Cone Health Alamance Regional Medical Center

What is 5S?
5S is a foundational principle of Lean management systems. The acronym 5S stands for: sort, set in order, shine, standardize and sustain.

In Lean manufacturing organizations, a 5S program is used to optimize the work environment. This is because cleaning the workplace and making items easy to find helps improve productivity over the long term.

The 5S relationship to continuous improvement
5S events are often misconstrued as simply work area cleaning or straightening exercises. However, 5S in a laboratory environment is actually meant to assist with the design of standard work that meets “necessary” quality and productivity measures.

5S can be easily associated with ISO and CAP requirements. However, before you can focus on the necessary, you have to remove the unnecessary from the environment. This leads to sorting, straightening and shining activities.

Engaging the Lean enterprise in 5S
5S is also a team engagement strategy. The team responsible for the work gather together to use the appropriate tools, then decide what’s needed to complete tasks on time and defect free.

This generates conversation around best practices and lays the groundwork for discussions pertaining to documentation of standardized best practices and their sustainment. Hospital teams in a laboratory moving to that point in their 5S journey are making headway toward becoming high performing. As high-performing teams, they are systematically defining and monitoring standard work to improve quality related to work sequence and processes.

This mindset and the associated behaviors lead to outcomes that are impactful and powerful. Think about how Lean a laboratory would be with engaged employees sharply focused on sustainment of standardized best practices. That’s why 5S is considered a foundational set of tools that assists organizations with Lean maturity development (see Figure 1).

The Lean System

Figure 1. 5S + Safety is the foundation of a Lean system.

Identifying challenges, finding opportunities
Cone Health Alamance Regional Medical Center (Alamance) in Burlington, NC, is a 238-bed, not-for-profit community healthcare organization. 

The Alamance laboratory needed to find ways to reduce waste and improve efficiency. To accomplish this, Alamance teams embarked on a thorough analysis of workplace organization issues. During the analysis, two sources of issues were frequently cited: sample flow and people flow.

Realizing there was an untapped opportunity to address both of those concerns, Alamance teams sought to improve flow through laboratory workstations. 5S events were the answer.

How Alamance used 5S to improve laboratory workflow
With help from our performance partnership consultants, the Alamance laboratory team members who most often worked at the workstation were engaged to conduct 5S events.

The 5S events included:

• Team-based approach to work evaluation 
• Use of team-based tools to evaluate the current state of the laboratory’s organization 
• Exercises to identify points of use and areas for enhanced workstation design and organization
• Guiding principles to ensure associate safety in an organized laboratory environment

In addition to reinforcing the cultural value of team-based collaboration, the Alamance laboratory also experienced observable and quantifiable benefits from their 5S events.

Created six new workstations
To better address their volume and variety of incoming tests, Alamance created six new functionally organized workstations as part of their 5S program:

• Send-out/pour-off
• Non-STAT spin station
• Cytology drop-off
• Print-and-fax station
• Osmolality
• Fetal fibronectin

Optimized sample-receiving workstations
Reorganized workstations and relocated centrifuges eliminate people travel and induce improved sample flow (see Figure 2).

Before and After: Sample-receiving Workstations

Figure 2. Before and after views of sample-receiving workstations show the effects of 5S. 5S “straighten and shine” activities reduced clutter. Organizing “necessary” items for best use (labeling, shadowing, rearranging according to use) put items in reach and help to ensure they stay in place over time.

Enhanced workplace safety
Alamance’s cytology drop-off station was a wheeled cart, which posed occupational hazards and impeded workflow. Building a stationary, dedicated station resolved both issues (see Figure 3).

Before and After: Cytology Workstation

 Figure 3. Before 5S, the cytology workstation was a dedicated point-of-use workstation out of the walkway. After 5S, the workstation was moved to a stationary alcove, which improved workflow and eliminated the trip hazard.

Improved laboratory workflow
After completing 5S/continuous flow training, as well as completing the 5S sort, straighten and shine exercises, Alamance was able to:

• Improve chemistry workflow 
• Improve their urine workstation 
• Improve sample receipt workflow 
• Improve overall laboratory workflow 
• Relocate equipment and work tables to reduce people travel and streamline pathways (avoiding circuitous routes) 
• Drive time and resource savings

Alamance also achieved significant quantifiable productivity results as a result of 5S (see Figure 4):

• Saved 219 hours per year in people travel based on 295 trips per day 
• Saved 20 hours per year in workflow-related time 
• Achieved combined savings of 239 people hours per year

Time Savings from Laboratory 5S Event