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Introduction: We analyzed the digital transformation of a pathology department in a German hospital. Our primary focus were psychosocial demands and resources. However, digital transformation also impacts ergonomics and work-related musculoskeletal disorders (WRMSDs). In digital pathology, diagnoses will be made at a computer screen instead of a microscope. This has the potential to improve, but also to create new work-related demands that could lead to WRMSDs. We aimed to understand the subjective relevance of WRMSDs as part of digital transformation in the pathology department. We will focus on the research question: To what extent are WRMSDs addressed by pathology staff in the digital transformation process?

Methods: We used an ethnographic research design. Data collection (summer of 2022 to fall of 2023), included participant observation, qualitative interviews, focus groups, and documents. No specific ergonomic assessment was performed. We analyzed the data using Reflexive Thematic Analysis.

Results: WRMSDs or work-related musculoskeletal stress were rarely addressed explicitly by pathology staff, but were implicitly observed: In the conventional workflow, pathologists spent a lot of time sitting during tissue sectioning, microscopy, and computer work, but got up frequently, e.g. to take case files back to the laboratory for additional staining. Frequent walking was perceived as disruptive to the individual workflow. Pathologists expected the digital workflow to result in less movement because most tasks would be performed digitally. For lab technicians (MTA), core tasks with risk potential for WRMSDs will not change through the digital transformation. Overall, pathology staff were more concerned about the psychosocial demands. Yet, in the course of the various phases of the transformation process, the challenges of implementation and the associated extensive work requirements became a bodily experience – especially for the MTAs who reported symptoms such as dizziness, physical tension and circulatory collapse.

Discussion: The ethnographic design ensured many opportunities for participants to define the topics they would like to address. However, they hardly talked about WRMSDs. This might have several layers: 1) Our research focus did not center ergonomics, 2) exceeding one’s physical limits is so normalized in health care that it is not worth mentioning, 3) in order to maintain their ability to work, pathology staff had to prioritize demands, and psychosocial demands were more pressing at the time of the process. This means that work-related demands might shift and deteriorate objectively (e.g. from regular to only little exposure variation and movement during sedentary work) without respective subjective perception. While this might be a functional short-term strategy, it may create high individual and organizational costs more long-term.

Conclusion: Digital pathology will transform pathologist’s workplace into a typical computer workstation. In the case of unsuitable ergonomics, the lack of movement could become a work-related stressor that could lead to WRMSDs.