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Like so many innovations, the 5S Lean Principles have roots in the post-war period. Not long after World War II, the founder of Toyota, Sakichi Toyoda visited multiple companies in the U.S. He closely observed the methodologies used by companies like the Ford Motor Company and Piggly Wiggly supermarket chain. Based in part on these observations, Toyoda began to develop the Toyota Total Production System. This gave rise to the Lean principles, or the 5S methodology.
So what exactly are the Lean principles and why are they important for healthcare organizations? Quite simply, implementing the 5S Lean system can enable medical businesses to maximize profitability by optimizing operational efficiency and reducing waste. And yes, you can achieve this while also prioritizing patient-centered, high-quality healthcare.
An Overview of the 5S Lean Principles
The 5s lean principles have roots in Japan’s automotive industry. However, Toyota can’t quite be credit
ed with 5S lean principles, as the model they adopted was the 4S system, with two of the principles being combined. It was Hiroyuki Hirano, a consultant for Toyota, who is credited with developing the five principles. These are explained in his book, 5 Pillars of the Visual Workplace. In this book, the five pillars are as follows:
- Seiri: In Japanese, seiri means to sort or organize. This principle recommends keeping only the materials or inventory at hand that you need for each task. In other words, it means to sort the unnecessary items from the necessary ones. This principle supported the “Just in Time” approach in the manufacturing industry.
- Seiton: This means to set in order or straighten up. After the elimination of the unnecessary items, every necessary item that remains must be neatly organized so that it can be easily found and used.
- Seiso: Seiso translates to shine or cleanliness. It advocates the importance of keeping the workplace clean and orderly to ensure maximum productivity.
- Seiketsu: Seiketsu means to standardize. In other words, it recommends identifying the best practices for each task and creating a consistent approach for getting each task accomplished.
- Shitsuke: Shitsuke translates to discipline, but in English, this principle is usually referred to as “sustain.” This lean principle recommends turning the implementation of the 5S methodology into a long-term, sustainable habit by consistently following the first four principles. Many managers discover that shitsuke is often the most difficult Lean principle to implement.
As you have probably already concluded, the 5S Lean methodology is intended to be implemented in order, from seiri to seiton, and so on. Another key ingredient for success with the 5S is consistency. In other words, it is necessary to get everyone in the workplace on board with the program. Every team member—from the executive suite to the janitorial staff—must “buy into” the methodology, understand it, know how to use it, and implement it consistently every day.
In order to get the entire team on board, it is incredibly helpful to reach out to a healthcare consultant. A consultant will bring a new, outsider perspective to the organization, easily identifying areas where waste can be reduced and how best practices can be standardized. Furthermore, a consultant can help your team members understand how the 5S Lean methodology benefits the entire organization, and how these improvements will translate to better healthcare delivery and an enhanced patient experience.
A Look at the Benefits of Using the Lean Principles
The benefits of using the lean principles are varied and far-reaching. In fact, it’s surprising that more medical businesses aren’t on board with 5S lean principles, given that it can accomplish the following improvements:
- Enhanced employee productivity: Worker productivity is important for every type of business. In the manufacturing sector, where the 5S lean methodology originated, increased worker productivity means more products being built every day, which drives profits. In the healthcare sector, better productivity is even more essential. Hospitals across the country are grappling with staff shortages, often turning to temporary travel nursing assignments to fill the gap. When it’s difficult to keep enough qualified employees across a hospital’s departments, the productivity of the individual employee becomes absolutely essential.
- Better track record of safety: Workplace injuries are a major problem in the healthcare sector. Nurses, other staff members, and the public may sustain severe injuries from slip and fall incidents, for example. Patient lifting-related injuries and sharps injuries are other common problems. A hospital with a high incidence rate of injuries will also have to deal with injured employees being out of work or, possibly, injured patients suing the hospital. Neither of these is an ideal situation, but fortunately, the 5S methodology can help you reduce workplace injury rates.
- Reduction of waste: The 5S lean principles are geared toward the reduction of waste by clearly separating needed items from unneeded items. In a healthcare setting, waste is rampant. It often stems from practices such as physicians ordering their preferred brand of supplies, even if there are already plenty of those supplies from another brand. The reduction of waste will improve the organization and operational efficiency of the hospital, while eliminating unnecessary expenses.
- Enhanced worker morale: Workplace morale is a major issue for hospitals. The stress of long hours and a large patient caseload, combined with the emotional issue of caring for patients with life-threatening health problems can lead to a high staff turnover rate. By implementing the 5S lean principles, the healthcare leadership team encourages each staff member to work toward a shared mission. This can raise workplace morale and contribute to a positive workplace culture.
To fully understand the benefits of the lean principles and to consider how you can implement them in your own healthcare organization, it’s necessary to do an in-depth examination of each principle.
An Explanation of Seiri
The first step, seiri, is to identify each item in a workspace as either necessary or unnecessary. Another way to look at it is to consider the value of each item. When identifying each item, ask yourself if it offers value to the particular workspace. If not, perhaps it could offer value to a different workspace.
The implementation of seiri isn’t something that typically happens overnight, especially in a large organization like a hospital, which may occupy multiple buildings or even multiple campuses. It may be helpful to first launch a pilot program for seiri. Identify just one particular department in one building to begin sorting through their items. Instruct each participating team member to keep notes about the progress of seiri. Their insights can be shared with the rest of the employees as they implement their own seiri processes in their own workspaces.
To maintain employee morale during this process, remind everyone of the benefits. For example, eliminating unnecessary items in a surgical suite can help reduce surgical errors (such as the accidental leaving of items in a patient’s body). Seiri can also involve ensuring that each staff member has every resource needed to complete their tasks at any given workspace.
The Achievement of Seiton
Seiton refers to organizing or setting things in order. Now that your hospital is finished with seiri and has eliminated unnecessary items, it will be easier to implement seiton. Another way to think of this principle is, “A place for everything and everything in its place.” Items should be placed where a worker would reasonably expect to find them. For instance, sharps containers should be located in exam rooms near the treatment table, where nurses will administer injections.
In addition, similar items should be grouped together. For example, in a room that stores surgical packs, you should keep surgical packs for orthopedic procedures grouped together. Another section of the storage area can be reserved for neuro surgeries.
The system your hospital will develop to implement seiton should support sustainability. That is, it should be easy for workers to know where newly received items should be kept. Labeling the cupboards, drawers, and storage bins can be helpful. In addition, consider the role of ergonomics. Items that are most frequently used should be placed in the most easily accessible location—one that does not require bending over or reaching up.
The Use of Seiso
Seiso means to shine or to support cleanliness. In a healthcare setting, seiso is critically important for the prevention of disease transmission and workplace injuries. For instance, properly cleaned floors reduce the risk of slip and fall incidences. Properly sterilized equipment reduces the risk of surgical infections.
Note that seiso can also involve more than cleaning and sterilization. It can also involve the proper maintenance or calibration of equipment so that everything is ready to be used when needed. In addition, seiso can support the morale of employees, and patients and their families. Consider the stress-reducing effect of simple environmental modifications, like switching to warm lighting or taking steps to manage chemical odors.
The Implementation of Seiketsu
Seiketsu is the act of standardizing best practices for consistent implementation. When your healthcare organization improves its seiketsu, you should see a significant improvement in productivity and operational efficiency. All best practices established should be geared toward supporting and sustaining the first three lean principles.
When developing standardized protocols, it’s generally advisable to seek the input of the staff members who are most often involved with the particular task. Since they are keenly familiar with the details of the task or department, they are the ones best situated to develop efficient and effective protocols. Once these standardized protocols are developed, it’s necessary to distribute them to all involved team members. Training workshops may be necessary to ensure that all staff members understand these protocols and know how to implement them.
In some cases, a bit of fine-tuning may be necessary. Consider setting up a procedure for soliciting the feedback of staff members who are directly affected by the new protocols. Use this feedback to adjust the protocols as needed.
The Development of Shitsuke
The last of the Lean principles is shitsuke, which means to sustain. This might seem like it’s the simplest step to execute, but it’s deceptively tricky. Many healthcare managers assume that by the time they reach shitsuke, all of the employees will be on board with the Lean principles and they will automatically execute the program. However, employees may require frequent reminders about protocol adherence.
It may also be necessary to periodically audit your practices to determine whether they are still working, and if not, which elements need to change to be in compliance with the Lean principles. In addition, hospitals frequently recruit and hire new staff members. Each new staff member, even if he or she is a temporary travel nurse, should receive training in the Lean principles and standardized protocols.
John Shufeldt, MD has 30+ years of experience in streamlining medical businesses for greater operational efficiency in a way that prioritizes patient-centered care. His consulting services for implementing the 5S lean principles are available for hospitals, clinics, and healthcare leadership teams. Contact us today to discuss how we can help you build a better healthcare business.