Go With The Flow: “5S” Your Practice

Author: Christian Bamber
Posted: Monday 12th September, 2011. 11:15:04

I was very pleased to receive quite a few enquiries about last week’s article and how Lean could be applied to a veterinary practice. So I’ve decided to look at another aspect of the Lean philosophy and practice this week: flow and 5S.

We can observe the power and necessity of flow all around us: traffic flows, blood flows, a river flows, an orchestra flows. But cause a break to the flow and we get problems. If demand exceeds capacity, traffic will jam or a river will burst its banks, music will become a chaotic cacophony if someone decides to play to their own rhythm, and obstruction to blood flow may cause a thrombus, heart attack and possibly death.

In Lean, flow is just as important and the discipline of eliminating waste is also about eliminating obstruction to flow, whether this may be people, information, materials, clients, or products. Like the orchestra, flow is dependent upon all the constituent elements working perfectly together.

5S is a set of five principles that establishes a platform for orderly flow within the organisation. It is very simple but don’t be fooled by this – it is the foundation of any Lean strategy.

5S refers to five Japanese words beginning with “S”. Unless you speak Japanese it makes more sense to convert these into similar English equivalents and the most commonly used format is: Sort, Straighten, Scrub, Standardise, and Sustain.

The first three of the Ss refers to the “get rid of all junk” phase, whilst the last two refer to creating a system so that there is a place for everything and everything stays in its place i.e. habit and discipline.

Let’s look at each of the 5Ss:

1. Sort
   
   Sorting is essential as it eliminates clutter. Unneeded items always seem to accumulate over time causing work areas to become an obstacle course and for needed items to end up buried beneath mountains of junk.
   
   Back in the days of film x-ray, how often did you lose a client’s x-ray under a pile of magazines, journals or dishes? How much time did you and your nurses spend searching for the print-off of an animal’s test results? And where is that bottle of NSAID that should be in the consulting room cupboard?
   
   So, divide everything in the workplace into three R categories:
   • Retain items that are critical to the function of the immediate work area.
   • Return any items that belong to another work area or department.
   • Rid the area of any other items! You must physically remove them to the bin for disposal or the staging area (where an item is tagged for disposal pending authorisation). Don’t just rid items to another area in the workplace where someone else will eventually have to deal with it.
   Even at a micro-level, we can apply 5S. For example, when a surgical kit is laid out, don’t just dump it haphazardly over the drape. Spread it out and arrange it according to frequency of instrument use: often needed instruments together nearest to you, less frequently used instruments together but further away. And return those Gelpi retractors that are still in your suture kit that belong somewhere else!
2. Straighten
   
   Now we need to organise everything that remains behind in the work area; find a place for everything and put everything in its place. Move the items that are always needed to where they are always needed.
   
   Try to establish and delineate the standard location for every item and make it as visual as possible, using labels, tape, marker pens etc. Using visuals reduces the possibility of error and makes locating items more efficient.
   
   The objective of straightening is to make any item both easy to find and easy to replace. I’m not going to give you any veterinary examples here as I think its application is fairly straightforward.
3. Scrub
   
   Now its time clean the whole area. This applies to offices, kitchen, reception, waiting room, freezer room etc. and it means deep cleaning everything.
   
   Dirt, stains and debris build up in the best-run facilities so check windows, equipment, lighting, ceiling tiles, walls, floors, sinks, counters, anaesthetic machines and so on. If it can’t be cleaned, paint it, replace it or cover it.
   
   Is this a bit of overkill? No as research has shown that people working in a clean environment tend to have a more positive attitude and are more productive. In addition, having clean equipment helps to detect faults more easily such as leaks and spills, and cleaner work areas make for a safer working environment.
4. Standardise
   
   Backsliding happens very insidiously and can go unnoticed for long periods of time. Before you know it, you will be back to square one unless you standardise the schedules and systems to maintain the area regularly.
   
   Do not devise elaborate and complicated procedures for standardisation as they will less likely be followed. Try to make it visual such as using clear and colourful rotas or schedules. I like to use photographs to remind people what an area should look like. Once you have performed 5S, photograph the area and place the photo at the workstation – this is what this area should look like.
5. Sustain
   
   The fifth and final 5S phase is about developing discipline and habit. You now need to turn a one-off event into the way business is always conducted. This is the most difficult step requiring constant reinforcement and time before the new habit becomes sustained.
   
   Without the discipline of habit, 5S will fail no matter how well the first four phases have been implemented. It is also the responsibility of each and every member of staff to do their part and managers must ensure that staff are performing their 5S roles and duties with gentle reminders of the overall goals of 5S if they are not.

The Keys to 5S Success

• Communication, communication, communication. Tell everyone about 5S and why it is important to your practice.
• Train staff where necessary in order that they can all contribute their part to a 5S practice.
• Ensure managers/senior staff are committed to providing resources for the first three Ss and the leadership required for the final two.
• Use as many creative visuals as possible.

Remember that the goal of 5S is twofold; to clean and organise your practice and therefore to eliminate sources of non-value-added work, and to create uninterrupted flow as far as is possible. Together with the seven wastes, 5s will provide the platform for a Lean practice.

For more information on how a Lean programme may help you, please contact Approach Strategy.

Christian Bamber is Principal Consultant and Director of Approach Strategy, a consulting firm specialising in strategy services to service industries and not-for-profit organisations. For more information, please contact Approach Strategy at christian@approachstrategy.co.uk. Tel: 01225 722 654 or visit their website www.approachstrategy.co.uk

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