Insights into improvement #1: What is all the fuss about 5S workplace organisation?

November 20, 2013

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This is the first in a series of insights into improvement from the team at wdid. We thought we would start somewhere simple but which is often misunderstood.

What is all the fuss about 5S workplace organisation?

5S: (Sort, Set, Shine, Standardise and Sustain)

Many people who either plan, take part, witness or just come across the use of 5S in healthcare misunderstand it. Generally it is just thought of as a bit of an elaborate tidy up, or something those ‘improvement’ people do while the more serious minded individuals try to figure out how to solve the organisation’s real problems….

Worse still some improvement project managers / leaders also miss the point – classing 5S as a bit of a one-off structured re-organisation of an area. Finally and most worryingly, in the case of the use of 5S in the NHS Productive Ward national improvement programme, we often come across improvement leaders in trusts that think that because they have 5S’d every cupboard in a trust, then they must have ‘done’ the Productive Ward.

So, to put things in a bit of context and to help you understand a little more about 5S, the following is a discussion around the aims and connections 5S brings, rather than a ‘how to’ guide. Anyone can ‘do’ 5S, but the real challenge is to use it appropriately, and position it as part of a much wider system level improvement.

5S and quick wins

Let’s get this bit out of the way quickly. 5S does have some handy quick wins associated with it.

  • It makes things a whole lot tidier, which for anyone who has worked on a ward, in a doctors’ surgery or similar environment will know is a constant headache. Store cupboards are renowned to be crammed full of Christmas decorations, old forms and equipment etc.
  • It saves time. For example on a ward, nursing staff are rushed of their feet. Wasted time running around looking for things really adds to the stress, and also means less time for patients. Think about a process that happens many times on a busy ward like taking a commode to a patient; followed by emptying and cleaning it. This happens countless times over a day and a carefully organised sluice can save hours of valuable nurse time.
  • It gets wary staff interested in improvement. Due to the inclusive nature of 5S, it is a firm favorite of improvement professionals. Staff can make a practical and very quick impact on their working environment, and this makes them more open to further improvement plans.
  • Reduces inventory. When using 5S to re-design, for example, store rooms, every item is questioned and stock (inventory) is refined. Taken even further, by using visual reorder signals (kanban), stock levels can be refined down. Depending on the type of stock held, reducing inventory can be a very useful contribution to reducing operating expense.

5S and variation

Getting towards the nitty gritty. 5S can help control variation, which in turn can help with more accurate work and workforce planning. In a sector such as healthcare, which is manpower intensive, variation occurs in the everyday practice of staff. Staff vary how they carry out tasks depending on their level of skill, their level of knowledge of their environment (e.g. they know that that piece of equipment they need just happens to be under the boxes of gloves in the ward sister’s office) and in their own interpretation of guidelines and policy. This variation is increasing even more so now as staff turnover increases and staff are required to work flexibly across multiple areas.

One result of this variation is that it tends to end up taking some people longer to carry out a task than others. So when thinking about an appropriate staff level – are you planning with the people who know where stuff is, or the people who run around looking for things? Using 5S to organise and standardise common areas can cut down on variation and thus make designing work and workforce design a lot easier. Reducing variation increases capacity and increases quality. If you can rely on common tasks taking a much closer spread of times, then you stand less chance of overloading staff members and more chance of achieving good quality goals.

5S and developing standardisation

Achieving adherence to policy and standards is often both a high priority and a serious challenge. Naturally independent minded clinicians don’t take very kindly to standards being imposed on them, especially if they have had them imposed on them (without input) or if standard ways of working have not featured that heavily previously. 5S can be used to bridge the gap and introduce using and upholding standards to teams. The cycle of teams of organizing a workplace, defining the standard and then upholding the standard using audit is a very valuable learning curve. This would help, for example, ward leaders de-personalise the process of upholding standards. This is something many managers in wards and in general practice say is a real hurdle to overcome – stating that staff take the upholding of standards personally.

5S and linking organisational policy to shop floor practice

Take the last point to its logical conclusion and you can see the link to policy in healthcare organisations. Senior Leaders in hospitals, CSU’s and in general practice state to us that one of their biggest frustrations comes from the challenge to put policy into practice, i.e. how do we make policy changes happen on the front line?

While we could get into a discussion around Hoshin Kanri (policy deployment and one for a future article), the basic problem is that if an organisation has very little experience of operating around standard operating procedures, then the disconnect from shop floor to organisational policy is going to be even greater. Policies, which are essentially high level standard operating procedures, need to be bridged to the shop floor and put into operation. Standard operating procedures do this, and 5S is a great way of introducing the role of standard operating procedures to healthcare organisations.

The big caviat:

With all of the discussed benefits, the great and most important note of caution is that to capitalise on any of them, 5S needs to be used as part of a wider system or pathway improvement. Not used in isolation.

For example, to capitalise on inventory reduction requires stock levels to be changed with the supplies department. For a capacity gain resulting from a reduction in variation to be capitalised upon, then something needs to be done with the saved time, e.g. it is used to take up increasing demand from theatres in a hospital or used to offer more appointments in a general practice. Without this connection to the wider systems, then the gains are not likely to be felt.

So doing 5S in isolation would essentially mean the effort would end up like countless other poorly connected improvement initiatives. It would end up making a short term gain, making things look a little different but not really show any improvement that impacts on an organisation’s bottom line. 5S is a means to an end, but not the end itself. Once an organisation decides, for example, what capacity increase it requires in a certain area to support its wider system re-design, then 5S could be one of the interventions that could achieve that gain.

Want help or want to discuss any of the themes in person? Contact us.