INTRODUCTION

As well-known, musculoskeletal injury caused by ergonomic hazards is the major health risk for care workers. The causes of musculoskeletal injuries in care workers are associated with inadequate protection measures at work. According to the report published in UK [1], manual handling causes over a third of all workplace injuries. To decrease injury risk in patient transfer tasks, No-Lift Policy was promoted in some countries which suggested using mechanical lifting devices can help reduce musculoskeletal injury of care workers. [2,3,4] However, it is indicated that Taiwanese care workers prefer employing transfer skills rather than using transfer equipment, and the care workers' training manuals mainly focus on manual handling. [5] The reasons include lack of appropriate training and technical support, insufficient funding and knowledge about assistive device, and time consuming, etc. [6,7,8] As the saying goes, “good craftsmanship depends on use of the right tools.” we intend to investigate the extent to which an innovative lifting device can be considered as the right tool to move patients. This paper is a case study of the commercialization process of a so-called multi-mode lifting device, which is different from former suspension type and designed to improve the limitations of device properties. In terms of multi-mode, this equipment has a variety of modules, with a variety of accessories can be used in different situations, such as between bed, wheelchair, toilet and bathroom. This equipment is currently almost ready to be marketed.

In the light of the perspective of social-technical innovation, we think that the success of innovation is related to the characteristics of the entire network of social technology, in that the market, institutional and management innovation are often more relevant [9]. In terms of this, social-technical innovation involves the reorganization of social value and industrial structure. This study is based on a two-year integrated project conducted by an interdisciplinary team including academics in engineering design, occupational therapy and social policy, together with practitioners such as OTs, doctors, and manufacturers. We observed and collected the information about the process in which the R&D team presented their innovative ideas and communicated with care workers in the long-term care institution through the assistance of occupational therapy team, which played the role of teaching caregivers about how to use the lifting device and therefore protecting themselves from occupational injuries.

METHODS

This paper is a qualitative research based on the case study of some elderly care center located in Southern Taiwan, which is an indicator institution with excellent service quality. The research methods which we adopted included both participatory observation and in-depth interview. Several observation records were made and analyzed in many settings, including the research team meetings, the meetings between the research team and the institution, the training and education courses, and the times when the Multi-mode lifting device was actually used on the patients. In addition, we conducted 11 interviews among different groups, including the R&D team, the OT team and the care institution. In terms of the care institution, 4 care workers, 2 nurses and 1 senior executive were interviewed. Each interview was recorded and then transcribed into verbatim text.

RESULTS

Based on the concern of occupational injury prevention, we focus on the extent to which the new lifting device has the opportunity to be accepted as a member of the "Safety Care Network" due to its friendly object design together with well-developed training program for care workers as the potential main users. The main findings include 3 parts: the training program and procedure, social dialogue and communication gap, and the institutional and management innovation.

The training program and procedure

There are two dimensions worthy of attention. One is the design of teaching materials before education and training, and the other is the predicament encountered at the moment. Regarding the former, the OT team spent a lot of time to figure out how to save time and effort, and to design foolproof mechanisms for the health care workers to go smoothly. However, they also considered that many operating methods rely on intuition to explore instead of words written in the operation manual. For example, it is difficult to express in words about the precise angle of the hanging cloth to be adjusted. The other dimension is related to the sudden situation that occurs in education and training. It is difficult for the teaching team to grasp the rhythm of education and training when the problem of operation mode proposed by the health care workers involves with modifying the accessories.

Most of the attendants thought that the operation of the multi-mode lifting device is not difficult, as long as they can maintain a certain frequency of use. In other words, it depends on whether the worker's attitude towards the use of the lift is positive enough. However, the designer believed that the training team should design a certain time course and observe how long it takes for the worker to become familiar with the operation steps.

Social dialogue and communication gap

In general, the explanation of the designer was necessary in order to allow the user to have a correct understanding of the new device. Sometimes, the user-side questions were used to enrich the interpretation of the use of technical objects or meanings. For example, with the hold module, the care-givers indicated that it would be difficult to force the elders to assume a holding position or grabbing the pole. Because some elders have stiff problems and some elders cannot sit for a long time, they always tend to lie down. In response, the designer explained that this was not the same as the original R&D imagination. Moreover, he suggested that this may become a good opportunity to train the elders from bed to seat, which can also reduce pressure sores. Sometimes the dialogue between both parties would help the designer to get correct understanding of the practical situations. For example, some caregiver pointed out that it would be difficult to use the lifting device independently for the patient cannot sit on the edge of the bed for a long time. Therefore, moving the patient from bed to chair or from chair to bed may require two caregivers while the lifting device was used.

During the education and training courses, we observed that care workers were willing to provide the research team with positive feedback. The attendants did not criticize or show their reluctance to use the lifting device for no reason. They only made suggestions after they performed it themselves. For example, some caregivers and their team leader suggested to the education and training team whether it would be more convenient to change the material of the draperies to be lighter, thinner, and better. However, the design team was not able to specifically improve the problems encountered by the education and training team in the organization. This also caused the hug module to be close to being placed unused.

The gap in communication occurred between different stakeholders, such as the designer and the user, and between the research team members. In the beginning of this research, most of the attendants held the expectation that the new device can save labor and reduce the burden on the body. However, after actually entering the institution, most of the attendants felt that using the device was too time consuming. The participants mentioned that the use of the device did indeed save much effort for moving the patients, and also decreased the physical burden of their bodies. However, they still preferred to use manual lifting in order to save time. Obviously work arrangements and work habits do not change in a short time. In addition, both learning to use a new technology and cultivating a new habit are time-consuming. Regarding solving the problems, the teaching team believes that they frequently inform the design side of the problem of the device, but often feel that the design team does not regard their report as one thing. The designer, however, considers that they have solved the problem. Therefore, instead of expounding the problem, he will definitely take a positive attitude to explain what they have done.

The institutional and management innovation

From the interviews the most complained by the health care workers is the "not enough time" and "insufficient manpower". The reason for the lack of time is mainly because the law has a certain standard of care, and the institution itself will arrange activities and existing administrative work. Although the institution has not specified the time limit for individual work, it is a potential consensus in the practice site that "It is the time at which the work must be completed." One thing is worth noting. The worker will be eager to get things done because it is necessary to reserve the time for the elder to have an emergency. If you don't reserve this time, everything will get stuck in the event of an elder's emergency. In terms of insufficient human resources, a care worker has to look at 13-14 patients. Therefore, it is difficult for them to spend “extra time” to use the multi-mode device. Apparently social and technological innovation involves management innovation, which means that institutional support is needed. In this institution, because the executive managers did not have special measures and reward mechanisms regarding the new device, the attendance of the caregivers was quite low.

Other restrictions on the care site include "multiple requirements by the patients", "small institutional environment" and "difficulties in recruiting manpower". In most of the time, the research team members are in direct contact with the workers. It seems that the head of the institution and the team leader did not make policy adjustments to promote the full use of the multi-mode lifting device. Therefore, since the managers are less active, the workers will not actively cooperate. In response to this problem, the institution director believes that she has not received any questions from the middle-level supervisor. So, it is not clear what happened.

CONCLUSIONS

Admittedly, whether a new shifting device can be widely accepted involves not only technological innovations but also the entire network of social technology. In terms of that, social-technical innovation involves the reorganization of social value and industrial structure. In the case of the multi-mode lifting device, positive dialogue between different stakeholders has facilitated the emergence of new ideas and innovative research dimensions. At length, this two-year project intends to provide empirical recommendations for developing the state “No-lift policy” in the long-term care system.