Nurse Shift Scheduling Design Using Cyclic Nurse Algorithm and Pittsburgh Sleeps Quality Index (Case Study

at Haji General Hospital Emergency Installation Unit Surabaya)

Rachmad C. Permana, Sritomo Wignjosoebroto, Ratna Sari Dewi Ergonomics & Work Design System Laboratory Industrial Engineering Department Institut Teknologi Sepuluh Nopember Surabaya, Indonesia Ph : +6231-5939361, Fax : +62315939362, email: m_sritomo@ie.its.ac.id Shift schedule is a common working system nowadays to meet the high demands of service availability from the society. Shift system is more common to apply in a company or facility that needs to operate for 24-hours in consecutive seven days a week. Implementation the shift system schedule naturally will requires the company or facility to employ more workers to work in different shift, and it is not a secret anymore that the application of shift system schedule in any field of practice is more likely to cost a lot of funding. Generally the shift schedule is split into 2-3 shift time based on the various reasons. It means there will be a work time that will operate outside the normal time. It assumed that working from 7/8 am -15/16 pm is a normal time based on human circadian rhythm. Working outside the normal work time demands the workers to change their body circadian rhythm especially at the night shift since this particular shift time have a potent risk for the workers to get health disturbances, sleep disturbances, and many more if not dealt wisely. And thus the schedule pattern must be designed properly to cope with problems from both management and the workers point of view. This research will be conducted at Haji General Hospital Emergency Installation Unit Surabaya, the research subject will be consists of 30 nurses within the installation. In this research, the qualitative approach will be measured by collecting and analyzing data regarding the characteristics, perceptions, and subjective preferences from the nurses towards the existing shift schedule system and towards the design concept of the new improved shift schedule, and by measuring their sleep quality by using Pittsburgh Sleeps Quality Index (PSQI). The quantitative approach is using the cyclic nurse algorithm and the work measurement of the nurses. This algorithm is aimed to find the optimal solution of the nurses schedule pattern distribution in mathematical solution where the work measurement aimed to find the utilization rate of the nurses in each shift. The aim of this research is to find a way to combine both senses into the process of shift scheduling with the cyclic nurse algorithm as a basis in order to provide more comprehensive way and hopefully will generate more ergonomics schedule. And this research also serves as a encouragement for future researcher and or schedulers in every field of practice to never denying the importance of a combination from both qualitative and quantitative senses in the process of the shift scheduling. Key Words : Applied Ergonomics, Shift Scheduling, Pittsburgh Sleep Quality Index, Cyclic Nurse Algorithm.

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Ergonomically Management and Strategies to Anticipate Negative Impacts of Nursing Night Shifts in Indonesia in the Age of Twenty Four Hours Society
Ida Bagus Gde DHISNU and Ida Ayu SANTHI SUPRIHATIN* Department of Mechanical Engineering, State Polytechnic of Bali, Badung, Bali *Student of Nursing Undergraduate Programme, University of Udayana, Bali As a consequence of the twenty four hours society phenomenon, public health service centres must be ready with a 24 hours service per day in 7 days a week; to maintain the continuity of service, nurses as the health care servers whose services must be ready any time the patients need it are commonly working in shifts: morning shift, evening shift, and night shift. The impairing characteristics associated with night shifts such as disrupting the Circadian Rhtyhms, extended duration, consecutively in execution, and short time for adaptation make its existance as a dilemma whereas on the contrary the current status of a night shift is a need indeed and unavoidable, without exception in Indonesia. Recently researches indicate that night-shifts give adverse impacts not only on patients safety but also on nurses themselves physically, physiologically, psycho-socially, and by health. Based on research evidences, the suggested ways-out to anticipate the impacts are as follows: (a) from staffing managements stand point: how to make nursing night-shifts more humane, competitive, and sustainable by minimizing its impairing impacts, and (b) from nurses stand point: night working strategies based on practice implications of research evidences related to. Keywords: twenty four hours society, night shifts, nurses, ergonomics. Introduction There are several causing factors which play a role in the birth of an ever-growing social phenomenon which is called the 24 hours society; the phenomenon was born to address the following factors : Poverty, which is often suffered by the everage people in underdeveloping countries with Indonesia as an example, which insists them to work over time lately at night or to be permanent night workers. Industrial demands, in which many manufacturing processes are said to be economic only with continuous form of working and in other cases expensive machinery needs to be used 24 hours a day to be profitable; these conditions are commonly occured in industrial countries (Grandjean, 1993). Tightly competitions in byday working vacancies, and the similar condition is also very familiar in Indonesia, so that the eliminated applicants will have no choice excepted they accept the only opportunity for night working. The 24 hours society is characterized by the changes of people customized daily life, time for sleep very often has to be replaced by working, and social communication in life frequently has to be left in order to do job to survive (Manuaba, 2009). Shift work and its night shift become more familiar and carried out intensively, and in North America shift work has been a reality for about 25% of working population (Abdalkader, 2008). Receiving the health service properly has become an integral part of human rights, so that in anticipating the 24 hours society phenomenon, the system of public health service consequently must be ready with a 24 hours service per day in 7 days a week; to maintain the continuity of public

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health service, nurses as the health care servers whose services must be ready any time the patients need it are commonly working in shifts : morning shift, evening shift, and night shift. The problem is the dilemmatic existance of night shifts because in fact (das sein) the current status of a night shift is a need indeed and unavoidable whereas what should be (das sollen) is reducing night shifts as much as possible due to the impairing impacts associated with. Nursing Tasks from Ergonomics Point of View A primary challenge of the future interhospitals competition is the quality of health providing service, in which nurses have an important role because they act as collaborating partners to the management in facing the so tight competition. The quality of health service depends so much on nurses performances in caring patients and the continuity of health care service is a must because anytime the patients need care, nurses must be ready. It is improper if the management treats nurses merely as a production factor because they are really human resources, the collaborating partners, so everythings that associated with nursing tasks - included night shifts should be nurses centered. The quality of service is one of performance indicators, and nurses could perform optimally if there is a balance between nursing-task demands (both physical workloads and mental workloads) and nurses capacities or in another word the ergonomic basic concept in fitting the tasks to nurses is fulfilled (Manuaba, 2000). Nurses capacities consist of: (1) personal capacity (which depends on age, sex, anthropometry, educational status, social status, health status, bodily fitness, and so on), (2) physiological capacity (the ability and endurance of cardiovascular, motoric and sensoric system of muscular nervous, the ability of five senses, and so on), (3) psychological capacity (mental ability and endurance, reaction times, adaptability, emotion stability, and so on), and (4) biomechanical capacity (the ability and endurance of musculoskeletal system, connective tissues (ligament, tendon, and fasciae), joint stability, and so on). Elements of physical workloads are: (1) Nursing Task Characteristics (by standard of National Nurses Association of Indonesia PPNI/Persatuan Perawat Nasional Indonesia consist of: identifying and analyzing the initial status of patients health, diagnosing, health care planning, the implementation of health care planning, and evaluating the progress of patients health status) and Nursing Material Characteristics (depend on the characteristics of health care equipments, for example in an Intensive Care Unit/ICU due to the complex nature of patients health problems the equipment required often using very sophisticated technology extensively), (2) Work Organization Characteristics (associated with work duration, rest pauses duration, shift work and its night shift, leave and days-off, management, and so on), and (3) Work Environment Characteristics (associated with interrelation among nurses, interrelation between nurses/paramedics and medics, temperature and humidity, noise and vibration, lighting, sosio-cultural, taboo, customs, etcetera). Mental workloads are associated with: (1) the obligation to maintain a high level of alertness (vigilance) over long periods, (2) the need of decisions making which involve heavy responsibility for health care service quality and patients safety, (3) occasional lowering of concentration by monotony (experienced more by nurses on night shift working), and (4) lack of human contacts, which is also often perceptible by nurses on night shift working (Grandjean, 1993). The Performance is determined by the ratio of nursing-task demands to nurses capacities, and furthermore if: 1. Nursing Tasks Demand is greater than nurses capacities, overstress/overloaded will be happened, which is characterized by: (a) by-performance: low quality of health care service, injuries increased, and low in productivity, (b) physio-physically: muscular tension increased, blood pressure increased, heart rate increased, and the activity of nervous system increased, (c) mentally: discomfort, fatigue, anxiety, and depression. 2. Nursing Tasks Demand is lower than nurses capacities, understress/underloaded will be occured, which is characterized by: boredom, lowering of concentration, lack of alertness (vigilance), and others which are mentally associated with. 3. Nursing Tasks Demand is equal to Nurses Capacities (the ratio is one), it means the balance is obtained which is characterized by: (a) optimal by-performance: high quality of health

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care service, nearly zero in work accidents, and high in productivity, (b) healthy physiophysically and mentally: safe, comfortable, and convenient. Negative Impacts of Night Shifts should be aware of Based on various research evidences, the negative impacts of night shifts can be classified into 4 categories, such as: 1. Negative Impacts of Nursing Night Shifts due to the Circadian Rhythm Disruption Many experts have blamed the night shift for human error made by nurses during their night works which will result in increasing risk of accidents and injuries, due to the Circadian Rhythm disruption it has done (Coffey, Skipper, & Jung, 1998 in Abdalkader, 2008). The Circadian Rhythm (CR) is a daily cycle of bodily functions (body temperature, heart rate, blood pressure, respiratory volume, adrenalin production, excretion of 17-keto-steroids, mental abilities, flickerfusion frequency of eyes, and physical capacity) that increase by day and decrease by night; during daytime when all organs and functions are ready for action is called by ergotropic phase, on the contrary at night when most of these are damped down and the organism is occupied with recuperation and renewal of its energy reserves is called by trophotropic phase (Grandjean, 1993). Daytime (ergotropic phase) is associated with the readiness to work and night (trophotropic phase) is associated with the sleep function, and that is the reason why human being is grouped into diurnal creatures. The night shift, as a task demand, disturbs/disrupts the CR by forced reversing the two phases which results in an exchanged state of both phases that is ergotropic and trophotropic are out of phase each other; a disrupted CR is usually followed by a sleep deprivation (which as if done by the ergotropic phase) so that the night shift can be assumed as a forced ergotropic phase. The problem related to the sleep deprivation/restriction consists of insufficient sleep, sleep loss/debt, shift-work sleep disorder, and bad sleep quality. Once the CR is disrupted, it needs several weeks to recover after several nights of consecutive night shifts (Grandjean, 1993). Insufficient Sleep is a condition that results from sleep duration less than daily normal needed (about 8 hours per day). Although some people are less impaired by insufficient sleep than others, several studies have shown that failure to obtain adequate sleep is an important contributor to medical error, and there is also a strong body of evidence that insufficient sleep has adverse effects on cognition, performance, and mood (Baldwin, 2004, and Dongen, 2005, in Rogers, 2008). Insufficient sleep decreases nurse performances, and those are at the lowest levels between 3:30 5:30 am (Coffey, Skipper, & Jung, 1998, in Abdalkader, 2008). A study evidence of Staff Nurse Fatigue and Patient Safety determined that there was a 3,4% chance of an error when nurses obtained 6 or fewer hours of sleep in the prior 24 hours and 12 or fewer hours of sleep in the prior 48 hours (Dawson, 2005, in Rogers, 2008). Although a 3,4% risk of an error or near miss sounds insignificant, it would translate to a probability of 34 events per day in an average teaching hospital with 1,000 nursing shifts per day. The quality of ones sleep is determined by the stages of sleep he/she obtained, and the sleep is said to be qualitifull if recuperative stages of sleep are obtained that consist of deeper sleep, deepest sleep, and dream sleep or sleep in REM (Rapid Eye Movements). Being not in harmonic with the CR, the daytime sleep of night workers is not as qualitifull as theirs at night, even many night workers say that they feel a certain restlessness during the day, and their daytime sleep is not refreshing enough (Grandjean, 1993). 2. Negative Impacts of Nursing Night Shifts due to the Extended Duration In Indonesia, night shifts in nursing usually have the longest working duration (about 12 hours) compared to both morning and evening shifts. Work hour limits for physicians have affected nurse schedules, so that nurses are often required to work increased over time to compensate for reduced physician hours (Lundstom et al., 2002, in Carayon, 2008). According to a recent report of National Institute of Occupational Safety and Health (NIOSH), working more than 40 hours per week (overtime), working extended shifts (more than 8 hours), and working both extended shifts

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and over time can have adverse effects on nurse health. Extended shifts have been associated with increased musculoskeletal injuries, increased neck and musculoskeletal discomfort, more cardiovascular symptoms, the development of hypertension, diabetes, poorer perceived health, and higher rates of job accidents. Studies have shown that in-job accident rates increase during extended periods of work, start rising after 9 hours and doubling after 12 consecutive hours (Rogers, 2008). Furthermore, a retrospective study - on error rates under three continuous shift schedules documented error from the recording between 1921 1931, revealed that the number of error over than 175.000 was against the time of the day; the highest number of errors occured around 3 am (Moser R, Dubravec M, 2001, Scott A, Kittaning, 2001, in Abdalkader, 2008). Beside significantly higher risk of errors, recent studies of the American Association of Critical Care Nurses (AACN) and American Nurses Association (ANA) in association with National Highway Traffic Safety Administration (NHTSA) have shown that extended night shifts worked by hospital staff nurses are also associated with high rates of drowsy driving and motor vehicle accidents or near misses when nurses were on their way home after work (Linda, 2007, and Rogers, 2008). 3. Negative Impacts of Nursing Night Shifts due to the Consecutively in Execution In Indonesia, nursing night shifts are usually executed in 2 or 3 consecutive shifts (depends on the number of staff nurses a hospital has). A daytime rest between 2 succesive night shifts is usually ineffective for recovery/recuperation, because the daytime sleep of night shift workers is not as qualitifull as theirs at night as explained before, so that the accumulation of fatigue and sleep debts (the accumulation of insufficient sleep) experienced by nurses over succesive night shifts might explain the rise in occupational accident rates as follows: average risk was 6% higher on the second night shift, 17% higher on the third night shift, and 36% higher on the fourth night shift (Folkard, et al., 2003, in Rogers, 2008). Logically, the rates of drowsy driving and motor vehicle accidents, compared to those on the first night shift, would be getting worse (higher) on the second night shift and the next on. 4. Negative Impacts of Nursing Night Shifts as the part of Nursing Shift Works As the part of nursing shift works,all negatif impacts of nursing night shifts have been mentioned above exposure the nurses repetitively, which initially the effects are often unnoticed and not aware of. The effect of cumulative impairments will just be experienced by nurses in their elderlihoods when they have been fully retired and have not been completely covered anymore by all risk insurances. From adaptation point of view, a permanent night-work is better than a nightshift-work (Fujino, 2001) because shift works just enable nurses to make a short adaptation at the beginning of every night shift, that is why many nurses suffer from shift work sleep disorder: the difficulty of remaining awake during their work shift and have trouble sleeping after working at night, yet have no trouble sleeping at night or staying awake during the day on their days off. Adverse effects of restricted sleep on patient safety and its cumulative by- health effects on nurses have been compiled and summarized by Ann E. Rogers from various sources (Rogers, 2008). Nursing Night Shifts in Indonesia Research findings indicated that, in foreign countries outside Indonesia, the night shift is a primary factor influencing nurses turn over; a study on 30 nurses working in an Intensive Care Unit (ICU) who choose to leave the ICU within last eight months results in 50% of them left the ICU due to the general dissatisfaction with various aspects of their job, specifically night duties (Mathew and Campbell, 1990 in Abdalkader, 2008). This evidence shows us how a night shift, an element of work organizations, acts as the potential stressor on nurses compared to the nursing task itself. Due to the local conditions (such as values, norms, socio-cultural, tight work vacancies, etcetera), in Indonesia the situation is a little bit different, nurses turn over is rarely happened and they must think twice to do that because if it is really done the nurses involved with will sure be idle in a quite long period and many candidates/applicants have been ready to replace them. The existing impacts of nursing night shifts in Indonesia (compared to those of morning shifts and evening shifts)

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can be illustrated by using results of the occupational-stress research carried out on 15 nurses working at Flamboyan Intermediate Surgery Room of Dr. Soetomo Public Hospital in Surabaya (Nursalam, et al., 2008); the conclusions of the research are: (a) occupational-stress experienced by night-shift working nurses is categorized into light to medium, and not significantly differs with that on morning shift and evening shift, and (b) shift work does not act as a dominant factor in nursing occupational-stress. Methods Anticipation refers to the application of a mastery knowledge (research-evidences based) that permits the management and nurses to foresee the potential for disease and injury, therefore it should be involved at an early stage (since the planning phase) of a process development. Results and Discussion Even though, in some countries outside Indonesia, the night shift acts as the potential stressor in nursing however research evidences related to the occupational-stress in nursing indicate that most of nightshift working nurses in Indonesia have been well adapted both internally (to internal environment) and externally (to external environment). Stress is an adaptability of the body to environment changes,and generally speaking, stress is a psychological pressure which can cause diseases physically and/or psychologically if it is not managed properly (Levi, 1991). In more detail Manuaba (1998) defined stress as the kind of load to human body shaped in various stimulant coming from external and/or internal environment, and if not appropriately controlled it can give human all sorts of negative impacts from health impairment until several diseases; occupationally speaking, stress is often associated with underloaded and/or overloaded conditions and its negative impacts are so potential in lowering nurses performances such as productivity and the quality of health care service. Conceptually, based on the stress definition, night shift acts as a stressor (independent variable) to nurses and its negative impact stresses/loads them by stimulating their bodies and then the nurses bodies respond the stimulant in the form of strain (dependent variable); strain behaves individually because every one has respectively distinct response to the same stress, and strain is commonly in the shape of physiological responses (increasing heart rate, stomach gripes/colic, sweating, etcetera) and psychological responses (arousal, mind set, emotion, and so on). In practice, the two terms (stress and strain) are interchangeable because both of them are used as the measure of workloads. Internally adaptation to nightshift depends on ones age, sex, health status, nutrition status, emotional status, motivation, expectation, sleep quality and quantity before nightshift working, experiences in previous nightshifts, etcetera and externally adaptation depends on the following factors: socio-cultural, political, economical, cycle of the day (light) and night (dark), work rotation and scheduling, interrelation among nurses, interrelation between nurses/paramedics and medics, interrelation between nurses and management, and so on (Pati, 2001). Tight competition in life and limited work vacancies make most of Indonesian nurses have strong motivation and expectation to survive, that is why nurses turn over are rarely happened in Indonesia (they must think twice to do that) and night shift (as a part of shift work) does not act as a potential stressor in nursing tasks; however the negative impacts associated with night shifts should always be aware of and anticipated properly by hospital management and the nurses themselves. Ergonomically Anticipation from Staffing Management Stand Point Nurses are not merely as production factors, but they act as the collaborating partners to management in facing the so tight inter-hospitals competition, so that the management must be responsible how to make nursing night-shifts more humane, competitive, and sustainable. Based on research evidences, a few points that should be taken into consideration are: (a) optimizing the rotation of shift-works to reduce the impacts of Circadian Rhythm disturbance (rapid rotation is preferable), (b) equalizing the work duration of night-shift, evening-shift, and morning-shift to 8 hours (for night-shifts, must be added with the duration of short nap), (c) to permit by-turns short

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nap for night-shift working nurses, (d) to make a compensating mechanism for social and by-health losses as consequences of night-shifts in the shape of incentives/rewards, which are given to nurses for every single night-shift working, and (e) preparing the shuttle transportation (home hospital home) especially for nurses on night shift working to avoid them from drowsy in driving home. Ergonomically Anticipation from Nurses Stand Point There are several evidence-based practice recommendations for nurses to anticipate the impacts of night-shift works, which have been compiled and summarized by Rogers (2008), such as: (a) get 7 to 8 hours of sleep duration each day (in 24 hours period) before going to work, (b) caffeine should be used therapeutically, at the beginning of a shift or about an hour before an anticipated decrease in alertness (e.g., between 3 a.m. and 5 a.m.) and the consumption should stop at least 3 hours before a planned bedtime to reduce the possibility of insomnia, (c) take a by-turns short nap during the break and meal periods and its duration must be less than 45 minutes to reduce the likelihood of awakening from deep sleep and experiencing sleep inertia, (d) light-adapting area should be available between bright-lighting area (such as control rooms and laboratory) and dimlighting area (patient rooms) to avoid lowering in alertness due to intermittent exposure of lights, (e) short exercise (not more than 10 minutes) is effective to maintain subjective alertness and cognitive performance, and (f) use effectively the daytime rest between two successive night-shifts to enable the body maximally recovered. Conclusion The consequently status of a nursing night-shift in the age of twenty four hours society is a need indeed and unavoidable; although some negative impacts associated with night shifts are still remained, the proposals about compensating mechanisms are still becoming the object of antithesis. Considering that nurses are not merely production factors, but they act as collaborating partners to management in propelling the hospital activities, the management should be responsible how to make nursing night-shifts more humane, competitive, and sustainable. In line with healthy society paradigm programmed by the government of Indonesia, related to the anticipation of nursing nightshifts impacts, all stake holders should be involved/participated holistically and that is the reason why Ergonomically Anticipation is urgently required. References
Abdalkader, R.H. (2008) Effects of Night Shift on Nurses working in Intensive Care Units at Jordan University Hospital, available at http://www.eurojournals.com/ejsr_23_1_07.pdf., accessed: February 26th, 2010. Carayon, P. (2008) Nursing Workload and Patient Safety : A Human Factors Engineering Perspective, Chapter 30, available at http://www.ahrq.gov/qual/nurseshdbk/docs/CarayonP_ NWPS.pdf., accessed: March 5th, 2010. Fujino, Y. (2001) Job Stress and Mental Health among Permanent Shift Workers, in Journal of Occupational Health, 43: 301306. Grandjean, E. (1993) Fitting the Task to the Man: A textbook of Occupational Ergonomics, 4th Edition, Taylor & Francis, London New York, pp. 217-230. Levi, L. (1991) Stress, in Encyclopedia of Occupational Health and Safety, ed. by Parmeggiani, L., ILO, Geneva. Linda, D.S. (2007) The Relationship between Nurse Work Schedules, Sleep Duration, and Drowsy Driving, available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2276124/., accessed: February 5th, 2010. Manuaba, A. (1998) Stress and Strain, in Bunga Rampai Ergonomi, Kumpulan Artikel, University of Udayana, Denpasar, 1: 20-25. Manuaba, A. (2000) Ergonomi, Kesehatan dan Keselamatan Kerja, in Proceeding of Seminar Nasional Ergonomi 2000, ed. by Sritomo, W. and Stefanus, E.W., Guna Wijaya, Surabaya, pp. 1-4. Manuaba, A. (2009) Twenty Four Hours Society, Its Impacts and Appropriate Anticipation as Consequences, in Panel Papers of 9th National Seminar Ergonomics 2009, Perhimpunan Ergonomi Indonesia, Semarang. Nursalam, Arie S., and Rahmatul F. (2007) Hubungan Shift Kerja dengan Stres Kerja dan Circadian Rhythm Perawat, in Ners Journal No.2, 2: 112-118. Pati, A.K. (2001) Shift Work: Consequences and Management, in Journal of Occupational Health, 81: 32-52. Rogers, A.E. (2008) The Effects of Fatigue and Sleepiness on Nurse Performance and Patient Safety, Chapter 40, available at http://ftp.ahrq.gov/qual/nurseshdbk/docs/RogersA_EFSNPPS.pdf., accessed: February 5th, 2010.

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Effect Scheduling Breaks to Workload and Workmanship Time Part of Cutting Step Aside Tile at Super Utama Tile Factory
Heri Setiawan and Mery Wijaya Department of Industrial Engineering STT Musi Jl. Bangau 60 Palembang, Sumsel, INDONESIA 30113 Telp./Fax. (0711) 366326, E-mail: heri_angel2008@yahoo.com Work of cutting step aside tile such done operator Super Utama tile factory is inclusive repetitive work and risk the happening of fatigue. Level of fatigue that happened is visible from level of work load measured by through consumption energyi. Redesign station work and intervence ergonomi appliance not yet last for overcoming mentioned. That require to get attention is duration of working without existence scheduling breaks. Go together the problem, this research try to study effect of arrangement scheduling breaks to work load and workmanship time. Operator used as sampel runly schedule work rest 60/10, 30/5, and the schedule generally. Each scheduling run during three clock (not inclusive of rest time) and calculated time needed to do cuting step aside tile and measured operator heart rate. Result of the measurement analysed by analysis of variance. From result analysis known that scheduling breaks not have an effect to heart rate. Schedule 60/10 giving highest productivity. The scheduling obtained mean of workmanshiptime 0.2770 minute and can finish 1516 units of tile in spanning working 9 hours (inclusive of rest time) Keywords : ergonomi, scheduling breaks, productivity Introduction Activity work employees as cutting step aside Super Utama tile factory in Palembang inclusive repetitive work and have risk high enough to happening of fatigue. Work system and the rest time applied still be conventional, that is 9 hours (inclusive one hours to take a rest lunch). This research for know what scheduling breaks giving optimal effect to productivity of cutting step aside tile. Basis for Theory Ergonomi Ergonomi is knowledge that stressed of design system of place of people do his work. The definition give congeniality that besides aim work productivity attainment, design of ergonomi also aim eliminate elements and device a long term can result disability of worker physical. Work Time Some research have proved that arrangement of in working interspersed with several times the rest time beside also change duration of period working can give impact to operator productivity. For example, from result of research with cut shortly work time from 8.75 hours/day become 8 hours/day can improve productivity 3% until 10% ( Sritomo, 2000 : 285). Conclusion pulled in this case is cut shortly daily work time increase output. On the contrary, lengthenedly daily work time can slow down speed of job which finally cause productivity degradation. Rest Time Duration rest time and frequency take a rest differ to each, depend on nature work, length working daily, gender, and the environmental condition. Time depth take a rest vary from

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30 minute until 50 minute, and frequency rest time during one day vary from one until five times ( Cormick, 2000 : 458). Several times short rest will give better result evaluated from output yielded and effect to body physical than given one blow take a rest on a long term. Measurement Consumption Energy One of yardstick, besides time which the application to evaluate whether work system have been designed a goodness or not yet is use consumption energy. Level of use energy show light weight job which must be somebody (work load). Analysis Of Variance ( anova) Elementary anova is classification pickings statistically according used variation source. Anova used test whether mean from the classification variation source or significant differ. Test of Data Sufficiency General formula used determine number of the following perception that is needed :
K N ( Xi 2 ) ( Xi ) 2 N = S Xi If N < N, hence the perception enough If N > N, hence need data addition
2

Methodologies This Research entangle two people cutting step aside tile. The operator asked do cutting step aside tile in three condition of schedule breaks different each other. First schedule is 1 hours work 10 minute take a rest (hereinafter shortened 60/10), secondly 30/5, and last is schedule in this time. Each scheduling breaks run during three clock (not the inclusive of rest time). The time execution of scheduling breaks, measurement of heart rate and workmanship time cutting step aside tile. Heart rate data used calculate consumption energy. Pursuant consumption energy knowable work load. Workmanship time data used to measure productivity. Data processed by anova to know whether there are difference effect of scheduling breaks to heart rate and workmanship time. Discussion

Figure 1. Workload and WorkManship Time Part of Cutting Step Aside Tile at Super Utama Tile Factory

Data Processing and Gathering Result of data processing and gathering presented Tables 1,2,3, and 4.

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Table 1. Operator Heart Rate

Jadwal istirahat
Awal 60/10 30/5 1 98 100 100 2 98 107 102 3 102 105 104

Heart rate (pulse/minute) 4 116 120 109 5 125 113 116 6 125 129 120 7 132 126 128 8 127 131 128 9 134 129 131 10 132 130 129

Total
1189 1190 1167

Mean 118.9 119.0 116.7

Table 2. Workmanship Time Jadwal istirahat 1 Awal 60/10 30/5 19.7 4 19.2 3 18.0 0 2 20.2 0 16.0 7 15.2 8 3 19.3 2 17.8 2 16.7 0 Waktu pengerjaan (detik/keping) 4 20.4 3 16.6 1 19.3 6 5 19.5 8 16.2 1 19.2 0 6 18.6 9 16.0 1 16.4 5 7 20.5 0 16.5 4 16.0 3 8 19.7 2 16.1 0 17.0 0 9 19.7 3 16.5 9 17.0 0 10 19.9 2 15.0 0 19.1 6 197.83 166.18 174.18 19.783 16.618 17.418 Jumlah (detik) Rata-rata

The cutting step aside process operator, heart rate 118.2 pulse/minute and oxygen consumption 1.364 liter/minute. Thereby consumption energy 6.5472 kcal/minute. Consideredly mean workmanship time each scheduling breaks, countable harsh productivity.
Table 3. Anova Denyut Jantung Sumber variasi Derajat Kebebasan ( dk) 2 27 29

Sum of squares (SS)

33.8 4469.0 4502.8

Mean square (MS)

16.9000 165.5185

Treatment Error
Total

Table 4. Anova Waktu Pengerjaan Sumber variasi Derajat Kebebasan ( dk) 2 27 29

Sum of squares (SS)

54.1682 33.2009 87.3691

Mean square (MS)

27.0481 1.2297

Treatment Error
Total

Table 5. Comparison Productivity Each Scheduling Breaks Jadwal Rata-rata total istirahat lama pengerjaan lama kerja (menit/keping) (menit) Awal 60/10 30/5 0.3297 0.2770 0.2903 480 60 x 7 30 x 14

waktu istirahat (menit) 60 10 x 6 5 x 12

Total waktu istirahat (menit) 60 60 + 60 60 + 60

Jumlah genteng yang selesai dikerjakan (keping) 1455.8690 1516.2455 1446.7792

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Analysis By anova known that scheduling breaks not effect to heart rate but having an effect on to workmanship time. This meaning any rest schedule type, consumption energy operator 6.5472 kcal/minute. While for the workmanship time known that with schedule 60/10 operator can give highest result output compared other schedule, that is equal to 1516 units. Conclusion Pursuant to data processing and analysis have been inferential that operator reach time workmanship of quickest cutting at schedule 60/10. Workload included level moderate. Schedule 60/10 giving highest productivity among schedule of other rest. References
Bridger, R.S.. (1995). Introduction To Ergonomics. McGraw-Hill, New York. Cormick, Ernest Mc., dan J Tiffin. (1974). Industrial Psychology. Prentice Hall Inc, New Jersey. Eddy. (2001). Analisis Faktor Shift dan Mesin Produksi Wafer Terhadap Cacat Produk Dengan Menggunakan Metode Perencanaan Eksperimen Faktorial Dwifaktor di PT Interbis Sejahtera. Skripsi Jurusan Teknik Industri, STT Musi, Palembang. Montgomery, Douglas C.. (1996). Design and Analysis of Experiments. Fourth Edition. John Wiley & Sons, USA. Nurmianto, Eko. (1996). Ergonomi Konsep Dasar dan Aplikaasinya. Edisi Pertama. Guna Widya. Jakarta. Sutalaksana, Iftikar Z, Ruhana Anggawisastra, dan John H Tjakraatmaja.(1979). Teknik Tata Cara Kerja. Departemen Teknik Industri ITB, Bandung. Wignjosoebroto, Sritomo. (2000). Ergonomi Studi Gerak dan Waktu. Edisi Pertama. Cetakan Kedua. Guna Widya, Jakarta.

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