Thursday, August 30, 2012

5 or 6 S: Having a Prepared Work Space to Get to Higher Reliability and More Joy on the Job

I remember Sr. Francis Martin imploring her fourth grade class to keep their desks neat because it was easier to get your work done if you could easily find the right book, your pen, and the correct notebook. I also remember being an intern in a delivery room that was poorly stocked and poorly organized trying to resuscitate a baby and feeling very frustrated.

In last week’s blog, I described a “messy” workspace (Nathan’s hot dog stand on the NJ Turnpike) and I also complimented the Maryland Emissions Inspection station in Owings Mills because it had no clutter and everything was organized to get the work done as efficiently as possible.

What tool might Sr. Francis Martin and the Team at the VEIP station at Owings Mills have used to make their workspace ready to get the job done? Ok, Sr. Francis Martin probably had not learned from the Toyota Production System while she was teaching me in grammar school but I bet the designers of the emissions inspection stations have heard of the 5S or 6S tool. 

When Safety is added the 6 S’s are:

1. Sort: eliminating everything not required for the work being performed.
2. Separate: efficiently placing and arranging equipment and material.
3. Shine: tidying and cleaning.
4. Standardize: standardizing and continually improving the previous three.
5. Sustain: establishing discipline in sustaining workplace organization.
6. Safety: creating a safe work environment.

I was thrilled this week to visit Unit 48 and to see how orderly the Unit was. Taking care of post-operative patients is hard work but it is made a bit easier if everything is in its place. Also, I was the Chief Medical Officer at Boston Medical Center when we had two fires on inpatient units and I was reminded how important it is to keep hallways clear in case patients need to be evacuated quickly.

How is it that Unit 48, under the guidance of their nurse manager Cele Gayhardt, RN, got so orderly? Well, the biggest reason is because the Unit 48 Team has begun to use the theory of 6S. But there is another reason, too.

We all know that our hospital was built awhile ago, before we had the need for so much stuff to take care of patients. I have been in many hospitals that lamented that there just wasn’t enough storage space on a unit for all the stuff so they just left it in the hallways. At GBMC, we are very fortunate to have a well-designed system for removing equipment from our units when we don’t need it and bringing it back when we do.

Under the leadership of Judie Kusiolek, our Director of Environmental Services and Patient Transportation, and Larry Stevenson,  Assistant Director of  Patient Transportation , we have a system that is designed, measured, and continually improved by empowered staff members. This system is focused on the people it is serving – both the patient and the staff and it is built on teamwork.

Here is how it works: when a piece of equipment (e.g. a bed, stretcher, IV pump) is not needed on a patient care unit, a staff member calls x6600 and gives this message to the dispatcher at the Transportation Hub. The time of the call is logged into the system and a transporter is sent to the Unit to get the piece of equipment. The transporter brings the equipment to the Hub where it is logged into the system and stored awaiting the next time that it is needed. When a piece of equipment is needed by a unit, they call the Hub and a transporter is dispatched to bring it to the floor. When the trip is completed, the transporter calls an automated number and logs in that he or she has completed the delivery.

Our Transport Team does a marvelous job managing this system. The Team completes over 12,000 trips per month, up from 3,000 six years ago! The average time from initial call to completion of a trip is under 15 minutes. I had the pleasure of spending some time this week with Murrell Hearns, a 10-year GBMC employee. Murrell explained the system to me and demonstrated the process for moving a piece of equipment or a patient. He showed me the importance of checking in with the staff when he arrives on the Unit and the care he takes in cleaning the stretcher when he is moving a sick patient. I watched and listened as Murrell treated every patient with kindness and respect. Murrell was the embodiment of our vision in action.  

Our transport system is a great system. But where might this system break down? In other words, what are its failure modes? Well, the biggest failure mode of this system we might call hoarding. This occurs when staff does not believe that Murrell and his colleagues can deliver on the promise that they will bring the equipment back quickly when it is needed. In this case, they don’t trust the system and they keep the equipment in a corridor or just outside of the unit and this then leads to clutter. In this instance, the staff do not believe that the system is reliable. In an unreliable system, everyone does what they think is best for them, in this case they hoard, thereby making the system even more unreliable.

Sr. Francis Martin and the folks at the Owings Mills Emission Testing facility know about the importance of having everything you need and only what you need and in its place. We are learning this too at GBMC through tools like the 6S and with the work of our wonderful Transport Team and our Hub! Thanks to everyone for helping to make our hospital more reliable to make it easier to get to our vision.

What can you do to make your workspace better organized?

Cancer Prevention Study
GBMC continues to be a learning organization and research is part of the way we can continue to make lives better.   As part of this effort, GBMC is partnering with the American Cancer Society on its landmark Cancer Prevention Study-3 (CPS-3), which seeks to enroll 300,000 people nationwide. On Friday, September 14 from 9:00 am-1:00 pm in the Civiletti Conference Center, enrollment will be available for anyone between 30 and 65 years old who has never been diagnosed with cancer (not including basal or squamous cell skin cancer) and is willing to make a long-term commitment which involves completing periodic follow-up surveys at home. Researchers hope this study will allow for a better understanding of the genetic, environmental and lifestyle factors that cause or prevent cancer, which will ultimately save lives. Anyone interested in participating can contact Laura Schein, Community Outreach Coordinator for the Sandra & Malcolm Berman Cancer Institute at GBMC, at 443.849.2037 or, or visit


  1. Of the 6s system, number 4 and number 6 go almost hand in hand. Safety protocols need to be standardized across an organization so that all employees are contributing to a safe workplace culture.

  2. I would like to comment on the transporters and distribution workers who push strechers and carts thru the hall ways. That day you where touring with the director of EVS the transporter pushed the strecher thru a intersection with-out stopping to see if somebody was walking down the hall, I mentioned this to the Director and her answer was they need a mirror, to me that was the wrong answer she needs to tell her workers to stop and look before pushing a strecher or cart into another hallway I've mentioned this to other directors and VP and the answer I got was nobody has be hurt, why should we wait for a patient, visitor or an employee to get hurt by a 100lb stretcher or cart for people to be more safe. The Directors answer should of been your right and I will advise my works to stop and look before proceding through interconecting hallways.

  3. Very nice post, thanks for sharing the information. Keep up the good work.

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