Tuesday, May 17, 2016

Do You See the Clutter?

February 2015
Making It Easier (and Safer) to Get the Work Done on an Inpatient Unit
July 2013
It’s easier to get the job done when everything is in its place - 5 (or 6) S's revisited
August 2012
5 or 6 S: Having a Prepared Work Space to Get to Higher Reliability & More Joy on the Job http://ahealthydialogue.blogspot.com/2012/08/5-or-6-s-having-prepared-work-space-to.html

I have written about the concept of 6 S's in this blog three times previously. So last week, when I was returning a wheelchair, to a wheelchair storage area, I wondered how many of my colleagues had walked by that wheelchair and had not returned it to where it belongs. I began to reflect on the reasons why things get out of place.

When I walk through the halls of GBMC, I often find stretchers, chairs and other things where they don’t belong. We don't want to put clinicians in the position of having to do work-arounds to meet patient care needs because they cannot locate the proper equipment. Things get out of place for many reasons. Sometimes we are doing something and feel rushed to get on to the next task that we leave an item anywhere we can just to quickly get on with our work. In these instances, we sometimes tell ourselves that we will put the thing anyway later, and then we forget. Sometimes things need to be returned to a place off our unit or department and we need to call transport to retrieve it which takes time. Sometimes we don’t know where something truly is stored.

When something is already out of place, like the wheelchair I found, there are many reasons why they don’t get returned. Sometimes we are in a hurry and feel we don’t have the time to return something to its correct place. Some people believe that it isn’t their job to replace things that they did not displace. I also think that we get immune to clutter and we begin to not “see” it. It becomes the usual to have “stuff” everywhere. Then there is the concept of “hoarding”. Sometimes we keep things where they don’t belong because we are afraid that if we put it back where it belongs (especially if it is stored at a distance from our workplace) that we won’t be able to get it back when we need it. This, of course, guarantees that someone won’t get it when they need it if no one else knows where it is. This is why we created an equipment hub in 2012. When people don’t trust the equipment storage system and they hoard, they unwittingly make the system less reliable.

Why should we care? I think there is a true hierarchy of reasons why we should not accept clutter. The first is patient and staff safety. I told the story in this blog of being in a hospital that had a fire and patients needed to be moved quickly. Beds, stretchers and other things in the hallway were a true safety hazard that day. The second is patient engagement. No one thinks well of a cluttered hospital. The third reason is it makes it harder for us to get our work done if we can’t find what we need or have to work around things that don’t belong where they are.

We need to create better accountability for our facilities staying in 6S condition. So, in case you have forgotten the 6S’s, they 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.

All managers must own their workspace and audit for clutter at some regular interval. They must enroll their people in keeping the department or unit clutter free. Our performance improvement colleagues will be happy to help managers create a system to make it easier to keep your space ready for business.

But we as individuals must avoid leaving things where they don’t belong and also help and remove clutter as we find it. If we all commit to this, it won’t be so hard because it will become much less frequent to find something that isn’t in its place.

What do you think?


  1. I was a patient at GBMC about a month ago. First I must remark that I felt that the health care services I received were excellent. However, I did notice clutter on the unit during my in-patient stay. I was able (and encouraged) to walk the halls before and after my procedure. However, I had to navigate around various obstacles. This was somewhat difficult when I had an IV pole to drag along. Even more concerning was the fact that I saw unattended computer workstations left logged on/unlocked. This was observed on the unit as well as in the ER. I would imagine protected health information was easily visible by peering eyes.

    I appreciate the opportunity to participate in this dialogue. I feel staff, management, administrators and patients can all contribute to improving the 6S's.

    1. Thanks, anonymous. The workstations do timeout after a short period of inactivity. We are asking our managers to own their own space to improve this situation.

  2. I think part of the issue is that when I am arriving at work and I see a wheelchair or cart in a place it does not belong, I don't always feel like I can return it because I might not be on time to clock in on my unit. If I did happen to return something and am 1 minute late clocking in I get an occurence. Same thing for walking a visitor to their location. I can't be late for work even though I am here helping I am not clocked onto my unit and therefore will be penalized.

  3. Thanks, Anonymous. And if you would not otherwise be late do you remove the clutter?


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