Using 5S in the consulting room

Dr Iolanthe Fowler

Six months ago a small group from NHS Improving Quality (NHSIQ) came to our practice, Richmond Medical Centre in South Yorkshire. We took part in a session based on ‘5S principles’ and applied this philosophy to help us organise our consulting rooms and administrative areas into leaner, cleaner and more efficient places in which to work.

5S is an acronym of Japanese words describing a method of making processes and the environment safer:

Seiri – sort and discard
Seiton – shift and arrange in order
Seiso – shine and inspect    
Seiketsu – standardise and improve
Shitsuke – sustain and discipline

5S could be misinterpreted as “just a tidy up” but done properly it is much more than this. It is a way of standardising work and improving efficiency by reducing waste and promoting flow. It has been shown to improve staff morale and workplace safety.

The commitment was an afternoon attended by all staff, those not normally working were paid to attend. The exercise was fun and developed a sense of productive team working. One or two rooms did not get the 5S treatment on the day and staff asked to have time to do this at a later date (which did happen).

This intervention was uniformly appreciated by all staff in our practice and we are still maintaining the changes, and reaping benefits, with minimal effort.

What we did...

5s-imageSort
We removed all clutter, duplication and waste from our rooms, including  draws, cupboards and corners – nowhere was left unturned. We had some surprises along the way ‐ What was that piece of equipment used for? Why are there obsolete forms from 10 years ago in that drawer? Why are there 10 blood pressure cuffs in this cupboard?

Set
We gave every item a location within the rooms and tried to standardise this in similar areas, for example in consulting rooms all rooms have specimen bags in the 5th drawer down. This was aimed to help new doctors and locums, and  to make hot desking easier.
We were encouraged to keep regularly used items close within reach, less regularly used in cupboards/ on shelves, and rarely used in known locations outside the room if necessary. We marked and labelled with printed labels, tape and marker pens, each location to facilitate stocking up and the replacement of items in the correct location after use, e.g. Tendon hammers and urine dipsticks.
 
Shine
After decluttering it was a lot easier to clean the practice thoroughly. We were encouraged to build in a daily clean to routines.

Standardise
Standard approaches to carrying out tasks and procedures can save time and promote safe practice. Knowing where equipment is due to the standardisation of rooms and areas, saves us time and helps efficient stocking up procedures‐ a label next to an empty shelf is a quick visual prompt.
Some people were concerned that standardisation of rooms and spaces would mean that they needed to sacrifice their individual preferences. This was not found to be a problem. Once the basic equipment was installed in a standardised way, there is room to add specialised items, as long as 5S principles are otherwise adhered too.

Sustain
We rolled this approach out and ran tutorials on it to trainees after the event. We have found it easy to make it a part of our practice life, by practicing and repeating the process, and educating all staff. We have been able to link 5S to the jobs that we do, and staff have reported that it has continued to help them to improve their workplace.

Staff were asked to provide feedback, and many positive comments were received, examples of which were:

“It saves time in the consultation”
“I don’t have to leave my room during consultations anymore to track down missing stock items”
“I can find items in my cupboards much quicker now”
“I feel happier working in other rooms now”

 

References;

1. Bringing lean to life; making processes flow in healthcare. 2014. [PDF] 
2. 5S Instructions ‐ NHS Improving Quality [PDF]

Thanks to Lisa Smith and Sean Manning from NHS IQ
5S is part of the Releasing Time /Productive General Practice programme.

 

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