Keywords

1 Introduction

With the rapid pace of economic development in China, service industry as the tertiary industry to occupy the whole national economy. One of the large area in service industry is a medical domain, China has tremendous population in the world so that healthcare faced even more difficult and specific problems than other countries. Based on the literature review, Liang et al. [1] described the doctor-patient relationship plays an important role in patient satisfaction with healthcare service. Obviously, the number of the doctor group is less than the patient group, it means the doctor as the service provider is confronted with enormous working intensity per working day and the mental health problem. There is a relevant connection between the doctor’s working strength level and the patient’s satisfaction. There is less research to focus on it, However, based on the literature, [2] Ciloglu et al. identified the passenger seat conform factor during the air traveling, [3] Hiemstra-van Mastrigt et al. proposed the active seating for the car passenger conform based on the physical inactivity of workers in many occupations is becoming an increasing problem (Straker and Mathiassen). According to survey, [4] Muir et al. reported that 22% of workers scan less than five hours per day, 67% scan between five and seven hours, and 11% scan more than seven hours per day. Only 45% of workers take more than three breaks of ten minutes or longer during the workday, and 55% of workers take two or fewer breaks per day. It conduct the sort of health problems especially lack of to adjust the work-rest time cycle during working status.

This study uses the service design methods to observe the B-ultrasound sonographer’s examination process and identify the problems in the real environment, collecting the qualitative data to dig work-related injuries that include the B-ultrasound sonographer’s neck and interscapular pain, upper arm muscle injury, lumbar muscle strain and shoulder pain, elbow pain, hand/wrist pain. The main reason of these problems is the heavy workload and body abduction in working status. These two factors refer to the user action reorganizing and the physical evidence from the perspective of service design thinking. Service blueprint and task analysis grid help us to refine the problems that we explored, it turns out that the working chair refer to the healthcare service physical evidence that needs redesign necessarily. Accompany with the evidence be redesign, the original user action will be changed and optimized as well. So that we designed a new ergonomic chair with an adjustable elbow support device to serve the sonographer’s body could release elbow muscle straining and bringing the comfort feeling. Furthermore, it will advance the efficiency based on the service provider’s action that from the touch-point between the doctor and seat to the whole interaction among the different stakeholders in the service processes.

2 Methods

This study uses the service design method to conduct the research and design in the holistic perspective. We used the Shadowing, Questionnaire, Behavioral Mapping and Ethnography as the observing research tool, in addition, the service blueprint and task analysis grid as the design tool. As the part of service design sectors, we examined the key problem of whole the physical evidence through sonographer task analysis grid, the ergonomic chair conduct the important role of the whole examining process in the diagnostic room. [5] Moggridge argued that the evidencing means taking the ideas and animate them as tangible evidence of the future. This kind of “archeology of the future” enables the designers to make early qualitative judgments about the implication of the design solution they’re conceiving. In this study, we analyzed and proved the effect of chair using situation, that situation concluded the physical evidence redesign could improve the whole service process from the sonographer’s body comfortable level and mental feeling degree of satisfaction to the efficiency of the entire examination.

3 Problem of the Sonographer’s Working Status

3.1 Problem in Service Processes

Each medical practitioner provides much more time and energy service than patient, it result in doctor have working hours and intensity problems during the each daily examination. We evaluated the correlation between injuries sustained in the workstation and factors such as age, gender, workload and intensity, scanning techniques, previous medical problems, and physical activity.

According to the survey, shoulder and neck pain were the most frequently reported for various age sonographer groups in Wuhan union hospital, as illustrated in Table 1, most sonographers experience discomfort in the shoulder, neck, wrist, lumbar muscles.

Table 1. Medical diagnostic results of sonographer’s sick part in Wuhan union hospital
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In addition, sonographers are postponing injuries treatment and forgetting the proper rest because of tremendous patient during daily working status, as time goes by, sonographers frequently forget even neglect the body fatigue and muscle strain.

3.2 Problem in Field Observation

Roughly 90% of the sonographers have significant musculoskeletal discomfort with their routine work in Medical imaging department. Meanwhile, sonographers demonstrate common physical disorders that include postural deficits, muscular imbalances, and poor dynamic stabilization of the upper body during the interview. We found the series of problems other than the problems they illustrated. Figure 1 depicts the service process working process by image that include different age and gender variables record.

Fig. 1.
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Investigation of workstation

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Male sonographer put his arm suspend in the air without any supporting in the examination, which in order to avoid touching patient’s belly that result in discomfort to patient, on the contrary, female sonographer put her arm on patient’s body during the subconscious status. These two micro-behaviors originated from the sonographer’s cognition that they consider the definition of touching patient’s body. However, the male sonographer strain his arm muscle for long time bring fatigue and pain. he description and frequency pattern of pain were similar across all age groups with slight variations. [8] Evans et al. reported Pain continues to be related to pressure applied to the transducer, abduction of the arm, and twisting of the neck and trunk (Evans, Roll and Baker).

4 Observation Results

4.1 Problem Matrix and Defining

There are serious problems during the checking period than other process such as preparing steps and connecting assistant steps, and the doctor will adjust their own posture frequently along with checking as well. Simultaneously, the changeable behaviors bring the irrational working posture on doctor’s body muscle, which can result in the muscle fatigue complication over time. Figure 2 describes the service blueprint of the B-ultrasound doctor in the examination, the orange blocks refer to the steps that can be optimized, and the key physical evidence in these processes is the ergonomic chair that makes interaction between the service provider and the customer. B-ultrasound examination requires the sonographer to hold the transducer in a proper plane of scanning. Conversely, it’s complex and dynamic posture during the examination, dynamic and repetitive movements of specific regions of the scanner’s body are then needed to manipulate the transducers and to adjust the monitor Armstrong et al. (1984).

Fig. 2.
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Service blueprint of B-ultrasound during examination

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4.2 The Pattern of Body Dynamic Supporting

The main requirements include the elbow dynamic supporting and the body forward dynamic supporting. The elbow dynamic supporting pattern could make sure the sonographer’s arm have a rational fulcrum to avoid the repetitive muscle stress during examination. Sonographer holds the ultrasound transducer in the right hand and to adjust the arm, elbow, hand wrist randomly within the body regions constantly changed in the examination. In addition, there is a necessary to equip a rational fulcrum for upper arm muscle when sonographers adjust their motion along with different body part especially as the important part of the body scanning procedure. Beside, sonographers interact with the interface of B ultrasonic examination instrument accompany with the body regions changed and checking the monitor, in the meantime, sonographer’s body parts are changing with the working states conversion. To analyze the basic motions consist of the body forward and backward, the body spinning around in the status of shifting between examining body and checking monitor. Therefore, the rational supporting pattern needs to satisfy the whole body forward, backward and turning motion.

5 Design

5.1 The Subjects

The upper arm pain and the shoulder blade fatigue that we can improve. Sonographer manipulates the interface button and watching monitor by left hand and holds the B-ultrasound transducer to scan different body parts by right hand, there are two types of motion include body lean forward and backward without supporting, it will bring the whole arm muscle strain and lumber muscle pain after long time working. Consequently, the adjustable elbow dynamic supporting device and the forward motion structure that under the ergonomic cushion to satisfy the dynamic body supporting when sonographer move forward or backward as the examination body part changing.

5.2 Ergonomic Design Concept

Considering the whole dynamic body motion, the new chair adds the four evolutional patterns consist of the adjustable upper arm dynamic supporting device, dynamic forward tilting structure, sliding pedal, saddle shape cushion. Figure 3 shows the functional construction of each part of the ergonomic chair.

Fig. 3.
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Functional design for working behaviors

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6 Estimation Results

The survey is aimed at the estimation of the chair using experience during the working process, which indicated examination of different body part and interaction between sonographer and patient. We using a 5-point scale, with 1 indicating strongly uncomfortable, 3 indicating neutral comfortable, and 5 indicating strongly comfortable.

Through the Fig. 4 shows the new chair brings the data generally increasing, in particular, the upper arm muscle and lumber muscle had significant improvement because of the elbow dynamic supporting pattern and the dynamic forward tilting structure that all offered by the adjustable elbow supporting device and the forward and backward. The crucial part of touch-points in the examination processes have had more optimized effectiveness partly than ever. Using the new working chair we can find the scanning process and the preparing process had been advance in certain extent. Besides, after some training recommendations the sonographers even experienced staff reinforce the self-awareness of the short-time rest such as moving the fatigue upper body or standing.

Fig. 4.
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Sonographer’s muscle comfort assessment and touch-point evaluation

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Consequently, the effectiveness of touch-points is advanced in Fig. 4. For the measuring variable comprehensively, the questionnaire consist of the physical and mental satisfaction. Eventually, we counted the data and analyzed the results, the consequence shows the positive results like comfortable feeling and resilient mentation after the prototype replaced the former chair.

7 Conclusions

This study validate that redefine and discovery the connection between the physical evidence and whole service processes is significant correlative. Meanwhile, to examine the physical evidence optimization during the will improve the working efficiency during the whole service process in the field of medical service industry. According to the discovering the real B-ultrasound examination, defining the frequent problems within the body muscle in the whole service process, designing the chair prototype on the basis of the frequent problems, depending on the service blueprint to matrix and solve the key testing muscle problems of doctor such as wiping lubricant, holding the probe to examining body and rotating button to check monitor. Consequently, it can be assumed that the working chair can cover more body motion and that body subconscious behavior will bring mistake posture without good design chair.

Although the physical evidence get better, the working onsite management and job process coaching should be a consideration by hospital administrator, such as flexible scheduling and working body motion cognitive training such as short-time regular exercise. Increasing the physical fitness will promote sonographer’s mindset and positive lifestyle. The sonographer’s working process includes the physical and mental activity, so that make these two factors seamless connect could optimize the touch-point effectiveness.