Invited presentation prior to Kaizen Even at the Allegheny Regional Hospital in Low Moor, VA. December 2011

1. 5S Training
Created for LewisGale Hospital at Alleghany
Kaizen Event Team
Sort
Pablo F. Cárdenas Orlandini,
PhD Student
Virginia Tech
December 2, 2011
Standardize
Sustain
Shine
Straighten

2. Kaizen Event Agenda
1.
2.
3.
4.
5.
6.
7.
8.
9.
Event kickoff
Goals of event
Hospital survey results
5s training
Overview of 5S audit tool
Ground rules of event
Brainstorming activity
Planning home locations
Implementing 5S method

3. 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

4. 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

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

6. 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

7. 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.

8. What are the issues in this
work environment?

9. 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!

10. Breaking Down
Each S

11. #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

12. 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.

13. 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).

14. SORT Strategies: Red Tagging

15. SORT Strategies: Red Tagging

16. 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

17. SORT Example:
Donations
• Unused shelves given to hospital employees

18. SORT Example:
Item Relocation
• Bins are removed from the workspace and
moved to different sections of the hospital

19. SORT Example:
Disposal of Expired Items
• Expired scrub brushes
Expired 9/2008

20. 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

21. 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

22. SORT Example:
Adjustment of Item Quantity
• Adjusting par-levels and warehousing
overstock items

23. SORT In Action!

24. 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

25. #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.

26. STRAIGHTEN Strategies
• Based on visual management
o
o
o
o
o
Labeling
Signals
Color coding
Shadow boxes
Discipline squares
• Distribution of items by location
o
o
o
o
Arrange by frequency of use
Group like items together
Group items together that are used together
Arrange in natural order

27. STRAIGHTEN Strategies:
Visual Management
• Visual Indicators
o
o
o
o
Outlining /Foot-Printing
Borders
Home and Return Addresses
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.

28. STRAIGHTEN Strategies:
Visual Management
• Comprehensive labeling.

29. STRAIGHTEN Strategies:
Visual Management
• Applying color-coded twist ties to equipment to know
where to return equipment to.

30. 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
o
o
o
o
Item Name
Part Number
When and how many are needed
Where the item is to be delivered
Contact name and phone number

31. 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

32. Start picking from the left bin
Implementation of
the Two-Bin System
Once you run out of items
from the left side, pick from
the buffer
Now it’s time to order more
and replenish!

33. STRAIGHTEN Strategies:
Discipline Squares
• Applying tape on the floor to create
equipment layout.

34. STRAIGHTEN Strategies:
Discipline Squares
Before
Disorganized IV Stands and Cylinders
No visual indication regarding location of equipment

35. 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

36. 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 Items are now in the
Swan Items are put
same cabinet and in thewere relocated, disposed
together!Items same
or donated
quantity

37. STRAIGHTEN Strategies:
Rearrangement of Supplies
• Complete rearrangement of supplies via
consolidation, and process flow improvement.

38. STRAIGHTEN Strategies:
Rearrangement of Equipment
• Clearing and rearranging equipment and
shelves.

39. STRAIGHTEN Example:
Better use of Vertical Space
• Using PVC pipes to create additional storage for extra
long items.

40. STRAIGHTEN Example:
Better use of Vertical Space
Information material
using half of the space
After
Before
Items that go together
are kept in the same
cabinet
Items were moved to different
cabinets

41. 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

42. 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

43. STRAIGHTEN Example:
Implementing Visual Aids
Old and not corresponding labels
List Old attachments removed
describes Par Items contained
Unnecessary document
Before
After

44. 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

45. 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

46. STRAIGHTEN In Action!

47. #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!!

48. 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

49. SHINE Examples
• A medication room before and after the first
three S’s

50. SHINE In Action!

51. #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.

52. 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

53. #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.

54. 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

55. SUSTAIN Strategies: Identifying
Issues and Future Improvements
• Conducting audits of the room daily for the next few
weeks to help sustain improvements.

56. SUSTAIN Strategies: 5S Audit Tool
LewisGale Alleghany 5S Audit Form
Audit Date:
Area:
Operating Room
Person auditing:
Poor
Marginal
Good
SD
SD=Strongly Disagree D=Disagree
sd=somewhat disagree
sa=somewhat agree A=Agree
SA=Strongly Agree
Category and Item
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.)?
SAFETY
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
Are there unnecessary equipment, supplies, tooling, or materials in the area?
Are there unnecessary items stored/placed on cabinets or shelving units?
SORT
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
D
sd
sa
A
SA
1
2
3
4
5
6

57. SUSTAIN Strategies: 5S Audit Tool
LewisGale Alleghany 5S Audit Form
Audit Date:
Area:
Operating Room
Person auditing:
Poor
Marginal
Good
SD
SD=Strongly Disagree D=Disagree
sd=somewhat disagree
sa=somewhat agree A=Agree
SA=Strongly Agree
Category and Item
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
D
sd
sa
A
SA
1
2
3
4
5
6

58. SUSTAIN Strategies: 5S Audit Tool
LewisGale Alleghany 5S Audit Form
Audit Date:
Area:
Operating Room
Person auditing:
Poor
Marginal
Good
SD
SD=Strongly Disagree
D=Disagree sd=somewhat
disagree sa=somewhat agree
A=Agree
SA=Strongly
Agree
Category and Item
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?
STANDARDIZE
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
Is the 5S process and progress discussed at Staff Meetings?
Is time to actively "5S" the area regularly planned and conducted?
SUSTAIN
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
D
sd
sa
A
SA
1
2
3
4
5
6

59. 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!

60. Thank You!