Wednesday, November 11, 2009

The ergonomics of home care

Today, I had an opportunity to observe a few more home visits, this time in two inner city neighborhoods of Boston. Shawn, a physical therapist, and Nancy, a nurse, were my guides.

I remember a recent tour of a brand new state-of-the-art ambulatory care center. I was directed to the set-ups in the patient care rooms and asked to consider the ergonomics of each workstation. A consultant had been hired to design the area where the clinicians sit and interact with the patients... and the computer monitors and keyboards that serve as gateways into an also state-of-the-art electronic health record system. Painstaking attention was paid to the placement of the large robot-like arms that allowed for optimal positioning of the technologies so that inputs and outputs could proceed unhindered. The chairs looked like they would have been at home in the finest Wall Street boardrooms and the tan oak desk was smart and attractive. It was an ideal environment.

Shawn and Nancy don't work in places like that. Shawn helped a woman recovering from knee replacement surgery navigate through a cramped bathroom and up and down a narrow flight of stairs as she stretched and pushed herself toward recovery. Nancy led me up three winding flights of stairs into a pleasant home where a newborn and his newmom were contending with the normal stress of the occasion and the not so normal stress of serious medical problems. Both clinicians bent over undersized laptops and entered critical medical information; Shawn hunched over his computer as he sat at the end of his patient's bed while Nancy leaned over and tapped onto the screen leaning against a pillow, inches from the baby's head.

Shawn told me that he had worked in a hospital for many years as a PT and that he would accompany his patients over to a designated spot where they could walk up and down a few steps. But now, he sees the actual steps where his patients live and the help he provides is real and impactful and immediate. Nancy explained, holding the actual containers that the mother uses to prepare the critical formula for her child, the precise proportions of water and powder. This is no classroom, no state-of-the art laboratory.

It is real. It is the ergonomics of life. And that makes a huge difference.

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