5S Training

Created for LewisGale Hospital at Alleghany

Kaizen Event Team
Sort

Pablo F. Cárdenas Orlandini, Standardize Sustain Straighten

PhD Student
Virginia Tech
Shine

December 2, 2011
 Kaizen Event Agenda
1. Event kickoff
2. Goals of event
3. Hospital survey results
4. 5s training
5. Overview of 5S audit tool
6. Ground rules of event
7. Brainstorming activity
8. Planning home locations
9. Implementing 5S method
Goals of the Kaizen Event
• Remove items from the hallway

• Reduce unnecessary supplies

• Reduce the storage footprint

• Create logical system of storage that anyone can

understand

• Bring ownership to the OR staff

 Ground Rules of the
Kaizen Event
• Start and end breaks on time

• Everyone’s opinion counts

• Speak up with ideas, thoughts, and comments

• One operating room must always be available

 Basic 5S Training
What is 5S and why do we want
to do it?
 5S Definition
Simple but highly effective set of techniques
that remove waste from your work
environment through:

▫ Better workplace
organization
▫ Visual communication
and management
▫ Standardization
▫ General cleanliness
 Definition of Each S
• Sort
o Organization: distinguish between what is necessary and what less
essential, removing unnecessary items or tools from the workplace.
• Straighten
o Neatness: item are put where they best meet their functional
purposes. There is a place for everything and everything is in its place.
• Shine
o Cleanliness: inspection for and elimination of waste, dirt, and
damage.
• Standardize
o Uniformity: maintain known and agreed upon conditions. Apply
methods consistently and revisit them frequently.
• Sustain
o Discipline: practice the habit of doing what is required. Maintain and
continually improve on 5S practices.
What are the issues in this
work environment?
 What Can 5S Do For the
Alleghany Hospital OR?
• Eliminates the need to search for items
• Better defined flow of materials and information
• Modifies the appearance of the
workplace, conveying a more professional image
• Persistent and continuous productivity
improvements
• Reduces clutter, waste and the probability of errors
• Reduced turnaround time
• Increases worker’s morale and pride
• A safer and healthier OR!
Breaking Down
Each S
#1: SORT: “Do I really need
this [many] here?”
• Keep only what is necessary in the work
area.
• Needed items are sorted by frequency of
use.
o Store often used items an easily accessible area close to
the point of use
o store infrequently used items away from the work area
• Proper quantities must be determined.
• Elimination of unnecessary items
SORT Eliminates Clutter!!!
• Accumulation of unnecessary items often
go unnoticed and this results in clutter.
• This clutter creates an obstacle course to
get needed items.
• Valuable floor space disappears because of
clutter.
• Clutter hides problems such as missing
items, defective equipment, outdated
medications and supplies.
SORT Strategies: Red Tagging
• Identifying and visually labeling unnecessary items
for disposal
• Allows everybody to approve the move, the
removal, and the categorization of items.
• Includes information such as, department, date
tagged, the name of the person tagging,
disposition, the asset code, and serial number (for
accounting purposes).
SORT Strategies: Red Tagging
SORT Strategies: Red Tagging
SORT Strategies:
Differentiating Unneeded Items
• Removing unnecessary items:
o Differentiating between waste, donations, items to move to
other locations in the hospital or to the warehouse
SORT Example:
Donations
• Unused shelves given to hospital employees
SORT Example:
Item Relocation
• Bins are removed from the workspace and
moved to different sections of the hospital
SORT Example:
Disposal of Expired Items
• Expired scrub brushes Expired 9/2008
SORT Example:
Elimination of Clutter
Some cabinets may be full of extraneous items
The cabinets are emptied!
All of these can be removed

Before
After
SORT Example:
Checking the System
• Employee looks up the usage of items in the
system:
o He finds multiple items that aren’t used, or expired, throwing
away or relocating them
SORT Example:
Adjustment of Item Quantity
• Adjusting par-levels and warehousing
overstock items
SORT In Action!
SORT Reminder
• The goal of SORT is not to throw away things,
but to remove unnecessary items from the
work area.
• Also consider:
o Donating
o Moving to other departments
o Warehouse for future usage
#2: STRAIGHTEN:
A Place for Everything
• STOP: Do not proceed to this step unless SORT has
been completed.

• “A place for everything, and everything in its

place.”

• Ultimate objective: Even someone not familiar with

the area should be able to easily find, use and
return something.
STRAIGHTEN Strategies
• Based on visual management
o Labeling
o Signals
o Color coding
o Shadow boxes
o Discipline squares

• Distribution of items by location

o Arrange by frequency of use
o Group like items together
o Group items together that are used together
o Arrange in natural order
STRAIGHTEN Strategies:
Visual Management
• Visual Indicators
o Outlining /Foot-Printing
o Borders
o Home and Return Addresses
o Patient Record Stickers
• Visual Signals
o Nurse call lights
o Color Coding
• Visual Controls
o Exact Bin Sizes
• Visual Guarantees
o Quick-connect fittings for different gases eliminating the possibility
of using the wrong gas.
STRAIGHTEN Strategies:
Visual Management
• Comprehensive labeling.
STRAIGHTEN Strategies:
Visual Management
• Applying color-coded twist ties to equipment to know
where to return equipment to.
STRAIGHTEN Strategies:
Kanban
• Kanban – Sign board
o Essentially, the card is sent to the supplier when the item has
reached its minimum. The card is sent back from the supplier when
the order is filled.
o There is a buffer supply to account for the time it takes for the
supplier to fulfill the order.
• Signals that an item requires replenishing.
• Can be a simple card, or any time of signal
• May include:
o Item Name
o Part Number
o When and how many are needed
o Where the item is to be delivered
o Contact name and phone number
STRAIGHTEN Strategies:
Two-Bin System
• Use two bins for supplies. When one bin is finished, it
gets moved to a designated are so the storeroom
clerk can order more.
• The second bin is used as the buffer.

Before After
 Start picking from the left bin
Implementation of Once you run out of items
the Two-Bin System from the left side, pick from
the buffer
Now it’s time to order more
and replenish!
STRAIGHTEN Strategies:
Discipline Squares
• Applying tape on the floor to create
equipment layout.
STRAIGHTEN Strategies:
Discipline Squares
Before

Disorganized IV Stands and Cylinders

No visual indication regarding location of equipment
STRAIGHTEN Strategies:
Discipline Squares
After

Organized IV Stands and Cylinders

Each equipment is labeled and has a home location
Discipline Squares and labeling as a visual management
method
STRAIGHTEN Strategies:
Item Put together by Functionality
This cabinet has a few random items
Idea: adapt it to hold the biggest
possible amount of related items
After
In-Process
Before

All Swan
SwanItems
Itemsare
arenowput in the
same cabinet and in
together! thewere
Items samerelocated, disposed
quantity or donated
STRAIGHTEN Strategies:
Rearrangement of Supplies
• Complete rearrangement of supplies via
consolidation, and process flow improvement.
STRAIGHTEN Strategies:
Rearrangement of Equipment
• Clearing and rearranging equipment and
shelves.
STRAIGHTEN Example:
Better use of Vertical Space
• Using PVC pipes to create additional storage for extra
long items.
 STRAIGHTEN Example:
Better use of Vertical Space
Information material
using half of the space

Before After

Items that go together

are kept in the same
cabinet
Items were moved to different
cabinets
STRAIGHTEN Example:
Better Organization of Cabinets

Before After
Expired Items removed
Items relocated to other cabinets
All Pacemakers put together
Special Procedure Items placed near each other
General Supplies brought from other cabinets
STRAIGHTEN Example:
Better Organization of Drawers

Before After
Not functional Items disposed
Items brought from cabinets
Surgical Tools organized in one drawer
Special Procedure Items organized in other drawer
Special Procedure Items brought from cabinets
Blood Pressure Items moved to other drawers
STRAIGHTEN Example:
Implementing Visual Aids
Old and not corresponding labels
List Old
describes Par Items
attachments contained
removed
Unnecessary document

Before
After
STRAIGHTEN Example:
Using Labels, Pictures and Checklists

? ? ?
Before
How can we know where the items are supposed to be kept
within a cabinet
When should the items be replenished
Are there minimum and maximum levels
 STRAIGHTEN Example:
Using Labels, Pictures and Checklists
After

Image and text indicating

how the cabinet should be set
for optimal usage
An erasable checklist works as
a trigger for replenishment
Picture for best layout
Minimum and maximum
levels for each item
Labels below each item
STRAIGHTEN In Action!
#3: SHINE: “Like New!”
• The workplace should be clean and
bright, a place where people enjoy working.
• If you can’t get something clean, then paint
it, replace it, or cover it.
• Morale booster!!
 SHINE Strategies
• Clean equipment and work surfaces
thoroughly
• Inspect for hidden damage and deterioration
• Make everything “like new”
• Find ways to prevent things from getting dirty.
o e.g. Plexiglass shield.

• Have proper cleaning tools and supplies

• Have assignments, checklists, schedules, and
maps
 SHINE Examples
• A medication room before and after the first
three S’s
SHINE In Action!
#4: STANDARDIZE:
Constant Application
• Helps maintain the gains achieved by the first three
S’s.
• Develop a set of best practices and make sure
everyone knows and agrees with them.
• This phase involves communication and training.
o People must be instructed to take only from the non-buffer
bins.
o Nurses must separate the empty bins and the clerk should
know to send in an order when the empty bin is pulled.
• Everyone is accountable.
STANDARDIZE Strategies
• Prevention
• Code of Conduct
o Every job has duties that use SORT, STRAIGHTEN, and SHINE
o Common duties to keep common areas in shape e.g.,
break room
• Best Methods
o Weekly 5S departmental tours
• Estimate Time
• Training
• Analysis: Ask “Why Not?”
• Checklists/Audits
#5: SUSTAIN:
Continuous Improvement
• Developing new habits
• An ongoing phase to ensure everything is
maintained in order and up-to-date
• Also responsibility of management – set an
example
• Without this discipline, all the previous S’s
work will be lost
o It may be very easy to slip back into old habits.
SUSTAIN Strategies
• Know what motivates you to do 5S
o Individual and MRH Benefits
• Create a sustainability plan to remind you
o Communication of 5S Kaizen event
benefits
o Individual motivators
o Visual cues will help as well
• Implement the Plan on an Ongoing Basis
SUSTAIN Strategies: Identifying
Issues and Future Improvements
• Conducting audits of the room daily for the next few
weeks to help sustain improvements.
SUSTAIN Strategies: 5S Audit Tool
LewisGale Alleghany 5S Audit Form
Audit Date: Area: Operating Room

Person auditing:

Poor Marginal Good SD D sd sa A SA

SD=Strongly Disagree D=Disagree

sd=somewhat disagree
Category and Item
sa=somewhat agree A=Agree 1 2 3 4 5 6
SA=Strongly Agree

1-2 3-4 5-4

Are there any trip hazards (hoses, electrical cords, etc.) in the area?

Is the life safety code being followed?

Are all items securely placed (e.g., will not fall off shelfs, carts, or cupboards)?

Are there any other work hazards in the area (sharp corners or objects, other items that
could be dislodged easily, etc.)?

Are all critical areas accessible (fire extinguisher, shutoff switch, etc.)?
SAFETY
Are all equipment items working properly?

Are all floor areas that should be clear free of debris?

Are shelves, cupboards, or other storage locations ergonomically designed (proper

height, avoiding excessive reaching, within safety restrictions, etc.)?

Are all electrical cords free of frayed areas?

SAFETY Average

Are there unnecessary equipment, supplies, tooling, or materials in the area?

Are there unnecessary items stored/placed on cabinets or shelving units?

Are there obsolete or broken items, equipment, tooling, or supplies in the area?
SORT
Are sufficient quanties of supplies in the area?

Has a proactive sort initiative been conducted in the area in the last 6 months?

SORT Average
SUSTAIN Strategies: 5S Audit Tool
LewisGale Alleghany 5S Audit Form
Audit Date: Area: Operating Room

Person auditing:

Poor Marginal Good SD D sd sa A SA

SD=Strongly Disagree D=Disagree

sd=somewhat disagree
Category and Item
sa=somewhat agree A=Agree 1 2 3 4 5 6
SA=Strongly Agree

1-2 3-4 5-4

Are labels and signs clear and easily readable?

Do all movable equipment and carts have a "home location" that is clearly identified?

Do all instruments and supplies have a "home location" that is clearly identified?

Are all items (equipment/carts, instruments, supplies) in their correct home

locations?

STRAIGHTEN Are locations for items logically organized (like items together, related items together,
etc.)?

Are stacked items (supplies and equipment) sorted properly (by type, size, etc)?

Is the work area visually appealing (neat and orderly)?

Is material/physical flow in the area clearly identified?

STRAIGHTEN Average

Are cleaning materials and tools easily accessible?

Are equipment and shelving units kept clean and free of dust, dirt, and debris?

Are designated walkways free of dirt, dust, and debris?

Is the area swept and the floor clean?

SHINE Is lighting in the area good?

Are all connections, hoses, cords, covers, and lids in place and secure?

Are trash bins and scrap/recycle containers emptied on a regular basis?

SHINE Average
SUSTAIN Strategies: 5S Audit Tool
LewisGale Alleghany 5S Audit Form
Audit Date: Area: Operating Room

Person auditing:

Poor Marginal Good SD D sd sa A SA

SD=Strongly Disagree
D=Disagree sd=somewhat
Category and Item disagree sa=somewhat agree
A=Agree SA=Strongly 1 2 3 4 5 6
Agree
1-2 3-4 5-4

Are all home locations for items clearly documented and accessible?

Does everyone consistently put items back in their home locations?

Are storage locations consistently replenished when needed?

STANDARDIZE
Are results of the previous 5S audit posted and clearly visible to all?

Have issues and areas for improvement identified during the previous 5S
audit been completed?

STANDARDIZE Average

Is the 5S process and progress discussed at Staff Meetings?

Is time to actively "5S" the area regularly planned and conducted?

Are people held accountable for adherence to 5S rules and policies?

SUSTAIN
Is performance on the 5S process part of supervisor's and associates'
appraisals?

Overall, is the area maintaining 5S rules and discipline?

SUSTAIN Average

OVERALL Average
 Finally, 5s is for YOU!
• Clean-up and organize your work area
every day so that each new day is easier
and safer than the day before
• Share your input with the team so that the
tools you need will be available, increasing
your efficiency.
• Take a good look around...Imagine zero
waste/zero confusion!
Thank You!