The International Ergonomics Association is the mothership for all human factors societies worldwide, and every three years it organizes a congress to bring everyone together. Beyond the panels and presentations, the event allows the executive council to physically convene and for the various technical committees (TC) to discuss strategies. One particular TC that has my interest is the Informal Work TC. It builds on the International Labour Organization's efforts in tackling the issues faced by workers making money in the informal economy. This World Economic Forum article captures the key descriptions about the informal economy, notably that it consists of "activities that have market value and would add to tax revenue and GDP if they were recorded", and that these activities as well as its workers "are not regulated or protected by the state". Emeritus Prof. Bernard Martin shared his early journey into this space during one of the congress' keynote address.
While informal workers are commonly associated with low-to-middle income countries, developed countries do take advantage of informal workers too. Think gig workers relying on platforms like Grab and Uber for jobs, or unregistered workers being paid for manual labor in farms and construction. Such a labor force allows companies to keep costs down which in turn helps to drive the economy. The larger the wage gap, the higher the likelihood that businesses are exploiting informal workers. In Singapore, plans are underway to ensure that platform workers are protected by law, ensuring that they get work injury compensation as well as appropriate workplace safety and health protection. That being said, many home businesses in Singapore tend to remain under the radar.
I am interested in this particular topic because all of us, who will be patients and caregivers, fit the definition of informal workers. How we manage health and care for ourselves and our loved ones has a direct impact on our ability to contribute to the economy. At the same time, the work that's required of us is unregulated and oftentimes poorly designed. This Vox article piqued my curiosity since 2016, and describes in detail the experiences of many, probably including you. This video about Madam Teo might resonate too. Yet I've only managed to present and share three times so far, the second and most recent being the 2023 ICOH Scientific Committee on Occupational Health For Health Workers. Whilst chatting about my presentation topic over lunch, Hanna Barton shared how they witnessed what was essentially a business endeavor within a family trying to coordinate care for a chronic patient.
This issue is further compounded by how convenient and popular it has been for healthcare institutions to "outsource" work to patients in the name of "patient empowerment" (thanks Ken Catchpole). With the proliferation of smart phones, different service providers developed their own apps for patients to access personal information, make appointments, as well as submit forms and requests from the comfort of their own homes. We even rolled out the Mobile In-patient Care @ Home (MIC@Home) so that some patients "who would normally spend time in hospital can now recover at home with the help of mobile medical teams, in an effort to allow them to get better in a familiar setting while helping to ease the hospital bed crunch". Indeed, many of these initiatives leverage on modern technology to alleviate traditional bottlenecks and inefficiencies. I have personally benefitted from making my own NHG polyclinic appointments through HealthHub, which releases appointment slots only during the night before, thus saving me the horrors of long waiting lines that polyclinics were once notorious for. Performing some of the work myself is a win-win for patients and care providers.
Yet in the case of MIC@Home, one can imagine all the professional work that now has to be performed by non-professionals in a non-professional setting. Someone has to accurately track data and input them in a system so that the professional care team members can see them, Someone has to monitor the wounds and change dressings when required. Someone has to know when and how to escalate before it's too late. We remain largely burdened by the mental load of managing our complex medication schedules, the constant need to remember our medical appointments, or the time and energy required to support us and our loved ones through ongoing therapy sessions. Human factors is great at making these chores less effortful, but most of us as embedded healthcare human factors practitioners are funded to improve problematic operations within the institutions (i.e.: professional work). Nothing wrong with that, it's just that while we are quick to redesign processes to have patients, parents, and caregivers "comply" (a word that Hanna hates in many contexts) with self-help tasks, we rarely allocate human factors resources to help support these unpaid, and oftentimes unskilled, care delivery workers. Instead, we expect them to be driven by intrinsic motivation to learn new knowledge and master procedures commonly taught in nursing school.
The gaps within health systems are real. Research has begun looking at the role of human factors in patient work and patient experience, emphasizing the roles of non-professional workers in the care ecosystem. Family and friends help to coordinate care activities across different locations as well as making sense of the information presented from various sources. A deep dive into dementia care reveals many invisible work that patients with other illnesses can relate. There's even an entire book dedicated to patient ergonomics. Still, many of these "last mile" gaps will remain real. We need to go beyond more research and analyses, and start coming up with actual improvements and solutions. If we truly seek to improve care plan adherence, we have to make these invisible work more ergonomic for our hidden, neglected, informal healthcare workers.
Speaking of work, did you know the ideal patient weight for lifting by a nurse, given many other factors, is 15.9kg? To quote the quote in Ram's presentation from Bill Marras, "The bottom line is, there is no safe way to lift a patient manually … the magnitude of these forces on your spine are so large that the best body mechanics in the world are NOT going to keep you from getting a back problem.".
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