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The 5s Can Improve Healthcare Quality and Culture

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Have any of you walked into a restaurant for a meal and then turned around and walked out without ordering?   I recently walked into a restaurant that went beyond the definition of a “greasy spoon”.  The counters were cluttered and dirty, there were piles of “stuff” everywhere, the floors were dirty with trash in the corners and the walls had not been cleaned in years.

I was worried about the quality of the food and did not want any extra protein or crunchies I hadn’t ordered.  I was also not interested in getting sick from food poisoning or germs.   I later realized this image and description of the dirt and clutter can be applied to some hospital departments as well.

The story illustrates we have a built-in perception that cleanliness, neatness, and organization are related to higher quality and standards of service.  In the over 80 different organizations and 300 plus processes I have worked with, I have yet to see a dirty, disorganized area provide a high-quality product or service.    As an area is cleaned up and organized, the level of the quality and service invariably improves.

Every organization does cleaning and housekeeping but how effective is it?   Who has the ownership of keeping an area clean and organized?  How empowered are the people who work in the area to reorganize, get rid of the clutter and improve their working environment?

A 5S process empowers employees to take ownership of their work area.  It does not mean they do the work of the Environmental or Housekeeping staff.   Housekeeping is responsible for buffing, vacuuming and cleaning rooms for infection control but they are not responsible for the clutter, layout, and organization of Nurses Stations, Offices, Labs, and work areas.  This is the realm of a 5S process.

To quickly review the 5S’s, the first is Sort, which is to get those excess items not being used for current work out of the area.  The second S is Set-in-Order which means “everything has a place and everything is in its place.”  The third S is Shine which means everything is clean, bright and maintained in “like new” condition.

The fourth S is Standardize where lists of activities and assignments are made to maintain the first three S’s.  The fifth S is the hardest and it is to Sustain the effort so the area does not fall back into its old habits.

Management provides the time and allows people to make changes to their work area themselves.   This is where continuous improvement comes into the 5S process.  The employees are empowered and take ownership of the layout of their area.   They organize the area to put the items used frequently near at hand, label the item and the location so it is always clear where an item belongs.

There is a place for everything.  The area becomes more visual and it is easier to find things and orienting a new employee takes much less time.  We find the efficiency will typically improve from 5 to 10 %, just because you don’t have to hunt for what you need anymore.

People have FUN cleaning up and organizing their work area and getting rid of the “stuff and junk” in the way.   They are very proud to show others what they have accomplished, how different it looks, how much cleaner and neater the area is, and how it has made their jobs easier.  Before and after pictures are wonderful ways to illustrate the improvements.  We quickly forget how messy, cluttered and disorganized it was.

Letting people reorganize their work area is a very powerful shift in the relationship between employees and managers.  People begin to realize they are not stuck because “we have always done it that way!” and “it has been this way since the first brick was laid!”  This is a very non-threatening methodology to allow the employees to begin to take ownership and make the change.

From the management side, they begin to let loose the reins and realize the employees really can be responsible to implement change.  Both begin to realize positive change is possible, desirable and we can work together to achieve it.

After 5S is implemented, the cleaner, more organized area demonstrates to the customer that even the small details are important.   It communicates we are even paying attention to the little things; like how a desk is organized and labeling things to eliminate mistakes and wasted time.  A 5S process says, “We take such good care of the little things, so we will certainly take very good care of the big ones.

You will receive great care here!”  The result is better customer results, improved outcomes and higher customer satisfaction scores – all from a simple, low cost, easily implemented and positive 5S improvement process.  So, what are you waiting for?  Let’s get that culture change started!

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