Implementation of 5S - Continuous Quality Improvement assessment
in the case of Mutoko District Hospital, Mudzi District Hospital,
Murehwa District Hospital, Mutawatawa District Hospital, Louise
Gudoitti Mission Hospital, Nyadire Mission District Hospital, Suswe
Clinic, Kawere Clinic, Mashambanhaka clinic and Macheke Clinic in
Mashonaland East
1.0 Introduction
5s is the part of Japanese term ‘’ kaizen’’ means good change. 5S is the name
of a workplace organization method that uses a list of five Japanese words,
translated into English, they all start with letter ‘’S’’ that is Sort, Set, Shine,
Standardize, Sustain. 5S was developed in Japan and was identified as one of
the techniques that enabled Just in Time manufacturing. Although the origins of
the 5S methodology are in manufacturing, now it is widely embraced in many
industries including healthcare. 5S describes how to organize a work space
efficiently and effectively by identifying and storing the items used, maintaining
the area and items, and sustaining the new order. The 5S’s characterize a
continuous and never-ending methodology for creating and maintaining an
organized, clean, and safe high-performance environment. The first S, sort, is
about removing items that do not belong or are not needed in the workplace.
Set, the second S, focuses on having a place for everything in the best possible
manner to facilitate work flow. Shine the third S, sets the pace of the classical
idea of housekeeping, inspection, and preventative maintenance by making
sure everything is clean. The cleaner an area is, the easier it is to identify issues
that may hurt quality. The forth S, standardize, is what allows the recursive
process of the first three S’s to occur by creating standard procedures. Fifth S,
sustain, which keeps the lean implementations maintenance in the long-term
and ideally part of the culture.
It aimed at establishing a 5S intervention model to address common chronic
problems in the work environment of health centers, such as a lack of orderliness
with documents and supplies, deficient labeling and directional indicators of
service units, and precarious overall cleanliness. To improve work environment
both for employees and patients, Government of Zimbabwe has implemented
above said 5S strategy throughout health departments from clinics and district
hospitals to provincial hospitals. In healthcare organization this strategy is
directed towards improving efficiency, clinical outcomes or health status &
financial performance. This report provides insights onto the implementation of
the 5S – Continuous Quality Improvement to government healthcare facilities in
Mashonaland east.
1.1 Background
5S is a lean method for workplace organization and it is also management
method that has been recognized recently as a potential solution for improving
the quality of government healthcare services in low- and middle-income
countries after a gap on its implementation has been spotted. Quality
Improvement is based on a set of principles and is the strategy chosen by the
Ministry of Health and Child Care to help you accelerate improvements in key
clinical priority areas. Quality is about creating systems that support us to do the
right patient at the right time every time to achieve desired health outcomes.
1.2 Objectives
1. To study the implementation of 5S in the clinics and district hospitals in
Mashonaland East
2. To study the perception of staff regarding 5S implementation.
3. To see whether there is any major difference in implementation of 5s in
clinics and district hospitals in Mashonaland east
4. To assess the effects of 5S implementation in improving work environment.
3.0 Methodology
This study was done, utilizing a purposive sampling technique by taking 2 mission
hospitals and 4 district hospitals in Mashonaland east. The study was done using
ready to use checklist form for implementation of 5S, prepared by Provincial
Medical Directors’ office in Mashonaland East. The study was done between
25/07/22 to 29/07/22. For each S, scoring ranges from 1 to 5 were given
depending on answers - where 5 denotes for very well while 0 denotes for very
poorly. Verifications were also done using quality improvement plan, quality
improvement minutes as well as physical visits to the storerooms/pharmacy
stores. The assessment was based on the sample size of district hospitals, 2
mission hospitals and 3 clinics domiciled in Mashonaland East namely, Mutoko
District Hospital, Mudzi District Hospital, Murehwa District Hospital, Mutawatawa
District Hospital, Louise Gudoitti Mission Hospital, Nyadire Mission District Hospital,
comprising officers PMD’s offices.
Summary of Findings
Mutoko District Hospital scored respectively for QIC composition to S3 - 80%,
74%, 73%, 88%
Mudzi District Hospital score respectively QIC composition for to S3 - 60%, 80%,
62%, 85%
Murehwa District Hospital scored respectively for QIC composition to S3 - 80%,
66%, 73%, 83%
Mutawatawa District Hospital scored respectively for QIC composition to S3 48%, 66%, 64%, 75%
Louise Gudoitti Mission Hospital scored respectively for QIC composition to S3 92%, 86%, 73%, 85%
Nyadire Mission Hospital scored respectively for QIC composition to S3 - 84%,
63%, 65%, 65%
100%
80%
60%
40%
20%
0%
QIC Composition
S1
S2
S3
4. Discussion
As seen from the result there is not much difference between phc & subcentre.
Although phc able to score high compare to both sub centres in all groups. The
reason why phc scored better compare to both sub centres might be because
it is directly under supervision of medical officer daily. While medical officer
tends to visit sub centres once in a while. Sobecause of lack of supervision might
be the important factor why sub centres scored less. As per result for S1 (sort)
mostly all centers did well. Almost all staff took training of 5s. Routinely used
things were sorted & kept handy. Only laggard in this group was – we couldn’t
find any red tag on unused items. S2 (set in order) was lowest performing among
all. Though things were arrange properly we couldn’t found any labeling on
cupboard, rack, drawer etc. in all health centres. S3 (shine) performed lower in
all centres. Overall cleanliness was satisfactory in all centres. But low result was
due to nonexistence of operation room, x-ray room, generator room, autoclave
etc. which scored 0 (doesn’t apply) according to scoring system. Sub centres
score less than 50% because apart from above reason there was non-existence
of medical officer room, emergency room, wards, laboratory etc. S4
(standardize) scored satisfactory in all centres Work distribution for cleanliness
was done. Also cleaning material was available in almost all centres. Display of
5S was present. But we couldn’t found any monitoring sheet for cleanliness & so
does the supervision of it was also missing. S5 (sustain) good in all centres. Overall
perception of staff towards 5S was good but we could not found any separate
visit book as mentioned in check list.