5S TrainingCreated for LewisGale Hospital at AlleghanyKaizen Event Team

Pablo F. Cárdenas Orlandini, PhD StudentVirginia Tech

December 2, 2011

Sustain

Sort

Straighten

Shine

Standardize

1. Event kickoff2. Goals of event3. Hospital survey results4. 5s training5. Overview of 5S audit tool6. Ground rules of event7. Brainstorming activity8. Planning home locations9. Implementing 5S method

Kaizen Event Agenda

• 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

Goals of the Kaizen Event

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

5S

What is 5S and why do we want to do it?

5S DefinitionSimple but highly effective set of techniques that remove waste from your work environment through:

▫Better workplace organization

▫Visual communication and management

▫Standardization

▫General cleanliness

• 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.

• Shineo 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.

• Sustaino Discipline: practice the habit of doing what is required. Maintain

and continually improve on 5S practices.

Definition of Each S

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 useo 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.

• 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: Red Tagging

• Removing unnecessary items:o Differentiating between waste, donations, items to move

to other locations in the hospital or to the warehouse

SORT Strategies:Differentiating Unneeded Items

Donations

WasteRelocation

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

Some cabinets may be full of extraneous itemsAll of these can be removedThe cabinets are emptied!

AfterBefore

SORT Example:Elimination of Clutter

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 Donatingo Moving to other departmentso 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.

• Based on visual managemento Labelingo Signalso Color codingo Shadow boxeso Discipline squares

• Distribution of items by locationo Arrange by frequency of useo Group like items togethero Group items together that are used togethero Arrange in natural order

STRAIGHTEN Strategies

• Visual Indicatorso Outlining /Foot-Printingo Borderso Home and Return Addresseso Patient Record Stickers

• Visual Signalso Nurse call lightso Color Coding

• Visual Controlso Exact Bin Sizes

• Visual Guaranteeso Quick-connect fittings for different gases eliminating the

possibility of using the wrong gas.

STRAIGHTEN Strategies:Visual Management

STRAIGHTEN Strategies:Visual Management• Comprehensive labeling.

STRAIGHTEN Strategies:Visual Management• Applying color-coded twist ties to equipment to

know where to return equipment to.

• Kanban – Sign boardo 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 Nameo Part Numbero When and how many are neededo Where the item is to be deliveredo Contact name and phone number

STRAIGHTEN Strategies:Kanban

• 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.

STRAIGHTEN Strategies:Two-Bin System

Before After

Implementation of the Two-Bin

System

1

1

12

2

2

Start picking from the left bin

Once you run out of items from the left side, pick from the buffer

Now it’s time to order more and replenish!

• Applying tape on the floor to create equipment layout.

STRAIGHTEN Strategies:Discipline Squares

STRAIGHTEN Strategies:Discipline Squares

Before

No visual indication regarding location of equipment

Disorganized IV Stands and Cylinders

STRAIGHTEN Strategies:Discipline Squares

After

Discipline Squares and labeling as a visual management method

Organized IV Stands and CylindersEach equipment is labeled and has a home

location

AfterIn-ProcessBefore

STRAIGHTEN Strategies:Item Put together by Functionality

This cabinet has a few random itemsIdea: adapt it to hold the biggestpossible amount of related items

Items were relocated, disposed or donated

Swan Items are put together!

All Swan Items are now in the same cabinet and in the

same quantity

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

Before After

Information material using half

of the space

Items that go together are kept in

the same cabinetItems were moved to

different cabinets

STRAIGHTEN Example:Better Organization of Cabinets

Before AfterExpired Items removed

Items relocated to other cabinetsAll Pacemakers put together

Special Procedure Items placed near each otherGeneral Supplies brought from other cabinets

STRAIGHTEN Example:Better Organization of Drawers

Before AfterNot functional Items disposedItems brought from cabinets

Surgical Tools organized in one drawerSpecial Procedure Items organized in other

drawerSpecial Procedure Items brought from cabinetsBlood Pressure Items moved to other drawers

STRAIGHTEN Example:

Implementing Visual AidsOld and not corresponding labels

Unnecessary documentOld attachments removed

AfterBefore

List describes Par Items contained

STRAIGHTEN Example:

Using Labels, Pictures and

Checklists

BeforeHow can we know where the items are supposed

to be kept within a cabinetWhen should the items be replenished

Are there minimum and maximum levels

?? ?

STRAIGHTEN Example:

Using Labels, Pictures and

ChecklistsAfter

Image and text indicating how the

cabinet should be set for optimal usage

Picture for best layoutMinimum and

maximum levels for each item

An erasable checklist works as a trigger for

replenishmentLabels 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.

• 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 Methodso Weekly 5S departmental tours

• Estimate Time• Training• Analysis: Ask “Why Not?”• Checklists/Audits

STANDARDIZE Strategies

#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 losto It may be very easy to slip back into old habits.

• Know what motivates you to do 5So Individual and MRH Benefits

• Create a sustainability plan to remind youoCommunication of 5S Kaizen event

benefitso Individual motivatorsoVisual cues will help as well

• Implement the Plan on an Ongoing Basis

SUSTAIN Strategies

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

ToolLewisGale Alleghany 5S Audit Form

Audit Date:   Area: Operating Room

   

Person auditing:  

                           

Category and Item

Poor Marginal Good

SD=Strongly Disagree D=Disagree sd=somewhat disagree

sa=somewhat agree A=Agree SA=Strongly Agree

SD D sd sa A SA

1-2 3-4 5-4

1 2 3 4 5 6

SAFETY

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.)? 

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  

SORT

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? 

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

ToolLewisGale Alleghany 5S Audit Form

Audit Date:   Area: Operating Room

   

Person auditing:  

                           

Category and Item

Poor Marginal Good

SD=Strongly Disagree D=Disagree sd=somewhat disagree

sa=somewhat agree A=Agree SA=Strongly Agree

SD D sd sa A SA

1-2 3-4 5-4

1 2 3 4 5 6

STRAIGHTEN

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?  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  

SHINE

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?  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

ToolLewisGale Alleghany 5S Audit Form

Audit Date:   Area: Operating Room

   

Person auditing:  

                           

Category and Item

Poor Marginal Good

SD=Strongly Disagree D=Disagree sd=somewhat

disagree sa=somewhat agree A=Agree SA=Strongly

Agree

SD D sd sa A SA

1-2 3-4 5-4

1 2 3 4 5 6

STANDARDIZE

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? 

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  

SUSTAIN

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? 

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!