- 期刊
運用批次處理模式減少重複性動作負荷：以大量團檢醫令開立為例
Using a batch operation model to reduce repetitive work: the case of a mass medical screening
摘要
背景：重複性勞損是由於重複相同動作或持續使用身體特定部位而造成的肌肉骨骼或神經系統損傷。透過工程控制或作業輪調等方式，可以降低重複性動作的人因風險，但最簡單或有效的策略是消除重複性動作的次數。本論文擬分享應用資訊系統批次作業及利用視覺化強調等方法，改善重複性動作的經驗。方法：自2016年起開始執行重複性動作之健康危害的改善計畫。團隊針對年度肺結核胸部X光團體篩檢的行政作業區分個別工作任務，使用資訊測試系統，模擬實際作業情形以收集及分析人員的作業負荷，如動作時的姿勢、頻率、時間或重複性等，找出可能的作業危害或問題點。依職場危害控制階層及職業安全衛生管理系統強調的規劃（Plan, P）－實施（Do, D）－查核（Check, C）－行動（Act, A）循環步驟，規劃及導入新作業模式後再次評估改善成效並標準化。結果：每年需接受肺結核胸部X光篩檢的健康照護人員達1000人；透過系統系統分析或模擬，可發現行政作業過程中，人員需輸入鍵盤或點擊滑鼠各數萬次、耗用超過30小時的工作時間、列印報表或檢查單達數千張或數百次的文件傳送；除增加人員肌肉骨骼或視力負荷，也使人員暴露於大量列印伴隨的廢氣或噪音。應用資訊批次作業及無紙化，可以有效消除個別醫令開立時的重複動作，降低人員健康風險及增加滿意度。透過資訊系統自動比對取代人工檢查，可減少人員視覺負荷與人為錯誤。透過自動標註疑似有活動性肺結核的異常個案提示人員立即處置，可提昇異常個案追蹤複檢之即時性。結論：本研究除改善原始預期的重複性動作的人因風險，透過資訊系統的整合與介入，除了減少人員作業時的噪音及空汚暴露，同時改善人員重複檢核的視覺及心理負荷，符合職場永續健康與安全發展的目的。此外透過資訊系統對作業的輔助，可提升臨場健康服務人員工作效率及達成原先期待之績效指標，可作為其它工作改善計劃之參考。
並列摘要
Background: A repetitive strain injuries (RSI) are injuries to parts of the musculoskeletal or nervous system caused by appropriate and excessive uses or repetitive movements. Engineering or job rotation are good ergonomic examples for reducing the risk of RSI. However, eliminating number of repetitive motions is often the simplest and most effective design. The study aims to share the experience of applying both batch processing and visual emphasis method to eliminate the need for manual and repetitive movements and reduce the ergonomic risk among operators. Methods: A workplace hazard control plan was started since 2016. At the start of the study, administrative procedures for the annual mass screening of tuberculosis chest X-ray were divided into different tasks. To collect and analyze possible workloads, including posture, pace, working time and repetition, information testing system was used to simulate actual operating situations. Four steps for the development of the program include (P) plan, (D) do, (C) check, and (A) act. This cycle was emphasized by the workplace hazard control hierarchy and the occupational safety and health management system. After developing and implementing a new information system and operating model to reduce workload, the effectiveness of actions was measured. Finally, the changes were analyzed and standardized to reduce workload of staff. Results: There were over 1,000 healthcare workers need to receive annual chest x-ray examinations for the detection of latent tuberculosis every year. Workers have to input tens of thousands of keyboard keys or click the mouse in about 30 hours of worktime, print or check thousands of sheets, and send files by simulating actual operations. In addition to health risks such as musculoskeletal or visual load for workers, printing also increases the negative impact on the air or noise of the working environment. Repetitive registration, ordering and purchasing tasks could be avoided using a batch operation model of the information system. Thus, ergonomic risk arriving from a certain numbers of repetitive movements of operating staff could be eliminated. The automation of data comparison could reduce visual workload and human errors of staff. Reports matched keywords would be marked automatically because cases must be referred immediately if the chest X-ray is suspicious of active tuberculosis. The improvement of visual communication via the conspicuous marks help staff to track the result of follow-up tests among suspicious cases. After applying the PDCA cycles, the completion rates of annual mass screening among health care workers successfully achieved the 'Excellent' level of the audit requirements. Conclusions: In addition to reduce the expected ergonomic risk from repetitive movement, our improvement plan also help to reduce the noise and chemical contaminations released during laser printers, visual and mental workload from repeating inspections. Our effective health practices enhance sustainability through minimizing hazards and waste from workplace. Integration of information technology into the service is feasible, successful and replicable. In addition to achieving the performance indicators, this plan also improved the work efficiency and reduced the ergonomic risks of on-site health service personnel. This study may share a simple design to similar workplace health promotion program.