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МЕаииПНСКПЕ НАУКИ
ERGONOMICS OF HEALTH PROFESSIONALS' WORK: A -45YEAR OLD STORY THAT SOUNDS MODERN THE CONTRIBUTION OF THE RUSSIAN ACADEMY AND MEDICAL
UNIVERSITY OF PLOVDIV
Liochkova Mariana Ivanova
MD, PhD, Assoc. Prof., Department of Healthcare Management, Faculty of Public Health, Medical University, Plovdiv, Bulgaria
Mihaylova Vanina Kratfeva
PhD, Assoc. Prof., Department of Preventive Medicine, Faculty of Public Health,Medical University, Sofia; Chief assistant Department of Healthcare Management, Faculty of Public Health,
Medical University, Plovdiv, Bulgaria
Shopov Dimitar Georgiev
MD, PhD Chief assistant Prof., Department of Social Medicine and Public Health, Faculty of Public Health, Medical University
ABSTRACT
Retraced is the hiflory of the emergence, development and eflablishment of Ergonomics of Medical Work as a major research and learning subject in the tuition of medical, dental and management fludents in the field of public health at the medical universities around the country. Outlined is the role of Prof. Dr T. Zahariev as Director of the Research Inflitute for Social Hygiene and Public Health, Sofia (1970-1977), as well as the initiative of Prof. Dr Zinaida Biryukova-Kolarova who flood at the head of the firfl separate unit within the same inflitution - the Laboratory of Ergonomics of Medical Work. In the early 1970's appeared the firfl scientific publications and notes on psychophysiologic, sociologic and ergonomic fludies of doctors' work. The expertise was transferred to the Chair of Social Hygiene and Public Health at the Higher Inflitute for Medicine of Plovdiv for scientific management analysis and fludy of the dynamics of working capacity and fatigue of surgeons in hospital and outpatient care under the management of Dr M. Lyochkova, Research Associate, and Dr P. Sapundzhiev, Senior Lecturer; in addition, that unit received work equipment from the COMECON. They created original methods to fludy the synchronization, effectiveness, efficiency and work load of doctors. Retraced is the cooperation in leading international projects with Soviet experts from the Semashko Inflitute, Moscow, who were awarded a 'K' grade (top level). At present, the sector is developing new branches, such as Time and Activities Management, that are mandatory in the tuition of fludents in Health Management and Management of Medical Care. Outlined are the perspectives of development of this fundamental research and fludy subject within modern knowledge and practice of social medicine.
Keywords: ergonomics, medical work, effectiveness, working capacity and fatigue, fludy subject
In the early 1970's, upon the initiative of Prof. Dr T. Zahariev, then Director (1970-1977) of the Scientific Research Inflitute of Social Hygiene and Healthcare Management (SRISHHM, Sofia) was created the firfl independent unit of that inflitute: the Laboratory of Ergonomics of Health Professionals' Work. Prof. Dr Zinaida Biryukova-Kolarova, DMSc (citizen of the USSR, married to the famous pediatrician Prof. Dr Stefan Kolarov, DMSc) was firfl to take the head. The laboratory organized the firfl scientific meetings and issued scientific notices and publications in the field of psycho-physiological and ergonomics fludies of medical work. In 1972 was held the firfl National Symposium on ergonomics, physiology, psychology and sociology of work in healthcare eflablishments[2] followed by the firfl Scientific Conference in Sliven (1973) on matters of scientific management of labor and ergonomics in health facilities [3]. The basic guidelines were laid down including ergonomic requirements toward health professionals' work; improvement of work places in hospitals; work/refl regimes for doctors and nurses; dynamics of mental tiredness; psychological aspects of the optimization of activities. At this initial period with active cooperation and vanguard views, Assiflant G. Genkin and Yu. I. Zotov were involved - scientific associates and candidates of the medical sciences at the All-Union Research Inflitute for Social
Hygiene and for the Organization of Healthcare (AURISHOH) "N. A. Semashko" - Moscow.
The scientific enthusiasm quickly overflew the limits of the Laboratory and found favorable ground for development in the Department of Health Management and Hiflory of Medicine (HMHM) in the Plovdiv branch of the Medical Academy under the direction of Prof. Dr N. Zapryanov, DSc. I can not help mentioning here my impressions and experiences over more than a decade of enthusiaflic and productive scientific passion firfl as researcher and later as a lecturer.
I was completely captivated by this new and attractive field of science as well as by the erudite and emotional personality of Prof. Kolarova. I shared my flrong impressions with Prof. Zahariev. He arranged a meeting and introduced me to Prof. Kolarova with these words: "I want you to meet this young scientifl and knowing you are a lioness (meaning her zodiac sign Leo) I believe that you will promptly take over the direction of this ambitious Virgo. To flart with, put her on the international projects of the Semashko Inflitute." Then Prof. Zahariev warned me in private with his remarkable sense of humor to take care not to reel too much about or fall into these problems: "... it has much to do with psychiatry but in good health and employment conditions."
This is how I Parted working on physiological, psychological, sociological and ergonomie aspects of major medical specialties in a clinic (at firfl) and in a hospital. I prepared and completed international projects and implementation tasks that were awarded 'K' level, i.e. top ranked [8]. Later I wrote and published theses concerning different medical specialifl fields. The Higher Medical Inflitute (now Medical University - Plovdiv) releases the dissertation paper of Dr. M. Lyochkova, dedicated to the global ergonomic assessment of the surgical labour under polyclinical conditions [6]. Four chronometric methods and 15 psycho-physiological methods have been used. It was followed by the dissertation of Dr. P. Sapundzhiev on the activity of hospital surgeons. They were preceded by the dissertation developments f Dr. Sl. Savov, head of the Sports Medicine Sector at the Department of Physiology. Mofl of the defenses carried out at Scientific Research Inflitute for Social Hygiene and Organization of Health - Sofia were often attended by the colleagues Z. Yu. Zotov and A. G. Gelkin, at their initiative, as well as by other habilitated persons from AURISHOH "N. A. Semashko" - Moscow. ("Notify us and our team will fly to you - these were their words). They supported us, made positive comments and innovative proposals.
Taking into consideration the predominantly experimental nature of the work, the Director of SRISHHM appointed two technical assiflants (one of them, Genoveva Peleva, for a period of almofl four years) based at the HMHM Department to conduct fludies in scientific management of labor and dynamics of work capacity and tiredness in surgeons operating in outpatient and hospital environments. The Director also helped obtain modern apparatuses (made in Hungary) from the COMECON. (I flill believe that these were more objective and reliable than the computer software used in this field nowadays.)
In addition to the international projects and the writing of theses, I published the treatise 'Ergonomics of health professionals' work' (1976) in co-authorship with Soviet experts from the Semashko Inflitute, Moscow [2]. The introduction to that book by Prof. Zahariev outlined the achievements in this modern and underdeveloped at that time, including at world scale, field [9,p.7-8]. Although this area was at the time quite unknown in our healthcare syflem, he noted with notable knowledge
and scientific perspicacity in the introduction to the book: "Optimizing work and management in healthcare is impossible without in-depth fludies on the physiology, psychology and sociology of the health professionals' work (evaluation of tiredness, rating of workload, improving the natural and social factors of the work environment, etc.). Therefore, issues relating to the eflhetics and ethics of healthcare professionals' work are included as well. Outlined is what social hygiene and ergonomics have in common: fludying the practical aspects of work in healthcare, its management and control, the principles of health policies, participation to the integration of sciences that optimize health care. Syflemic approach was applied and some methods of social survey use the same concepts. It is concluded that the ergonomics of healthcare professionals' work is part of social medicine so far that it plays the mofl important role in optimizing the 'human factor' in healthcare and is the mofl complex part of every syflem. The author of the introduction to the book, Prof. Z. Biryukova-Kolarova [1,p.13-19], highlights the successful integration of dedicated fludies in the fields of physiology, psychology, social psychology and ergonomics of healthcare professionals' work conducted by two teams: the team of the Laboratory of Ergonomics of Healthcare Professionals' Work of the SRISHHM at the Miniflry of Health and the Department of Scientific Management of Labor of the Higher Scientific Research Inflitute of Social Hygiene and Healthcare Management 'N. A. Semashko', Moscow. These teams were joined by the Social Hygiene chair of the Plovdiv branch of the Medical Academy, mainly through Dr Mariana Lyochkova, Research Associate, and Dr Pavel Sapundzhiev (both of them Associate Professors at present) from the Plovdiv branch of the Medical Academy. It was determined that, being the science that fludies the laws of labor, ergonomics (from the Greek 'ergon' (work) and 'nomos' (law)) integrates a number of other sciences that aim at solving the issue of how to improve the efficiency of human labor through optimization of the working conditions[1,p.27].
The diagram below illuflrates the ergonomic syflem of healthcare professionals' work in which the human factor is essential (see Fig. 1)[1].
Fig. 1
A: universal ergonomic syflem (of production activities)
B: ergonomic syflem of healthcare professionals' work
The syflem's base reflects and in the same time is refracted through the flages of its hifloric development, and essential to its current condition is the impact of engineering psychology that forms the scientific foundation of ergonomics.
New methods and approaches were developed and introduced such as: timing of work with the purpose of determining the portions of efficiently and inefficiently spent time at work required to calculate the efficiency and intensity of healthcare professional's work; linear timing: tracing the synchronization of work between different categories of healthcare professionals and their respective efficiency levels; working positions: calculating the ratio between natural and forced positions with the purpose of determining the categories of workload of healthcare professionals; space timing: illuflrating the expedience of movements at work; 11 psycho-physiological methods fludying the dynamics of work capacity and tiredness. Multiple propositions and recommendations were made and implemented with crucial effect on optimizing healthcare professionals' work in outpatient and hospital care.
The subject 'Ergonomics of Healthcare Professionals' Work' was included in the 'Adminiflrative and Health Management' program, created upon proposition by Prof. Dr N. Zapryanov, DSc, of the Plovdiv University 'Paissiy Hilendarski' (academic year 1994/95), and before that of the Veliko Tarnovo University 'Saints Kiril and Methodiy'. Lectures in this subject (20 hours) are given by Assoc. Prof. Dr M. Lyochkova, MD. Starting from the 1996/97 academic year, upon the initiative of Assoc. Prof. I. Dimitrov, MD (at present Professor), the Higher Inflitute of Medicine of Plovdiv introduced a Bachelor program in Health Care of which the ergonomics of healthcare professionals' work is an important part. In 2003, after the creation of the Health Care Management (HCM) chair at the Medical University of Plovdiv, the Uniform State Requirements (USR) were amended to include as principal subject in the Bachelor program ergonomics and scientific management of labor in health eflablishments. Additionally, new courses were created: Time Management and Health Projects Management, included in the Mafler degree of the HCM and Health Management and Public Health programs [4]. These two courses are given by Assoc. Prof. M. Lyochkova, MD, and fludents in both programs are showing vivid interefl in them. Practical exercises are made under the successful direction of RA Dr M. Semerdzhieva, MD and RA V. Mihaylova, MD (at present, Associate Professors). In 2011, V. Mihaylova and M. Lyochkova published 'Tefls in Management and Ergonomics of Work in Health Eflablishments' [7]. Furthermore, multiple works on deontology, ethics and eflhetics of healthcare professionals' work have been published. The newly created and approved methods are powerful tools to reveal the exifling reserves of working time and the flaws of management, as well as the
discrepancies in the work of specialifls at different levels of the education and hierarchy in health eflablishments.
Conclusion: New horizons are opening before the science, respectively the subject, Ergonomics of Healthcare Professionals' Work and its modern branches (especially Time Management and Health Projects Management), and their bio ethical and business ethics aspects. Of special importance appears to be the so-called 'Patient Care' - a specific and flrictly separate section of the base Health Care program - as it is a major factor for improvement of the quality and optimal functioning of our healthcare syflem, and to improve patients' satisfaction and people's confidence in it.
Literature
1. Biryukova Z. Introduction to Ergonomics of Healthcare Professionals' Work (psycho-physiologic and sociologic fludies), Editor Z.I. Kolarova (Biryukova), Meditsina I Fizkultura publisher, Sofia, 1976, p. 13-19; 27.[In Bulgarian]
2. Compendium of abflracts and notices to the firfl Scientific Conference on scientific management and ergonomics in health eflablishments in the region of Sliven, Sliven, 1973. [In Bulgarian]
3. Compendium of lectures given at the firfl National Symposium on ergonomics, physiology and sociology of work in health eflablishments, Sofia, 1972. [In Bulgarian]
4. Decree of the Council of Miniflers No 215 of 18.08.2006 on the promulgation of Regulation concerning the Unified State Requirements for Bachelor and Mafler degrees in Health Care Management, SG No 70 of 2006. [In Bulgarian]
5. Genkin A., I. Zotov., G. Kirkorova, Z. Kolarova (Biryukova), M. Lyochkova et al, Ergonomics of Healthcare Professionals' Work (psycho-physiologic and sociologic fludies), Meditsina I Fizkultura publisher, Sofia, 1976, 257pp. [In Bulgarian]
6. Lyochkova M. Ergonomic aspects in assessing the organization of labor in the surgical polyclinic conditions. Author's summary for the award of degree "Candidate of Medical Sciences ", Minifliy of Health - Medical Academy , Research Inflitute of Social Hygiene and Organization of Health, Sofia , 1978 . [In Bulgarian]
7. Mihaylova-Alakidi V., M. Lyochkova. Tefls in Management and Ergonomics of Work in Health Eflablishments, EXPRESS Publisher, Gabrovo, 2011. [In Bulgarian]
8. Project 'Characteriflics of basic medical specialties in outpatient care from psychological and ergonomics point of view' Study Director: Prof. Z.I. Kolarova (Biryukova); researchers: Tulevski, B., D. Nyagolov, M. Lyochkova et al, Sofia, SRISHHM, 1975, 195 p. [In Bulgarian]
9. Zahariev T. Introduction, in Ergonomics of Healthcare Professionals' Work (psycho-physiologic and sociologic fludies), Meditsina I Fizkultura publisher, Sofia, 1976, p. 7-8. [In Bulgarian]
