5S - The Foundation of Improving Process

5S (Sort, Simplify, Sweep, Standardize, Sustain) is the philosophical basis for improvement of health care wait times. There are only so many scheduling “tricks” and reallocation of resources that can improve patient flow then process must be advanced. 5S is a reference to a list of five Japanese words that start with the letter S. In Japan, businesses and people adopted it as a way of life. In North America and the UK we view it as a means to improve process.

The two key targets are to improve morale (with a clean work environment and ownership) and improve efficiency (by decreasing clutter and adding visual cues). Think of a surgical tray. For a practiced surgeon or scrub nurse/assistant; if even a single instrument is out of position it’s noticed. There are visual cues on the tray for procedures such as notes to give antibiotics in the prep tray, or a note to “time out” (check the procedure) with the marking pen. Another example is the resuscitation room where passionate arguments can flare about the best location for the defibrillator. Both are examples of 5S.

The benefits come from the employee deciding what should be kept, where it should be kept and how it should be stored. The process transfers ownership of the process to the employee and builds a clear understanding of work flow. It can be as simple as re-organizing the desk of an administrator (see this story for an extreme example of a disorganized desk leading to disaster) or as complex as cleaning and reorganizing an ER to optimize patient flow.

The 5S’s are:
Seiri (整理): Sorting. The practice of storing or discarding all but the essential tools/materials for a process to decrease hazards and clutter.
Seiton (整頓): Simplifying. Creating an orderly workspace that puts tools and materials in a place to minimize extra movement and improve workflow.
Seisō (清掃): Sweeping, Systematic Cleaning, or Shining. Making cleaning an area part of a daily routine and build it into the routine of workflow (usually at the end of shift) rather than a sporadic action.
Seiketsu (清潔): Standardizing. Whereas systematic cleaning is making an area clean, Seiketsu means standardizing the workflow so any repetitive work is conducted in the same manner.
Shitsuke (躾): Sustaining. Regularly reviewing and improving the 4S’s above.

The 5S’s are well proven in real world applications to improve productivity and morale (Toyota, Hewlett-Packard, Boeing to name a few). By improving patient flow by 10% in the OR there could be a corresponding drop in surgical wait times by 10%. For the GP’s out there, how many times in a day do you have to go “hunting” for materials for a routine patient (swabs, requisitions, etc…)? Hunting for pens & stethoscopes in hospitals is a running joke. It is not enough for the practice manager, administrator or provider to be the only believer in the system. 5S is a concept about global changes and ownership of process by the people that provide it. Adopt 5S, and then apply it to processes in a practice both big and small.