I am standing in front of an image of one of

our medical surgical wards because this is where many of you will be implementing 5S.

5S can also be implemented in clinics and other patient and storage spaces.

Let me start my presentation with a patient.

A 36-year-old woman was being seen in a family medicine clinic.

She requested that her IUD be removed because she planned to start a family.

A family medicine resident ordered the IUD removal kit.

Unbeknownst to him, the supply room was poorly organized and

a uterine biopsy kit had inadvertently been

placed in the slot normally reserved for the IUD kit.

The resident was unfamiliar with the IUD kit,

did not notice the hook had

a very sharp prong designed to cut out a small specimen of the urine wall.

He tried to use it to pull out the IUD string,

but instead cut the string and caused intrauterine bleeding.

When the attending physician was called,

the error was immediately detected.

Fortunately, the patient suffered

only temporary bleeding and the IUD was able to be retrieved.

Following this serious mix-up,

the supply room underwent a 5S exercise.

5S, as the name implies,

consists of five elements:

Sort - separate the wheat from the chaff.

In other words, separate the necessary from the unnecessary.

Simplify - a place for everything and everything has its place.

Sweep - assure that everything is where it belongs; visually confirm.

Standardize - map work areas,

clarify the roles of each team member,

establish accountability and consistency.

This will reduce training time.

Self-discipline - it's easy to do 5S once,

but maintaining this approach requires personal commitment and leadership.

There are five levels of 5S,

and in the clinic I just described,

the supplier error was at level one.

Necessary and unnecessary items were mixed together.

Items were located at various places.

Key work items were missing.

No standards for work area organization were in place.

Work area checks were not done regularly,

staff were not focused on 5S.

When beginning 5S, you should recruit a team

to perform a waste walk and identify all forms of waste.

I work on a medical surgical floor and I

recruited our clinical leader and head nursing administrator,

along with the charge nurse,

to conduct a waste walk.

The results were eye-opening.

Look what we found: unused equipment placed in the nurse locker room.

Christmas decorations in June were also

found in the nurse locker room along with unused gloves.

Cabinets in the nursing station were filled with old papers and other junk.

An outdated infusion pump was found in a storage cabinet.

Outdated portable computers for patient education were found at the nursing station.

A crock pot, left by a patient over three months ago,

was sitting on a counter.

Empty and defective hand sanitizers were discovered in several rooms,

as were old corkboards collecting dust.

Misplaced and old, outdated forms were found in our form distribution area.

It was clear that our floor was at level one.

After our first meetings,

we began our 5S journey and moved quickly from level one to level two.

Needed and not needed were identified,

the unnecessary items were removed,

and items that might be used in the future were red-tagged.

Needed items stored and organized by frequency of use.

We chose actually to organize alphabetically and by function.

We had a patient education slot,

a physician forms area,

and a unit staff form.

Our clerk had agreed to check items twice daily and

will document performance levels using a checklist.

Our work group has documented agreements for needed items,

organization, and work area controls.

Documentation of 5S achievements will be posted and

5S incorporated into our employee orientation on our floor.

We are now moving toward level three that focuses on making our system visual.

Preliminary sorting is completed, as you can see.

We now have actually aligned each of the items under a specific category.

We have disposed of most of the material after being red-tagged.

Needed items are listed and proper locations labeled,

proper inventory is defined,

and visual controls are established,

allowing assessment of equipment, supplies, and files.

Visual controls are documented – this has not yet been achieved.

Work group routinely checks areas to assure

5S agreements are maintained – we are beginning this journey.

We aspire to level four that focuses on reliability.

Protocols are in place assuring

every item has a place and protocols are consistently followed.

Visual controls assure supplies are maintained.

All areas are inspected daily and areas are consistently

restocked and organization maintained.

All members of the workgroup consistently follow the 5S protocols.

Mistakes and failures following protocols are documented as part of routine work.

Root cause analysis are conducted and PDSA cycles are performed to correct failures.

And finally, level five focuses on continual improvement.

Potential problems leading to disorder are

identified and preventative actions are in place.

Storage rooms' maps are created to allow rapid access to all items.

Additional potential problems are identified and preventative measures documented.

Protocols and preventative measures are shared throughout similar work areas.

Root cause analysis has eliminated conditions that lead to

disorganization and new preventative measures are continually being developed.

How do you begin 5S?

You must go and see.

That is, go to the site and determine the present state.

Ask why.

Understand the reasons for the present condition.

It is also important to show respect and avoid scolding or disbelief.

Organizing methods can be used to encourage those on the frontlines to participate.

By creating a campaign,

you are showing respect for everyone's opinion and viewpoints.

First, you will want to identify champions and create

a leadership team to maintain 5S as described in "Fixing Healthcare 1.0."

Use one-on-ones to determine who is interested in helping with 5S.

Create a leadership team or working group to create measurable goals.

Develop strategy and tactics for implementing 5S.

Use frequent huddles, as shown on the left,

to celebrate your successes and plan future tactics.

Use posters and, possibly, videos.

Generate measurable milestones.

We expect to achieve level three within five months and level four within 10 months.

Keep in mind, 5S is an everyday activity,

not just an event.

I remember what my mother always asked me,

"Freddie, did you pickup your room?"

When it comes to health care,

we should all take our mothers' advice.

Shouldn't we keep our health care facilities neat and well-organized using 5S?

As the case described at the start of this lesson illustrates,

the safety and well-being of our patients depend on it.

Thank you.

5S

Fixing Healthcare Delivery 2.0: Advanced Lean

Meet the Instructors