Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study
Background. Healthcare work is shaped by a combination of physical effort and cognitive workloads. Prolonged exposure to these demands can contribute to musculoskeletal strain, fatigue, and risks to both patient and staff safety. Although Human Factors and Ergonomics (HFE) have been applied in healt...
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| author | Li, Hangjia Lu, Hanyu |
| author_facet | Li, Hangjia Lu, Hanyu |
| author_institution_txt_mv | [
{
"author": "Hangjia Li",
"institution": "Shanghai Lixin University of Accounting and Finance, Shanghai, China"
},
{
"author": "Hanyu Lu",
"institution": "Shanghai Open University, Shanghai, China"
}
] |
| author_sort | Li, Hangjia |
| baseUrl_str | https://ees-journal.com/index.php/journal/oai |
| collection | OJS |
| datestamp_date | 2026-06-30T15:36:43Z |
| description | Background. Healthcare work is shaped by a combination of physical effort and cognitive workloads. Prolonged exposure to these demands can contribute to musculoskeletal strain, fatigue, and risks to both patient and staff safety. Although Human Factors and Ergonomics (HFE) have been applied in healthcare for some time, less attention has been paid to the interaction between ergonomic conditions and Cognitive Systems Engineering (CSE) in everyday clinical work.
Purpose. This study aimed to explore how frontline healthcare professionals experienced ergonomic changes in relation to physical strain, cognitive load, and their ability to adapt to demanding clinical work environments.
Findings. This exploratory single-case study focused on ergonomic improvement initiatives implemented during 2022–2023 in a public general hospital in China and combined semi-structured interviews with non-participant observations involving 15 frontline healthcare professionals (7 doctors and 8 nurses) from five hospital units. The data were interpreted through an integrated ergonomics-CSE lens using thematic analysis. Three themes were identified: perceived reduction in physical workload, redistribution of cognitive load, and adaptation to stressful situations. Overall, 80.0% of the participants reported lower physical strain after the ergonomic changes. Nurses tended to highlight improvements in patient transfer and bedside care, whereas doctors more frequently cited fewer workflow interruptions and better concentration during procedures.
Implications. The integrated ergonomics-CSE perspective provides a useful way to understand the connections among physical working conditions, cognitive demands and adaptive practices in routine clinical work. In this single-case study, ergonomic initiatives were linked to safer task performance, enhanced task focus, and improved adaptation to demanding hospital environments. These findings indicate that this perspective can complement a broader sociotechnical framework when hospital managers make decisions on equipment procurement, workflow redesign, staff support, and ergonomic training priorities. |
| doi_str_mv | 10.61954/2616-7107/2026.10.2-7 |
| first_indexed | 2026-07-01T01:00:34Z |
| format | Article |
| fulltext |
Economics Ecology Socium e-ISSN 2786-8958
Volume 10 Issue 2 (2026) ISSN-L 2616-7107
94
Research Article
UDC 614.8: 004.94
JEL: I18, J28, D83
INTEGRATING ERGONOMICS AND COGNITIVE
SYSTEMS ENGINEERING FOR OCCUPATIONAL
SAFETY IN HEALTHCARE WORK SYSTEMS: AN
EXPLORATORY STUDY
Hangjia Li
Shanghai Lixin University of
Accounting and Finance,
Shanghai, China
ORCID iD: 0009-0003-5353-8410
Hanyu Lu *
Shanghai Open University,
Shanghai, China
ORCID iD: 0000-0003-1902-3117
*Corresponding author
E-mail: luhanyuwill@sou.edu.cn
Background. Healthcare work is shaped by a
combination of physical effort and cognitive workloads.
Prolonged exposure to these demands can contribute to
musculoskeletal strain, fatigue, and risks to both patient and
staff safety. Although Human Factors and Ergonomics (HFE)
have been applied in healthcare for some time, less attention
has been paid to the interaction between ergonomic
conditions and Cognitive Systems Engineering (CSE) in
everyday clinical work.
Purpose. This study aimed to explore how frontline
healthcare professionals experienced ergonomic changes in
relation to physical strain, cognitive load, and their ability to
adapt to demanding clinical work environments.
Findings. This exploratory single-case study focused
on ergonomic improvement initiatives implemented during
2022–2023 in a public general hospital in China and
combined semi-structured interviews with non-participant
observations involving 15 frontline healthcare professionals
(7 doctors and 8 nurses) from five hospital units. The data
were interpreted through an integrated ergonomics-CSE lens
using thematic analysis. Three themes were identified:
perceived reduction in physical workload, redistribution of
cognitive load, and adaptation to stressful situations. Overall,
80.0% of the participants reported lower physical strain after
the ergonomic changes. Nurses tended to highlight
improvements in patient transfer and bedside care, whereas
doctors more frequently cited fewer workflow interruptions
and better concentration during procedures.
Implications. The integrated ergonomics-CSE
perspective provides a useful way to understand the
connections among physical working conditions, cognitive
demands and adaptive practices in routine clinical work. In
this single-case study, ergonomic initiatives were linked to
safer task performance, enhanced task focus, and improved
adaptation to demanding hospital environments. These
findings indicate that this perspective can complement a
broader sociotechnical framework when hospital managers
make decisions on equipment procurement, workflow
redesign, staff support, and ergonomic training priorities.
Keywords: Cognitive Engineering, Decision-Making,
Ergonomics, Human-System Interaction, System Performance.
Received: 12/03/2026
Revised: 05/05/2026
Accepted: 01/06/2026
Published: 30/06/2026
DOI: 10.61954/2616-7107/2026.10.2-7
© Economics Ecology Socium, 2026
CC BY-NC 4.0 license
Economics Ecology Socium e-ISSN 2786-8958
Volume 10 Issue 2 (2026) ISSN-L 2616-7107
95
1. Introduction.
Human Factors and Ergonomics (HFE),
also known as ergonomics, examines the
interactions among people, tasks, technologies,
and work environments to improve safety,
health, and performance. Healthcare is an area
where humans are often required to meet a
range of physical and cognitive demands.
Therefore, it is appropriate to study the effects
of these requirements on individuals working in
healthcare settings. Furthermore, various
methods exist for studying these relationships in
healthcare, each with its own focus and benefits.
In healthcare research, different human
factor traditions have often been used for
various analytical purposes. Ergonomics has
commonly focused on physical workload and
equipment design; socio-technical approaches
have examined coordination and work system
conditions; the Systems Engineering Initiative
for Patient Safety (SEIPS) model has provided a
broad framework for linking work system
design to patient safety; FRAM has been used to
examine variability and emergence; Cognitive
Systems Engineering (CSE) and Cognitive
Work Analysis (CWA) have offered more fine-
grained accounts of distributed cognition in
demanding clinical settings.
Although it is common to discuss the
physical and cognitive demands of healthcare
work separately, these factors are interrelated in
the healthcare environment. Each of these
physical factors can affect the cognitive aspects
of healthcare work, and the cognitive aspects of
the work can affect the physical aspects. Any
occupational hazards arising from these factors
are not limited to those related to the physical or
cognitive demands on healthcare workers today
but also include hazards arising from the
interaction between these two types of demands.
In this study, Cognitive Systems
Engineering (CSE) was not used as a
replacement for SEIPS 2.0, the Functional
Resonance Analysis Method (FRAM), or other
comprehensive socio-technical frameworks but
as a complementary interpretive lens. SEIPS is
particularly useful for mapping the overall work
system, whereas CSE is particularly helpful for
examining how attention, tool use, and
adaptation unfold in real time.
Therefore, integrating ergonomics with
CSE enables a more focused examination of
how physical conditions shape cognition during
daily clinical work. Against this background,
the present study aimed to investigate the
ergonomic changes in healthcare work from an
integrated perspective of ergonomics and CSE.
The investigation will focus on healthcare
professionals’ experiences with ergonomic
issues in their daily work. The questions
investigated in this study were as follows:
RQ1: What are the experiences of
healthcare professionals regarding the physical
and cognitive demands of their work?
RQ2: How do they perceive the impact of
ergonomic changes on their work?
RQ3: How can an integrated ergonomics-
CSE perspective inform future safety and
adaptation initiatives in healthcare?
These questions address on the
ergonomics of healthcare work.
2. Literature Review.
The term ergonomics was first introduced
by Jastrzębowski (1997). Subsequently,
Murrell (1973) established ergonomics into a
field related to the workplace. Beyond the
workplace, ergonomics has developed into a
field related to work, well-being, and human
flourishing (Norman, 2013). International
developments in ergonomics include the
principle of “fitting the job to the worker”,
which later enabled its application in
healthcare and other fields (Karwowski, 2006).
Human factors and ergonomics
encompass cognitive, physical, and
organisational aspects. Authors such as Wickens
et al. (2004), Sanders and McCormick (1993),
Karwowski (2006), and Dul and Weerdmeester
(2003) have all discussed the importance of
human capabilities in ergonomics. These
authors considered the individual differences in
humans and their anatomical and physiological
characteristics. Furthermore, authors such as
Vicente (1999), Rasmussen (1983), Hancock
and Warm (1989), and Reason (1990) have
focused on the cognitive aspects of human
factors and ergonomics. These studies addressed
human factors related to cognition in complex
environments and tasks, as well as errors that
occur during those tasks.
Economics Ecology Socium e-ISSN 2786-8958
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Helander (2005), Salvendy (2012),
Stanton et al. (2013), Proctor and Van Zandt
(2008), Wickens and Hollands (2021), and
Kirlik (2018) have discussed the workload, team
cognition, and dynamic work aspects of human
factors. Three CSE-related concepts were used
to make the physical-cognitive link explicit.
Cognitive allocation refers to the way a clinician
allocates attention among patients, equipment,
body posture, and competing task demands.
Adaptive strategies are practical adjustments
that employees make when job pressure,
physical stress, or equipment constraints
change. Reallocation of attention refers to the
shift in mental focus that occurs when
ergonomic conditions reduce or exacerbate a
physical discomfort. These concepts help
explain how physical ergonomic conditions
affect cognitive tasks in clinical practice.
Vicente and Rasmussen (1992) and Guastello
(2023) studied the interface between humans
and technological devices and the errors that
arise in complex technological environments.
Jacquier-Bret and Gorce (2023)
demonstrated that ergonomic interventions
alone can reduce strain among healthcare
workers, although musculoskeletal disorders are
prevalent among healthcare workers. Abdul
Halim et al. (2023b) conducted a review of
interventions to reduce musculoskeletal strain
among healthcare workers and found that the
most effective interventions incorporate
ergonomic considerations into recommendations
for healthcare workers. Abdul Halim et al.
(2023a) found that although various patient
transfer devices can help reduce nurses’ strain
and be effectively integrated into nursing
workflows, which benefits the workers.
Recent studies have also found that tasks
related to patient transfer and bedside care place
the greatest strain on healthcare workers
(Vinstrup et al., 2024). Early nursing
ergonomics research has also linked patient
handling, ongoing work demands, and clinical
workload to musculoskeletal complaints in
healthcare workers (Engels et al., 1996; Nelson
et al., 2003; Trinkoff et al., 2002), while broader
ergonomics research continues to identify gaps
in musculoskeletal disease prevention (Rempel
& Krause, 2021). Thus, approaches that address
various aspects of nursing and healthcare may
help reduce the strain on workers.
Therefore, these frameworks are better
understood as complementary rather than
competing. SEIPS 2.0 offers a strong macro-
level account of the socio-technical structure in
healthcare, whereas CWA/CSE provides a
closer view of cognitive work and adaptation.
What remains comparatively underdeveloped in
empirical hospital studies is an analysis that
explicitly traces how local ergonomic
conditions, bodily strain, and moment-to-
moment cognitive demands are experienced
simultaneously in frontline work.
The integrated ergonomics-CSE lens used
here is intended as a focused interpretive
combination for that purpose rather than as a
claim that broader systems models do not exist.
Recent work on occupational fatigue and
healthcare control centres likewise points to the
value of linking work-system conditions with
staff experience and adaptation (Watterson et
al., 2023; Paterson et al., 2024). Table 1
presents human-factor models relevant to
healthcare work, along with the reasons for
integrating ergonomics and CSE concepts.
Table 1. Comparison of Human Factors Frameworks and Their Relevance to Healthcare Work.
Framework Focus Strengths Limitations in Healthcare
SEIPS / SEIPS 2.0
(Carayon et al., 2006;
Holden et al., 2013)
Work system
and patient
safety
Strong socio-technical
focus; widely applied in
healthcare
Broad socio-technical scope; less emphasis
on how local ergonomic conditions shape
distributed cognition during frontline tasks
FRAM (Hollnagel,
2012)
Variability and
emergence
Captures complexity
and resilience in socio-
technical systems
Minimal attention to ergonomics or
healthcare-specific design
CSE / CWA (Vicente,
1999; Rasmussen, 1983)
Cognition and
decision-making
Rich insights into
distributed cognition
Less explicit attention to musculoskeletal
strain and organisational ergonomics
unless combined with ergonomic analysis
Proposed CSE–
Ergonomics Approach
Integrated
cognitive and
physical
ergonomics
Bridges decision-
making, workload, and
ergonomic design in
healthcare
Requires empirical validation across
diverse clinical contexts
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Economics Ecology Socium e-ISSN 2786-8958
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Purposive sampling was used to recruit
participants who could provide detailed
accounts of clinically demanding work
involving both physical and cognitive
requirements. The final sample consisted of 15
frontline healthcare professionals, including 7
doctors and 8 nurses, whose work experience
ranged from 3 to 16 years. For this bounded
qualitative case, the sample size was determined
by information power and thematic sufficiency
rather than numerical representativeness
(Malterud et al., 2016). Recruitment was
discontinued when recurring patterns appeared
across the two professional groups and the
selected units, and when further accounts did
not substantially expand the core themes.
The findings were analysed across cases
rather than used for unit-specific comparisons.
The inclusion criteria required participants to be
actively engaged in frontline clinical work, have
at least 2 years of professional experience, and
encounter both physical and cognitive demands
in their jobs (Table 2).
Participants were deliberately recruited
based on professional role, frontline experience
and qualifications during the study, rather than
to achieve unit-level proportionality or gender
balance. The uneven gender distribution in some
units (e.g., operating theatres and intensive care
units) reflects the limited number of qualified
frontline staff in these settings. It should not be
used as a basis for gender comparisons.
Table 2. Summary of Participant Characteristics.
Profession Department/Unit Gender (F/M)
Years of Experience
(2–5 / 6–10 / 11+)
Doctors (n = 7) Emergency Department (ED) 1/1 1/1/0
Doctors (n = 7) Intensive Care Unit (ICU) 1/1 0/1/1
Doctors (n = 7) Operating Room / Perioperative Unit 0/1 0/0/1
Doctors (n = 7) General Medical/Surgical Ward 0/1 1/0/0
Doctors (n = 7)
Rehabilitation / Geriatric / Long-term
Care Unit
1/0 0/1/0
Nurses (n = 8) Emergency Department (ED) 1/1 1/0/1
Nurses (n = 8) Intensive Care Unit (ICU) 1/0 0/1/0
Nurses (n = 8) Operating Room / Perioperative Unit 2/0 1/1/0
Nurses (n = 8) General Medical/Surgical Ward 2/0 1/0/1
Nurses (n = 8)
Rehabilitation / Geriatric / Long-term
Care Unit
0/1 0/1/0
3.4. Data Collection.
Data were collected from two sources:
semi-structured interviews and non-participant
observations of routine clinical work. All
participants completed individual semi-
structured interviews. The interviews addressed
bodily strain, cognitive demands, equipment
use, workflow interruptions, and suggestions for
improving hospital ergonomics.
The observation sessions were conducted
in the participants’ work units. As routine care
activities unfolded, the researcher documented
the postures, equipment use, task flow, and
adaptive strategies in real time. The observer
did not participate in the work process or
interfere with the clinical tasks. The observation
duration was typically approximately 45-60
minutes, with variation depending on the
department’s workflow needs and patient care
activities.
3.5. Data Analysis.
Interview transcripts and observation
notes were reviewed and coded manually to
identify recurring themes related to physical
strain, cognitive workload, equipment use,
workflow disruption, and adaptation. The
material was reviewed repeatedly to become
familiar with the data. Segments related to
bodily strain, attentional demand, equipment
use, workflow disruption, and adaptation were
coded and analysed. These first-cycle codes
were subsequently organised into broader
categories and compared across the interview
and observation materials to examine
similarities, differences, and areas of overlap.
Table 3 presents how excerpts moved
from initial coding to categories and themes.
Because the dataset was small and confined to a
bounded case, the analysis did not rely on
dedicated qualitative data analysis software.
Economics Ecology Socium e-ISSN 2786-8958
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A formal inter-rater reliability coefficient
was not calculated, as the aim was interpretive
theme development rather than quantifying
coder agreement. To maintain analytic
consistency, the codes and themes that emerged
during the analysis were checked against the full
dataset. Revisions were made when the category
boundaries were insufficiently clear or not
adequately supported by the original material.
For excerpts that could reasonably be placed in
more than one category, the researcher returned
to the wider interview or observation context
and compared them with similar excerpts before
making the final coding decisions. Ambiguous
cases were noted analytically and reconsidered
during subsequent thematic refinement until the
coding framework captured the participants’
meanings with adequate accuracy.
Theme counts, when included, refer to
participants who mentioned a given theme at
least one time. Their purpose is limited to
describing relative prominence in the dataset;
they are not used as statistical tests or as
outcome measures. Methodological rigour and
transparency were supported by following
Braun and Clarke’s (2006) six-phase thematic
analysis framework.
The process involved: (1) familiarisation
with the data through repeated reading of
interview transcripts; (2) generation of initial
codes capturing both semantic (explicit) and
latent (interpretive) content; (3) development of
candidate themes by systematically collating
and reviewing codes; (4) review of candidate
themes to assess their internal coherence and
distinctiveness across the full dataset; (5)
refinement, definition, and naming of final
themes to represent salient and meaningful
patterns; and (6) construction of a cohesive
analytic narrative grounded in empirical
evidence.
In line with the interpretive character of
qualitative enquiry and established qualitative
standards, inter-rater reliability coefficients
were not calculated. Instead, four
complementary trustworthiness strategies were
implemented: (a) negative case analysis, which
involved systematically identifying and
examining disconfirming instances, such as the
three participants who reported no reduction in
physical strain, followed by contextual
exploration, such as shared equipment use, to
refine thematic boundaries; (b) researcher
reflexivity, supported by a comprehensive
analytic audit trail that recorded decisions,
evolving assumptions, and the rationale for
coding and thematic revisions; (c) peer
debriefing, in which two independent qualitative
researchers unaffiliated with the study reviewed
emerging themes and critically challenged
potential interpretive biases; and (d) data
triangulation, through which interview-derived
insights were cross-verified against
contemporaneous observational field notes to
assess convergence between reported
experiences and observed behaviours.
Table 3. Example of the Coding Process.
Illustrative excerpt Initial code Category Theme Analytic interpretation
Since we began using the
lifting device, my back pain
has decreased considerably,
and long shifts have become
easier to manage with less
strain.
Lifting device
reduced back pain
and long-shift
strain
Ergonomic
support for
patient handling
Perceived reduction
in physical
workload
Equipment reduced
bodily strain during
routine care tasks.
The adjustable operating
tables and chairs help us
pay more attention to the
patient instead of being
distracted by discomfort.
Adjustable
workstation
improved focus on
the patient
Reduced
disruption in
procedure
workflow
Redistribution of
cognitive load
Physical adjustment of
the workspace supported
attention allocation.
Even on night shifts, the
new equipment makes it
easier to continue working
safely without becoming
overly exhausted.
New equipment
sustained safe
work during night
shifts
Support for work
under pressure
Adaptation to
stressful situations
Ergonomic changes
were linked to sustained
safe performance in
demanding conditions.
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3.6. Trustworthiness and Ethical
Considerations.
Trustworthiness was enhanced through
the triangulation of interview and observation
data, purposive recruitment of experienced
frontline staff, and repeated comparison of
emerging interpretations with the original
material. The observational data were not
treated as independent outcome measures.
Instead, they were used as contextual evidence
to help corroborate, refine, or, in some cases,
challenge interview accounts.
This iterative process across data sources
strengthened the credibility of the final themes
and reduced the risk of interpreting individual
quotations out of context. Before data
collection, each participant was informed of the
purpose of the study and provided written
informed consent.
Data were managed and reported in a
manner that protected confidentiality, and no
personally identifiable information was included
in the study or data set. Since observations were
conducted in active clinical settings, observer
effects cannot be completely ruled out. This
issue is revisited in the limitations section.
4. Results.
The final analysis identified three closely
connected themes: (1) perceived reduction in
physical workload, (2) redistribution of the
cognitive load, and (3) adaptation to stressful
conditions. Table 4 presents a descriptive
summary of the frequency with which these
themes appeared across the sample and between
the two groups. These counts were used to
indicate relative prominence in the dataset
rather than serving as statistical indicators.
Table 4. Distribution of Themes by Professional Group.
Theme
Total
(n = 15)
Doctors
(n = 7)
Nurses
(n = 8)
Typical emphasis
Perceived reduction in
physical workload
12 (80.0%) 5 (71.4%) 7 (87.5%)
Nurses: patient transfer, bedside care, bodily
strain; Doctors: posture and procedural
comfort
Redistribution of cognitive
load
10 (66.7%) 6 (85.7%) 4 (50.0%)
Reduced distraction, smoother workflow,
and improved concentration during
procedures
Adaptation to stressful
situations
9 (60.0%) 4 (57.1%) 5 (62.5%)
Safer performance during long shifts, night
work, and high-pressure situations
Note. Counts indicate the number of participants who mentioned each theme at least once. Participants
could mention more than one theme. Percentages are descriptive only and are not intended for
statistical inference.
4.1. Perceived Reduction in Physical
Workload (Theme 1).
Participants commonly reported that
ergonomic modifications reduced the physical
demands of their routine tasks. This theme
emerged in 12 of the 15 accounts (80.0%),
specifically, 5 of the 7 doctors (71.4%), and 7 of
the 8 nurses (87.5%). Nurses tended to attribute
the perceived improvement to patient handling,
bedside care, and long shifts, whereas doctors
more frequently emphasised better posture and
increased comfort during procedures. One nurse
explained that, after starting to use the lifting
device, long shifts had become less stressful to
manage (study participant, nurse).
A similar view was expressed by a ward-
based participant, who described routine ward
duties as considerably less exhausting than
before (study participant working in the
ward).
Across units, participants consistently
framed ergonomic tools not merely as comfort
aids but as practical means of supporting safer
task performance. These accounts were
corroborated by observation notes, which
documented frequent bed-height adjustments
and reliance on transfer aids prior to patient
handling. The findings were consistent with
the participants’ descriptions of reduced back
and shoulder strain.
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4.2. Redistribution of cognitive load
(Theme 2).
The second theme concerns how
ergonomic adjustments may alter attention
management at work. Participants reported
fewer interruptions attributable to poor posture,
discomfort, and repeated equipment
adjustments. Physicians most commonly
associated this pattern with surgery, workstation
adjustment, and the ability to maintain focus on
the patient rather than physical discomfort.
One doctor noted that the adjustable
operating tables and chairs enabled greater
attention to the patient rather than discomfort
(doctor participant). Another explained that,
given the equipment’s largely ergonomic
design, less mental energy was devoted to minor
physical difficulties (doctor participant).
Echoing this, a participant from the
perioperative unit observed that the workflow
had become smoother once repeated
readjustments were no longer required
(perioperative participant). Collectively, these
findings suggest that ergonomic design
indirectly influences cognition by reducing
bodily interference and workflow disruption.
Descriptively, the theme was identified in 10 of
the 15 accounts (66.7%) and was more
prevalent among doctors than nurses (85.7%
versus 50.0%). Consistent with these accounts,
observations in the OR and ICU revealed fewer
posture readjustments around adjustable
workstations and a more continuous task flow
when ergonomic equipment was available
(Table 4).
4.3. Adaptation to stressful situations
(Theme 3).
The third theme concerned how
ergonomic support helped the staffs maintain
safe working practices under pressure. The issue
was raised by 9 participants (60.0%),
comprising 4 of the 7 doctors (57.1%) and 5 of
the 8 nurses (62.5%). This was particularly
evident in accounts from the ED, ICU, and OR,
where long shifts, time pressure, and physically
demanding tasks were commonly reported.
One doctor noted that even during night
shifts, the new equipment made it easier to
continue working safely without becoming
exhausted (doctor participant).
A nurse described a similar experience,
noting that although fatigue still arose on busy
shifts, long shifts had become considerably
more manageable (nurse participant). For
participants, ergonomic support was associated
not only with comfort but also with the capacity
to sustain performance during long shifts,
demanding tasks and time-pressured situations.
Several studies have advocated for wider access
to patient transfer devices and ergonomic
training to extend these benefits.
Consistent with these accounts,
observation notes from high-pressure units
indicated that the staff used ergonomic
equipment to maintain a safer posture and a
steadier work pace during prolonged or
physically demanding tasks.
5. Discussion.
Taken together, the interviews and field
observations suggest that the participants did
not regard ergonomic change merely as an
improvement in comfort. Rather, they linked it
to the organisation of physical effort, attention,
and safe task performance in everyday clinical
work.
The first finding was that participants
perceived ergonomic changes as reducing
physical strain in their daily work. Their
accounts centred on tasks, equipment, and
workstation arrangements that made patient
handling, prolonged standing, and other
physically demanding activities more
manageable. From this perspective, the value of
ergonomics extends beyond comfort to safer
task performance. This pattern is consistent with
recent evidence indicating that patient transfer
and bedside care rank among the most
physically demanding tasks in healthcare and
those ergonomic measures can reduce
musculoskeletal strain when incorporated into
routine workflows (Abdul Halim et al., 2023a;
Abdul Halim et al., 2023b; Vinstrup et al.,
2024).
The second finding was that participants
described ergonomic changes as reducing
disruptions in work processes. When less effort
was required to compensate for discomfort or
awkward equipment, staff reported being able to
direct more attention to the patient and the
immediate demands of care.
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This pattern aligns with the CSE
perspective, which conceptualises cognition as
being shaped by interactions among workers,
tools, tasks, and the surrounding environment
(Hollnagel & Woods, 1983; Vicente, 1999;
Nemeth et al., 2004).
Comparisons between professional
groups further revealed differences in role-
related emphasis. Nurses more frequently
discussed bodily strain associated with patient
handling and bedside care, whereas doctors
more often emphasised reduced distraction,
smoother procedures, and improved
concentration. These patterns underscore the
importance of examining physical and
cognitive demands jointly rather than as
separate domains. In this regard, the integrated
ergonomics-CSE lens complements broader
socio-technical frameworks, such as SEIPS, by
highlighting how local ergonomic conditions
are embedded in cognition and adaptation
during care delivery.
Third, participants associated ergonomic
improvements with their ability to work safely
during long shifts, physically demanding tasks,
and high-pressure situations. Although
resilience was not directly measured, the
findings suggest that ergonomic support may
strengthen adaptive capacity by making
demanding work sustainable. This interpretation
is consistent with systems-oriented discussions
of adaptation in complex healthcare settings
(Hollnagel, 2012; Waterson, 2009).
From a practical standpoint, integrating
ergonomics with CSE in healthcare involves
more than introducing equipment. Ergonomic
initiatives need to be aligned with local
workflows, coordination requirements, and the
specific task demands of different units. Recent
socio-technical work on occupational fatigue
and healthcare control centres makes a similar
point: tools, staffing conditions, coordination,
and local operating pressures need to be
understood together rather than in isolation
(Watterson et al., 2023; Paterson et al., 2024).
These findings also inform ergonomics training
courses for healthcare administrators and unit
managers by highlighting how equipment
decisions, workflow redesign, and employee
feedback can be considered during the
implementation.
Departments such as the ED, ICU, and
OR may therefore benefit most from this
integrated approach, and staff feedback should
be incorporated during implementation to
ensure that ergonomic changes align with local
practices.
This study had several limitations. It was
conducted in a single hospital and drew on a
relatively small, purposively selected sample;
therefore, the findings should be regarded as
analytically transferable rather than statistically
generalisable. Some units were represented by
only one or two participants, which made the
dataset better suited to cross-case pattern
identification than to unit-by-unit comparison.
The study also relied on interview accounts and
non-participant observation rather than on
standardised instruments such as National
Aeronautics and Space Administration Task
Load Index (NASA-TLX) or Borg-type ratings;
the reported changes should accordingly be
interpreted as experienced and observed
patterns rather than as calibrated workload
measures. As part of the evidence rested on
self-reported ergonomic improvements, the
findings may additionally be subject to
response bias, including social desirability and
retrospective interpretations of changes.
Furthermore, because observations took
place in active clinical settings, the Hawthorne
effect may have influenced the behaviour.
Finally, formal inter-rater reliability statistics
were not used for manual coding. Future
research could build on these findings by
combining qualitative analysis with validated
workload measures, broader sampling, and
explicit comparative designs. This study
suggests that occupational safety in healthcare
can be better understood when ergonomics is
examined alongside the cognitive demands of
clinical work.
6. Conclusions.
This study examined how ergonomic
changes in healthcare work can be understood
from an integrated ergonomics-CSE
perspective. Participants described ergonomic
interventions as beneficial for reducing
physical and cognitive workloads and
supporting sustained safe performance in
demanding clinical environments.
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Specifically, 80.0% of the participants
reported a reduction in physical load, 66.7%
described a redistribution of cognitive load, and
60.0% noted improved adaptability to stressful
situations. Nurses more often linked ergonomic
changes to patient transfers and bedside
pressure, whereas physicians linked them to
smoother procedures and better concentration.
These findings underscore the value of
integrating CSE into discussions on ergonomics
and occupational safety in healthcare.
Future research should extend this work
through more diverse samples, longitudinal
designs, and objective indicators, such as
motion analysis, electromyography, NASA-
TLX, the Borg Rating of Perceived Exertion, or
related measures of physical and cognitive
demand. This study clarifies how perceived
ergonomic improvements relate to measurable
changes in workload, safety, and performance
over time.
Ethical Approval.
Ethical approval for this study was
obtained from the Academic Ethics Committee
of Shanghai Lixin University of Accounting and
Finance (Approval No. 2025007).
Conflict of Interest Statement.
The authors have declared no conflict of
interest.
Funding Disclosure.
This research received no external
funding.
AI Use Statement.
The authors used Deepseek-V2 solely for
language polishing. All suggested changes
were reviewed and approved by the authors,
who assume full responsibility for the final
text.
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| id | oai:ojs2.www.ees-journal.com:article-346 |
| institution | Economics Ecology Socium |
| keywords_txt_mv | keywords |
| language | English |
| last_indexed | 2026-07-01T01:00:34Z |
| publishDate | 2026 |
| publisher | Dr. Viktor Koval |
| record_format | ojs |
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| spelling | oai:ojs2.www.ees-journal.com:article-3462026-06-30T15:36:43Z Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study Li, Hangjia Lu, Hanyu Cognitive Engineering, Decision-Making, Ergonomics, Human-System Interaction, System Performance. Cognitive Engineering, Decision-Making, Ergonomics, Human-System Interaction, System Performance. Background. Healthcare work is shaped by a combination of physical effort and cognitive workloads. Prolonged exposure to these demands can contribute to musculoskeletal strain, fatigue, and risks to both patient and staff safety. Although Human Factors and Ergonomics (HFE) have been applied in healthcare for some time, less attention has been paid to the interaction between ergonomic conditions and Cognitive Systems Engineering (CSE) in everyday clinical work. Purpose. This study aimed to explore how frontline healthcare professionals experienced ergonomic changes in relation to physical strain, cognitive load, and their ability to adapt to demanding clinical work environments. Findings. This exploratory single-case study focused on ergonomic improvement initiatives implemented during 2022–2023 in a public general hospital in China and combined semi-structured interviews with non-participant observations involving 15 frontline healthcare professionals (7 doctors and 8 nurses) from five hospital units. The data were interpreted through an integrated ergonomics-CSE lens using thematic analysis. Three themes were identified: perceived reduction in physical workload, redistribution of cognitive load, and adaptation to stressful situations. Overall, 80.0% of the participants reported lower physical strain after the ergonomic changes. Nurses tended to highlight improvements in patient transfer and bedside care, whereas doctors more frequently cited fewer workflow interruptions and better concentration during procedures. Implications. The integrated ergonomics-CSE perspective provides a useful way to understand the connections among physical working conditions, cognitive demands and adaptive practices in routine clinical work. In this single-case study, ergonomic initiatives were linked to safer task performance, enhanced task focus, and improved adaptation to demanding hospital environments. These findings indicate that this perspective can complement a broader sociotechnical framework when hospital managers make decisions on equipment procurement, workflow redesign, staff support, and ergonomic training priorities. Background. Healthcare work is shaped by a combination of physical effort and cognitive workloads. Prolonged exposure to these demands can contribute to musculoskeletal strain, fatigue, and risks to both patient and staff safety. Although Human Factors and Ergonomics (HFE) have been applied in healthcare for some time, less attention has been paid to the interaction between ergonomic conditions and Cognitive Systems Engineering (CSE) in everyday clinical work. Purpose. This study aimed to explore how frontline healthcare professionals experienced ergonomic changes in relation to physical strain, cognitive load, and their ability to adapt to demanding clinical work environments. Findings. This exploratory single-case study focused on ergonomic improvement initiatives implemented during 2022–2023 in a public general hospital in China and combined semi-structured interviews with non-participant observations involving 15 frontline healthcare professionals (7 doctors and 8 nurses) from five hospital units. The data were interpreted through an integrated ergonomics-CSE lens using thematic analysis. Three themes were identified: perceived reduction in physical workload, redistribution of cognitive load, and adaptation to stressful situations. Overall, 80.0% of the participants reported lower physical strain after the ergonomic changes. Nurses tended to highlight improvements in patient transfer and bedside care, whereas doctors more frequently cited fewer workflow interruptions and better concentration during procedures. Implications. The integrated ergonomics-CSE perspective provides a useful way to understand the connections among physical working conditions, cognitive demands and adaptive practices in routine clinical work. In this single-case study, ergonomic initiatives were linked to safer task performance, enhanced task focus, and improved adaptation to demanding hospital environments. These findings indicate that this perspective can complement a broader sociotechnical framework when hospital managers make decisions on equipment procurement, workflow redesign, staff support, and ergonomic training priorities. Dr. Viktor Koval 2026-06-30 Article Article Peer-reviewed Article application/pdf https://ees-journal.com/index.php/journal/article/view/346 10.61954/2616-7107/2026.10.2-7 Economics Ecology Socium; Vol. 10 No. 2 (2026): Economics Ecology Socium; 94-105 Економіка Екологія Соціум; Том 10 № 2 (2026): Economics Ecology Socium; 94-105 2616-7107 2616-7107 10.61954/2616-7107/2026.10.2 en https://ees-journal.com/index.php/journal/article/view/346/298 Copyright (c) 2026 Economics Ecology Socium https://creativecommons.org/licenses/by-nc/4.0 |
| spellingShingle | Cognitive Engineering Decision-Making Ergonomics Human-System Interaction System Performance. Li, Hangjia Lu, Hanyu Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study |
| title | Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study |
| title_alt | Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study |
| title_full | Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study |
| title_fullStr | Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study |
| title_full_unstemmed | Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study |
| title_short | Integrating Ergonomics and Cognitive Systems Engineering for Occupational Safety in Healthcare Work Systems: An Exploratory Study |
| title_sort | integrating ergonomics and cognitive systems engineering for occupational safety in healthcare work systems: an exploratory study |
| topic | Cognitive Engineering Decision-Making Ergonomics Human-System Interaction System Performance. |
| topic_facet | Cognitive Engineering Decision-Making Ergonomics Human-System Interaction System Performance. Cognitive Engineering Decision-Making Ergonomics Human-System Interaction System Performance. |
| url | https://ees-journal.com/index.php/journal/article/view/346 |
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