volume set is a handbook in the sense that it covers the gamut of all topics that are kind of salient within the area of patient ergonomics.

DocWire News: How can these books help the average physician enhance their practice?

Dr. Richard Holden: That’s a great question. I mean, first of all, it’s a bit of an awareness and a realization that as I said, patients do work, which we sometimes take for granted. I’ve had a student who was a nurse for a long time in her career. She, I think worked as a nurse for 30 years on the floor. And then she started studying with me and she became actually one of the big leaders in patient ergonomics for medication management. And she said to me, one day, “For 30 years, I used to think that it was all about the doctor tells the patient to take medication and they just do it. They just comply or they don’t comply.” And she said to me, “I’ll never call it compliance ever again, because it’s way more than just taking a pill that you were told to take.”

It involves a lot of managing of supply, making decisions. Should I take it now? What if I missed it? What do I do? It’s a lot of cognitive work, a lot of physical work. And a lot of things that really rely on outside influences, financial influences, the support of family, access to transportation, what we sometimes call social determinants of health. And so I think number one is just like that student had a realization, I think that readers who haven’t really thought about all the factors, all the work system factors that go into human health, it’ll be a bit of a realization. It’ll be an opportunity to think about what can I do besides managing the medical care of this individual? What can I do in terms of facilitating the work they do?

Some of my colleagues actually, and this is a good group of researchers at Mayo Clinic in Minnesota, they’ve started looking at patient work and patient workload. So the amount of demand put on a patient to manage disease and both by the disease itself as well by the treatment. And they’ve started training their physicians and preparing their physicians to do what they call minimal disruptive medicine. And that is reducing the amount of recommendations made to do difficult things. Or if you’re going to recommend that somebody go and do cardiac rehab, exercise for 30 minutes a day, every single day of the week, then you have to provide some kind of support. So you might need to provide transportation. You might need to provide free or reduced access to exercise facilities.

And so that’s a really concrete example of where physicians are being trained to really not just be aware of the concept of patient work and the potential for patient ergonomics, but also how to implement it into their own practice. So we’re hoping that some of the insights that we have from the science and the engineering will also be useful for physicians, but obviously also useful for people designing health information technology, and various other tools for physicians and other professionals.

DocWire News: In your opinion, what is the future of patient ergonomics in health care?

Dr. Richard Holden: Yeah, that’s a great question. I think we’re kind of early in the development of this community of practice or discipline. And I think that as a result, we’ve really focused on certain groups and certain phenomena that are really essential and salient. And some of those are older adults and aging, chronic disease. So, that is really well covered. We did a scoping review of what has patient ergonomics actually looked at over the last 10 years and aging and chronic disease are definitely covered. Health information technology I already mentioned. So technology and various other tools that people use, especially that are used by patients, for example, patient portals and apps. Those have been studied very well as well. So when we start going outside of that, I think that we need to expand the application areas. And that’s why we wrote the second volume to really start looking at new application areas.

So one of the places where we think that there’s a lot of potential is the community. So settings like community pharmacies, where people make a lot of very important decisions about prescription medications, over-the-counter medications, groceries. So that’s one area where we think that there’s an opportunity to expand, as well as others in the community settings. But also we want to look more at groups that have been underserved and who are ravaged by health disparities. And so again, when you look at the kind of people that have been studied, the kind of people that have been benefited by patient ergonomics, very often, it’s wider, more educated individuals. And so we’re, not just now, I mean, there are a lot of people doing this work, but we’re moving the field to really think about what can we do for people who are underserved, people who are in rural settings, people who are lower health literacy and so forth.

DocWire News: Where can people go to purchase this two-volume set?

Dr. Richard Holden: Well, you can search The Patient Factor on amazon.com. That’s probably the easiest. You can also visit Taylor & Francis or Routledge to go straight to the publisher. Or for those who are able to remember this long way of getting there, you can visit our website, which speaks all about patient ergonomics. It’s theinnovativeu.com/lab/ptergo for patient ergo. And we have a lot of materials, not only for accessing the book, but also reading several of our articles and finding many, many town halls discussion panels and workshops that we’ve done on the topic.

DocWire News: Closing thoughts?

Dr. Richard Holden: Yeah. I want to say that there are a lot of individuals who are already doing things that are very much in line with patient ergonomics. The term ergonomics is foreign to a lot of people. It’s literally Greek for work science. So patient work science is what patient ergonomics means, but a lot of people are doing it and they call it very different things. What we’d like to do is create a community of practice that’s broader than just the term patient ergonomics, broader than just the discipline that we’ve created and really allows people from across disciplines to work together, to improve the work that patients do.