5S Audits and LEAN in Healthcare - a technique for the controlling micromanager

Let's take 5S and Audits to mean that you have identified a checklist of criteria that can be observed showing that a workplace is being maintained to standard, monitored with results posted in the workplace.

Definition of 5S:

5S – (Sort, Shine, Set in Order, Standardize, and Sustain) A method of creating a clean and orderly workplace that exposes waste and errors.  

http://www.mayomedicallaboratories.com/about/quality/framework/glossary.html

Now, let's look at TheLeanThinker's blog entry on 5S erosion:

http://theleanthinker.com/2010/08/03/5s-erosion-continued/

"Note that I am not questioning the value of having a standard for workplace organization. I am not even directly challenging audits, measurements, etc. However these things must have a clear purpose, or we are just blindly implementing tools and repeating mantras. And if we cannot articulate the core purpose of these things to each other, how can we ever ask others to do these things with any more authority than “because I said so” or “because it is in this book?”

The LEAN intruder could not agree more with the LEAN thinker.  This makes sense, doesn't it?  Let's not "blindly implement tools" without clear purpose.  This is LEAN Intruder's main bone to pick with LEAN - BLIND IMPLEMENTATION of TOOLS.  Now, more on the story with a response to the LEAN Thinkers blog entry with LEAN Intruder's (LI) comments:

Jim Fernandez wrote:

OK, I’ll give you the simple answer. I can tell you what the purpose of the audits have been here where I work. Not in any particular order of importance:

1. Audits provided a score that was posted in the cell area. It was supposed to create some healthy competition between cells. And thereby, hopefully, some motivation to maintain the 5S condition.

LI comment:  Not sure what group of employees engages in healthy competition between cells.  Haven't found it to be the case with cells of nurses or cells of laboratorians.  Maybe the cells of surgeons would respond (ha!) - they are a competitive bunch. (smile).  Healthy competition between cells huh?  Sounds like a white man's game to me- healthy competition (perhaps another oxymoron)  Right?    Not sure the female dominated health care fields will hunker down for this one.

2. Audits were a means to a free lunch. The audit score was used to give awards (a free pizza lunch) for the cell with the highest score.

LI comment:  This is an epidemic in our schools - the pizza party as reward.  The elementary kids may buy this approach, but once you get past middle school it's not the reward that works for the masses.  Let's offer the neurosurgery cell vs. the othopedic cell a free pizza lunch for the best performance on their audits - yeah!

3. Audits provided at’ta boys. They provided feedback to the workers telling them that management, or other cell leaders, thought they were doing a good job.

LI comments:  Intrinsically motivated health care workers aren't much for the at'ta boy.  

This sounds so paternalistic, and again appealing to the white male hospital management club.  

4. Audits provided feedback to the workers to tell them which area of 5S needed more work. And which area was “good enough”.

LI comment:  The workers can't figure that out for themselves?  Are you kidding?  It's their workplace isn't it?  Aren't they familiar with expectations and the critical needs for the job to be done well and the area to be neat?

Most people went to school and are used to getting grades. If they get a B+, they can be proud. If they get a D, they know they need to try harder.

LI comment:  And some people give up with the D, especially if what they are being asked to do is stupid, pointless, and instituted by a manager who wants to show off audit sheets to tour groups.

The problem that the audit was supposed to solve was a lack of adherence to 5S principles.

LI comment:  Lack of adherence to 5S principles.  Take a look - that's some serious cult talk there - it's a piece of jargon that cannot stand alone.  Sad.

We observed the problem by noticing that the work areas were falling back into a pre 5S condition.

LI comment:  And this is defined in LEAN terms as the human element as resistant to change. 

Posted 03 Aug 2010 at 11:19 am ¶

5S and Audits provide a very neat platform for controlling micromanagement in Healthcare. The more micromanagement, the less likely the team is to perform at peak levels.  So wake up all you controlling micromanagers and get back to finding something else to do with your excess time at work.