Chapter 3 Macro-Ergonomics

By

Syed Ali Hussain

B.S.P.T (R.M.C)

M.S O.M.P.T* (Riphah)

Learning ObjectivesAfter reading this chapter and completing the exercises, the reader should be able

to do the following:

1. Understand the definition, principles, and use of macroergonomics.

2. Describe the role of therapists in assisting in macroergonomics interventions

or research efforts.

3. List the ways in which macroergonomics may differ from as well as interface

with other disciplines, such as industrial engineering, organizational

psychology, physical therapy, and occupational therapy.

4. List some basic principles of macroergonomics and how they may contribute

to long-term, lasting change within an organization.

5. Select, understand, and discuss a macroergonomic versus a microergonomic

approach, when to use each, and their pros and cons.

INTRODUCTION• Participatory ergonomics:- The process by which workers of all

levels help identify ergonomic problems and solutions.

• Macroergonomics:- A sub-discipline of human factors or

ergonomics that emphasizes a broad system view of design and

fitting the organization to the person or persons within that

organization.

• Microergonomics:- An approach to ergonomics that emphasizes

the examination of the interface between person and the

product, as opposed to other factors.

CASE STUDY• An example may help you understand macroergonomics, as well as why a

macroergonomic approach is more likely to lead to large scale, long-lasting results.

• In this case, the Army Medical Department Center and School commander asked

ergonomists (also known as human factors engineers) to assist with reducing

musculoskeletal injuries among soldiers attending advanced individual training

(AIT) to become U.S. Army Health Care Specialists.

• Soldiers attend this rigorous training program after completing basic training.

• At the time of the intervention the training program was 10 weeks in length.

• The hope was that the intervention program developed at this training site, if

successful, might also be duplicated at other training sites.

• The ergonomic team quickly recognized that the most effective method of

evaluation and intervention would involve a macroergonomic approach.

Musculoskeletal injuries are high

among soldiers attending basic

combat training as well as advanced

individual training programs.

RATIONALE OF THIS CHAPTER• This chapter defines macroergonomics and provides a brief

introduction to macroergonomics as a sub-discipline of human

factors or ergonomics and as a problem-solving approach.

• The chapter also investigates the potential role of occupational

and physical therapists in using macroergonomics, lists governing

principles of macroergonomics, and demonstrates with a case

study example.

• Finally, guidance is given for helping therapists decide when to use

a micro versus a macro approach.

MACROERGONOMIC ORIGINS AND MOVEMENT• In 1978 the Select Committee on Human Factors Futures (1980-2000) was

initiated to study societal trends and their impact on human factors and

ergonomics.

• The sixth item identified was the “failure of traditional (micro-) ergonomics.”

• The point was that a specific solution to a known ergonomic issue, regardless of

how well it was conceived or implemented, did not always result in the expected

positive results.

• Paying attention to specific components of the system, such as a workstation,

might mean the bigger picture of the work environment was lost.

• Therefore, although an ergonomist might evaluate and redesign a single

workstation to fit an individual, overall work effectiveness, including productivity,

safety, and the overall work environment, might not change at all.

• For more on the history of the development of macroergonomics,

consult Hendrick and Kleiner,1 Kleiner,4 and Robertson.

• More recently, organizational design and management (ODAM) has

been integrated into the human factors or ergonomics field, with

venues including the Macroergonomics Technical Group within the

Human Factors and Ergonomics Society and other countries’

societies.

• The Human Factors in ODAM symposium occurs every 2 to 4 years.

• Macroergonomics has also been a major topic at the International

Ergonomics Association triennial conferences since 1985.

MACROERGONOMIC ORIGINS AND MOVEMENT

MACROERGONOMICS DEFINED• Depending on whom you speak with, macroergonomics can be defined as a perspective, an

approach, a specific discipline, or a subdiscipline of human factors or ergonomics. Basically,

rather than a “fitting the task to the man,” macroergonomics proposes to “fit the

organization to the person or persons within that organization.”

• Yet it is more than even that.

• In fitting the organization to the people, the ergonomist assesses each element of an

organization with the thought that each element has the potential for redesign.

• In addition, the ergonomist must also consider systems outside the organization that affect the

organization.

• From the highest level of the organizational hierarchy to the entry-level worker and from the

most intricate technology to the simple interactions by the water fountain, all elements are

interconnected with one another.

• All have an impact on the achievement of an organization’s objectives.

MACROERGONOMICS DEFINED• Because of the nature of organizations (as systems of systems), the

design process is neither linear nor singular, the way the design of a

coffee cup or a computer wrist rest might be.

• Instead, the process is complex, iterative, and ever-changing as people,

societies, technologies, goals, missions, and knowledge change.

• Although humans are apt to stay with what is familiar to them,

metamorphosis is a constant; perhaps it is the only constant.

• Metamorphosis can occur by chance or it can be managed according

to evidence-based facts, but it will continue nonetheless.

MACROERGONOMICS DEFINED• According to Hendrick and Kleiner, organizational psychology and macroergonomics

differ in their focus and approach;

• Organization psychologists are more inclined to use selection, incentives, climate,

and leadership to achieve objectives ,whereas

• Ergonomists redesign to ensure optimal human interactions with “jobs, machines,

and systems.”

• It is author’s opinion that any separation of the two is arbitrary—that is, the

examination and design (or redesign) of a work system will potentially include

personnel systems, selection processes, and climate (described as part of

organizational psychology).

• Only by examining the whole can an ergonomist know which portions need redesign.

MACROERGONOMICS DEFINED• To leave out a part because it is psychology or industrial engineering rather than

macroergonomics defeats the broader approach that macroergonomics brings.

• Instead, an initial wide-ranging analysis will identify existing elements of the organization,

along with the links and the gaps.

• It will demonstrate work flow, information flow, decision points, and the need for decision

aids.

• In short, when designing an organization, the ergonomist needs to understand each of the

systems within that organization, the inside and outside pressures, and the overarching

mission and goals, as well as the intricacies of the culture and subcultures.

• Only by knowing these things, as well as knowing the research literature on organizational

effectiveness, hierarchic structures, teamwork and so on, can the ergonomist assist with

designing a thoroughly harmonized organization.

MACROERGONOMICS DEFINED• Macroergonomics evaluates and optimizes the interface among human, machine,

organization, technology, and environment by examining the personnel subsystem, the

technologic subsystem, and the internal and external environments.

• At the same time, the assessment includes looking at the organization’s complexity—that is,

both the segmentation of the organization, known as differentiation, and the integration of

the organization, known as integration, formalization (degree of standardization), and

centralization.

• The bottom line is that in a true macroergonomic project, the goal is to design (or redesign)

any and all parts of the organization in order for the entire organization to operate in a

harmonized fashion.

• A harmonized fashion means that because of the design the organization (or work system)

operates as smoothly, efficiently, and safely as possible and everyone working there

experiences a sense of value, satisfaction, and commitment.

MACROERGONOMICS DEFINED

• Although this sounds like workplace nirvana, it is close to

the goal of all ergonomic design: to create products,

places, and procedures that are simultaneously efficient,

effective, easy-to-use, and sufficiently challenging enough

to be interesting, as well as safe and comfortable.

• The difference between “regular” ergonomics, also known

as Microergonomics, and Macroergonomics lies primarily

in the complexity, both in terms of effort and time.

The Paralyzed Finger Trick

• Okay, give this one a try: bend your middle finger like

the picture on the left shows and put your hand on

the table. Then lift your thumb, index finger, and

pinkie. No problem, right? Now try the ring finger.

WHY YOU CAN'T:

• The tendons in your fingers are independent

from one another apart from the ones in your

middle and ring finger. These tendons are

connected, so that when your middle finger is

folded down you cannot move your ring finger.

It feels like your ring finger is stuck!

THE MACROERGONOMIC PROCESSInitial Evaluation:

• The first step in the process is to examine all systems that influence the issue in question.

• In the case study mentioned previously, all systems and subsystems that might affect soldier fitness

and musculoskeletal injury status were examined.

• This included EXTERNAL FACTORS such as level of fitness before enlisting on active duty, previous

dietary habits, history of exercise and injury during and before basic training, and

recommendations by various organizations such as the Centers for Disease Control and Prevention

(CDC) and the American College of Sports Medicine.

• INTERNAL FACTORS included the military structure and schedule, the physical training regimen,

current marching requirements, dietary habits, methods of seeking medical care, attitudes of the

trainers, intramural sports and accessible exercise facilities, doctrine and standard operating

procedures, and so on.

• In this way, what existed before the assessment was annotated and what existed at the time of the

assessment was plainly delineated.

THE MACROERGONOMIC PROCESS

Initial Evaluation:

• In addition, each system and each level within a system,

including the organizational structure, resources, agencies,

personnel, policies, surveillance systems, and communication

systems, were examined using a broad-to-focused approach.

• Meetings, interviews, and focus groups were conducted with

local supervisors and managers to ascertain attitudes, as well as

noting who would assist with change and who would resist

change.

Participatory Ergonomics

• Orchestrating organizational change takes time.

• Introducing changes systematically and gradually using a

participatory process throughout each level of the

organization will vastly improve the probability of success.

• The participatory process is one of the primary methods

used during a macroergonomic project.

• During this process, workers and managers participate in

identifying problems, methods to investigate those

problems, and the development of solutions.


• They are actively engaged in the decision-making process concerning the work

practices and activities that directly affect their work lives.

• Because of this, knowledge and power spread to each organizational level.

• Although some individuals refer to this as “buy-in,” there is more to it. It is a

means and process to steadily introduce change into the everyday business

practices of an organization.

• During this progression, workers at all levels discover how to investigate and

understand their own organization, as well as how to introduce lasting change.

• In fact, at the end of a successful macroergonomic program, workers and

managers may wonder what the researchers did, because they “did all the

work themselves.”

Participatory Ergonomics• It is important to understand the perspectives of the workers and supervisors

at the start, as they may have preconceived ideas that conflict with either the

process or the research results.

• For example, in this case, not all of the supervisors believed that

musculoskeletal injuries were a problem during AIT (Advanced Individual

Training) or later at a soldier’s permanent duty station or in a deployed

war-time situation.

• Yet, there were sufficient data to show that all three are true. In fact,

supervisors were not at all sure they could effect changes by the way they

trained (and worked with) their soldiers, which was the basis for the

intervention.


• In investigating and reducing musculoskeletal injuries during the case

study, careful attention was paid to building communication systems

between researchers, workers, and supervisors on a regular basis.

• In fact, weekly meetings were held between ergonomists and

stakeholders

• The best team member was identified for each interaction.

• For example, commanders reacted more positively when dealing

directly with the research team leader, whereas our civilian

researchers or our physical therapy assistant, who was an active duty

sergeant, achieved better results with drill sergeants and instructors.

Participatory Ergonomics• When initially developing unit-led injury prevention teams, the research team

leader, who was also an occupational therapist with considerable experience

running groups (as well as being a human factors engineer), worked with the team

leaders to help them understand the important role of facilitating interaction

among group members.

• This was particularly important, as many soldiers do not learn how to facilitate

open communication among soldiers, but merely expect that it will happen.

• They are trained in leadership but not in group process, group dynamics,

motivation, and methods of recognizing and recording issues for later resolution.

• The soldiers often know many of the involved issues, but they must feel free to

disclose them and often need subtle, yet pointed questions or suggestions to help

them recall and share pertinent information.

A, Supervisors’ responses to the question, “Are there too many overuse injuries occurring in your unit?” B, Supervisors’ responses to the question, “Can injuries be decreased by changing the way you train your soldiers?”

Participatory ergonomics: determining injury control “buy-in” of U.S. Army cadre, Work.

Note: Numerous participatory meetings are required to involve all levels of workers in the process. These are the average number of meetings per week during the

macroergonomic injury prevention program at FortSam Houston, Texas.

Using a Team Approach to Identify and Fill the Gaps

• The immediate team included personnel with backgrounds in research, ergonomics,

physical and occupational therapy, and athletic training.

• In addition, a team of consultants was developed from the initiation of the project.

• These individuals received updates and could voice their opinions and provide feedback

throughout the process.

• The consultants included personnel with backgrounds in preventive medicine,

kinesiology, exercise physiology, epidemiology, physical and occupational therapy, and

ergonomics.

• They worked all over the country and were from organizations that included the CDC,

the Department of Defense Injury Prevention Integrated Processing Team, the U.S.

Army Physical Fitness School, the U.S. Army Center for Health Promotion and Physical

Fitness, and the U.S. Army Research Institute for Environmental Medicine.


• The existing structure, procedures, and processes were evaluated by trainee

supervisors and subject matter experts (SMEs) from the immediate ergonomic team.

• This information was compared with research findings and recommendations for

preventing musculoskeletal injuries, as well as being used to examine alternate

methods of injury identification and early treatment.

• Consequently the gaps between what existed and what should exist (according to the

literature, supervisors, and SMEs) were used to develop best practice scenarios for

physical training of the soldiers.

• This included educational programs as well as changes in standard operating

procedures and exercise regimens.

• These solutions were broad-based, as opposed to being targeted toward a specific

causality or type of injury.


• However, by carefully documenting the number and

types of injuries throughout the investigation process,

they could track how their implemented solutions

influenced injury rates.

• In this case, musculoskeletal injury rates were measured

in terms of medical clinic visits.

• This overarching set of changes resulted in a decrease in

medical clinic visits of approximately 11% for

musculoskeletal injuries.

A Research-Based and Community Process• By tracking clinic visits as well as the reasons for the visits, they were able to

identify the type and severity of each injury (as measured by time of limited duty

per injury).

• They also gathered information from a soldier with an injury and the health care

practitioner who treated the soldier.

• With this information, they could begin to identify potential contributing factors

in order to target interventions.

• Clear outcome data should drive decision making and intervention strategies.

• Macroergonomic evaluations and interventions can be costly.

• It is up to the ergonomic team to assure the funding is well spent by

demonstrating results through evidence-based outcomes.

A Research-Based and Community Process• Simultaneously with the above system, process, and

procedural evaluations, as well as clinical tracking, they administered surveys.

• Surveys were gathered from all new health care specialist trainees and all graduating health care trainees, including those experiencing a musculoskeletal injury and the health care practitioners who treated their injuries.

• This information allowed them to identify soldiers at greatest risk of injury, as well as the primary contributing factors.

• Based on this information, a targeted program of intervention was put into place.

• The primary contributor to injuries during AIT was the running portion of the Army physical fitness program.

A Research-Based and Community Process• Significant organizational changes were required to put such a targeted intervention program

into place.

• Enacting these changes was possible only because of the rapport, processes, regular injury

prevention and fitness council meetings, and cultural changes that had begun to take place over

the previous 18 months.

• Although the previous changes had resulted in decreased injuries after initial interventions such

as increasing awareness, changing policies, and changing procedures, the targeted interventions

achieved even greater results.

• The targeted interventions resulted in a 36.5% reduction in medical clinic visit rates for

musculoskeletal injuries and a 48.6% reduction in limited duty assignments for musculoskeletal

injuries.

• All findings were also described in terms of dollars expended and troops readily deployable, both

of which are important in a military environment.

Number of clinic visits for musculoskeletalinjuries per 100 soldiers in training.

THE ROLE OF OCCUPATIONAL AND PHYSICAL THERAPISTS

• Most occupational or physical therapists will not take an assignment or consultation job that

requires true macroergonomics.

• Therapists are not trained to evaluate and design organizations or the interactions between

humans and technologies from a systems perspective.

• Therapists spend years studying and understanding normal and abnormal human development,

interruptions to normal functioning, and therapeutic interventions to help their clients return to

their roles as spouses, parents, workers, students, and children.

• Well-trained therapists should understand the individual.

• They should recognize how that individual can potentially fit into various environments during

and after treatment, and they provide the guidance to help the individual get back to the “job”

of life.

• Most therapists have been involved in task analysis, especially on a physical and biomechanical

level.

THE ROLE OF OCCUPATIONAL AND PHYSICAL THERAPISTS

• Yet few therapists have studied organizational effectiveness,

work behavior, criterion characteristics of performance,

judgmental measures of performance, or the psychosocial

context of work performance from a systems perspective.

• Most know little about human systems integration, just as few

ergonomists know when and how to construct an ulnar splint or

what type of movement patterns might be most efficient for a

person with cerebral palsy; each profession has its own unique

set of knowledge and skills.

THE ROLE OF OCCUPATIONAL AND PHYSICAL THERAPISTS• However, therapists can apply a macroergonomic approach to a specific

problem or participate on an ergonomic team.• For example, individuals in a work setting might be experiencing a large

number of work-related musculoskeletal disorders (WRMD).• A typical microergonomic approach would be to examine and redesign the

workstations of all individuals who have sought health care for a WRMD.• A more comprehensive approach might be to examine all workstations and

have employees complete a survey on their symptoms or identify the tasks associated with their job, in order to help determine physical risk factors.

• An even larger perspective might involve addressing other contributing factors, such as the physical and psychosocial considerations associated with an impending plant closing, the aging workforce, a predominance of workers who no longer fit the physical profile to easily use the equipment (being overweight or underweight, too short or too tall, or under strength), or an influx of workers from a different culture with differing values associated with work.

• Without a broader approach, a simple a workstation change may influence very little.

A FEW PRINCIPLES• Ergonomics involves the applied study of humans and their capabilities

and limitations across a broad spectrum of performance in order to design

products, places, and procedures to match those capabilities and

limitations.

• Thus all ergonomic design is human-centered, including designs as diverse

as a particular medical tool and a road system to produce a more fluid

traffic flow.

• This does not mean that all design is individual centered, as organizational

design must also account for collective groups of individuals who can work

and behave quite differently under diverse conditions and situations.

• Some basic principles of macroergonomics follow.

Principle 1

• All relationships within an organization are reflected throughout the

organization.

• In using a macroergonomic perspective, ergonomists recognize the

impact of all relationships within an organization.

• For example, a hierarchic structure will work well for certain types

of organizations and people, whereas a flat system will work better

for others.

• The balanced scorecard approach, which helps each person and

each section know their role and how they contribute to the good

of the whole, is based on this principle.

Principle 2

• Each potential solution, and each decision about design,

depends on the results of assessments of the organization.

• Assessment results drive the design. These assessments

can be formal or informal and can consist of observations,

interviews, focus groups, surveys, or record reviews.

• If the goal is to conduct an analysis and redesign of an

organization, then a 10-step process described as

macroergonomic analysis and design (MEAD) might be

used.

LARGE-SCALE AND LASTING CHANGE

• Ergonomists often choose a macroergonomic approach to achieve large-scale

and lasting change (LSLC).

• The following additional principles apply:

1. Any change must clearly support the mission and goals of the

organization.

2. Any change must clearly reflect the culture and values of the organization.

3. LSLC is unlikely to occur unless all relevant aspects of a system are

involved.

4. LSLC is unlikely unless workers of all levels understand and agree with the

need for change.

5. Dictated changes do not last; attitude and belief changes do last.

LARGE-SCALE AND LASTING CHANGE6. LSLC is more likely when workers of all levels help identify the problems and

solutions (participatory ergonomics).

7. LSLC occurs when each individual recognizes his or her role.

8. LSLC occurs more readily when participatory ergonomic methods are conducted from

the top down, bottom up, and sideways in.

9. LSLC tends to occur when carefully and methodically introduced, not when

introduced quickly and dictatorially.

10. Although evidence-based design can persuade others that change is necessary, both

the evidence and the display of the evidence must be relevant to the viewer.

11. Overall system change sets the stage, so that targeted change can occur in a climate

of acceptance, yielding the greatest results.

12. Top-level support is essential.

LARGE-SCALE AND LASTING CHANGE• When the macroergonomic effort involves injury prevention, it must also be recognized that health care

practitioners are consultants only.

• The workers and supervisors bear the primary responsibility for maintaining their fitness and health.

• Although it is not always possible to examine the same facility years later, in this case study a follow-up

evaluation occurred 2 years later.

• Data revealed that injuries and limited duty assignments had been reduced even further, with no additional

assistance from researchers or health care providers.

• In the opinion of the researchers, this was because the knowledge and the tools were given to the soldiers and

supervisors during the macroergonomic intervention.

• They had numerous classes on the most recent literature on injury prevention, given on arrival at their

assignment, annually during recertification as drill sergeants, and during other regularly scheduled training

times.

• They were taught how to track injuries and look for variations and possible causes of those variations.

• Most importantly, this information was permanently included in their standard operating procedures.

• They owned it. It became part of their normal, everyday job.

WHEN SHOULD A PRACTITIONER USE A MICROERGONOMIC APPROACH?

• A microergonomic approach is appropriate when the identified problem

is limited in scope.

• An example would be conducting an evaluation and finding a solution for

a single individual with a history of back pain and/or back surgery who

could benefit from a supportive chair and a better workstation design.

• Another example would be if a rash of injuries occurred after the

introduction of a new process or tool.

• If that tool or process is undoubtedly the culprit, then large-scale

evaluations and interventions are unwarranted.

• Basically, a microergonomic approach is best when there is no indication

that a larger scale approach will yield greater results.


• Limitations in resources can also dictate a microergonomic approach.

• A macroergonomic approach is impossible without sufficient funds,

personnel, time, or interest on the part of the client.

• Sometimes, when resources are limited, a linear, stepwise approach can

be used for problem solving, prioritizing those issues that are most

important and implementing solutions as resources become available.

• An alternative would be to investigate with a macro approach but to

implement changes or interventions in a linear, one-ata-time fashion.

• A third option with low-level funding is to make changes but incur the

charges over time.


• Many ergonomists move from micro to macro approaches,

using the “low-hanging fruit”—that is, quick achievement of

lesser goals—to fuel their future work to make bigger, lasting

changes.

• This technique works well in situations where costs and benefits

of ergonomics are relatively unknown, or held suspect, by

managers.

• As managers see improvements and cost savings, they are more

willing to invest in additional ventures to improve conditions.

CONCLUSION

• Therapists are unlikely to perform MEAD unless they obtain substantial additional

training, such as attending a degree program or a series of college courses.

• These are not skills that can be gained in a short course.

• However, therapists can play a significant role in helping individuals and managers

see the value of ergonomics through microergonomic applications.

• Subsequently they can suggest a supplementation of their efforts, and a team

approach, in order to attain large-scale, long-lasting organizational changes

through macroergonomics.

• Having an understanding of the power of system-wide evaluations and

interventions can help therapists explain why certain levels of achievement may,

or may not, be met using a specific technique or technology.

CONCLUSION

• Based on the case study provided in this chapter, what actions might an

ergonomic team take during the initial evaluation phase of a macroergonomic

project?

• What actions did the ergonomic team evaluating musculoskeletal injuries

take?

• Which principles of macroergonomics did the ergonomic team evaluating

musculoskeletal injuries seem to consider?

• How would you have done things differently?

• What evidence-based outcome measures did the ergonomics team use?

• What other measures do you assume they used (but that may not be

mentioned in this chapter)?

Documents

Chapter 3 Macro-Ergonomics