5s Your Veterinary Practice

One of the questions I’m frequently asked about Lean is “where do I start?” Well, Lean is several things: it’s a set of tools, a management system and a philosophy, and as such needs to be considered altogether. Missing out any one of these vital components means you won’t see the maximum benefit of what Lean can deliver.

Having said that, staff doesn’t necessarily want to be bamboozled by the ins and outs of what Lean is from day one! The trick is to sew a seed. So, here’s a Lean tool that gets everyone into the spirit of Lean thinking within the practice.

5S: Sort, Set, Shine, Standardise, Sustain

Have you ever found yourself asking any of the following:

5S needed!

• Why am I out of 2ml syringes?
• Why are these cupboards full of leaflets?
• Where’s my stethoscope?
• Why do I have to leave the consult room every time I need nail clippers?
• Why is the microchip scanner always in a different place?

The 5 Steps of 5S

Chances are you probably have or at least can think of similar annoyances when you’re at work. The 5S methodology minimises all of these wasteful situations through better workplace organisation and visual management – remember, Lean strips out waste from our daily activities, increasing the amount of value-adding work we do. So how does 5S work?

1. Sort

The first step is to sort all unneeded, non-value-adding items taking up valuable space from those that are needed and value-adding.

So ask yourself how much of what surrounds you is actually needed or how much is there just because one day it might be needed, or even how much is there just because no one has every bothered removing it.

Now is the time, then, to remove all those information leaflets in the cupboard you were given about the latest canine super kibble that they don’t even make now, or the parts of broken computers and other equipment long since superseded by newer technology. Another favourite is yellowing stationery and dried-up pens from ten years ago lurking in the bottom drawer of the consulting room.

Example of a red tag used in the Sort phase of 5S

The really obvious unwanted items should be immediately disposed of whilst more questionable items are “Red Tagged” and moved to a holding area for a specified period of time, often one week. If no one claims tagged items, then these too can be suitably disposed of. Claimed items must have a genuine value-adding purpose and should be replaced in a suitable position based on frequency of use (see below).

2. Set

Don’t stop now! Give remaining items a logical, ergonomic home. This is also a good stage to recognise any missing items and replace them. Consider equipment and stock that may be located in other areas of the building that are more appropriately located in the area undergoing 5S but beware of adding unnecessary extra inventory to your newly sorted area.

Spaghetti diagrams can be useful in illustrating the wasted motion of staff members fetching necessary items when performing an activity. Such an example is given below.

Spaghetti diagram to show motion of a nurse setting up for an iv cannula

A simple 5S solution for iv cannula placement

Ideally, you want to place equipment, consumables and stock you use, say every consult or every operation, as close to hand as possible. Lean encourages visibility (to avoid wasted time searching) so you may have such items stored on top of counters in open containers instead of in drawers.

The proximity and ease of access to lesser-used items should then logically dictate their location. Don’t be tempted to slip into old habits by hiding unneeded items behind closed doors!

3. Shine

The shine step focuses on cleanliness in the work area. As a clinical environment, we need to be concerned with such things as infection control and should therefore always be striving towards a thoroughly clean workplace.

Dust collecting on top of surfaces may go unnoticed, such as this air-conditioning unit.

Familiarity with our surrounding environment often leads to desensitisation and we soon don’t notice that layer of dust building up on top of the cupboards or vaccine fridge, or the hair that’s accumulating amongst the tangle of various wires.

So “shine” is essentially a thorough cleaning of the work area. It also helps to alert us to problems that may go unnoticed such as leaking dental equipment or autoclave, frayed wiring, spillages etc. Shine should not be considered as a “making work” activity but as an opportunity for the clinical team to show pride in their workplace at all times. And if we’re lucking enough to have a cleaning team, we should still take responsibility for the finer details of cleaning our immediate workspace.

4. Standardise

In order to maintain the 5S status of a work area, it not only needs to be easily reproducible to the same standard each time 5S is carried out, but also easily maintainable throughout every working day.

This means that the person working in that area has some kind of reference to be able to replace items in their designated location after use. For example, a vet or nurse should readily be able to know that the nail clippers belong in the top drawer or that the thermometer lives in a pot to the right of the computer. No one should have to guess where items go.

There are a number of ways of achieving this: one is to display a simple laminated sheet with all items listed alphabetically with their designated location for quick reference. Another is to “shadow” the location of items with fine tape to show their physical outline on a work surface. A third method is to label each area, drawer or cupboard with the contents of each. And a fourth method is the use of foam drawer liners with shapes of various pieces of equipment cut out to provide a safe and neat method of their storage. Of course, each solution has its merits and the most practical one should be sought.

As far as is possible, standardisation should also extend across any separate but similar work areas. For example, if there is more than one consulting room then it is Lean logic to have them arranged in a similar fashion to each other. This cuts down wasted time and effort familiarising yourself with the location of items in the event of switching rooms.

An important point about standardisation is that standards should be designed by those members of staff doing the work, not handed down from more senior management who may not even set foot in the work area undergoing standardisation.

In addition, standards are not rigid. There may be times when exceptions must be made and if such exceptions are being made frequently then it must be asked whether the current standard is indeed the best standard to be working to. We should always be striving to improve our processes and this may mean occasionally rewriting standards as appropriate.

5. Sustain

Perhaps the hardest part of 5S is sustaining all the efforts of the first 4S aspects. This is why practices need to build in some kind of audit or quality management system to ensure 5S does not become just a one-off event. Additionally, our 5S efforts should be regularly reviewed to search for improvements upon the existing process.

It’s often immediately evident to staff when 5S improvements are not being sustained as the work area becomes messier, things begin to go missing and our daily work becomes more frustrating. We all have a responsibility to sustain our improvement efforts and we should be thinking not just about improving our own jobs but those of our colleagues who have to work with and around us.

5S is as much about respect for people and self-discipline as it is a tool to improve the workplace and this is why it embodies the philosophy of Lean more than it may at first seem. This is also why it’s a great starting point towards a Lean practice.

Finally, the successful implementation of 5S requires clear communication to all members of staff why 5S will benefit the practice, clients and patients, as well as why it will be of benefit to them (the “what’s in it for me”). When carried out effectively, 5S can create a united team who are positive and motivated about continuous improvement and to taking that first step towards a Lean veterinary practice.