Surgery centers can put workflow processes in place that are sustainable — if leaders use the right tools. One way is directing the team to collaborate using the Lean method and its philosophy of “5S.”

As defined by the American Society for Quality, the five S’s are: Sort (separate items in the space, eliminating whatever is not needed); Set in order (organize remaining tools, equipment, and supplies, arranging and identifying them for easier use); Shine (keep the workplace clean); Standardize (schedule regular cleaning and maintenance so the workplace looks the same each day and over time); and Sustain (Make the five S’s a way of life and a habit for employees). (Learn more online at:

The foundational philosophy of 5S pertains to a workplace making equipment and supplies available at the precise place where they are needed, according to Brian Selig, DNP, MHA, RN, director of perioperative services at the University of Kansas Health System.

Following this Lean process, Selig says his health center saw a substantial reduction in lead time, cutting off 90 minutes over the first couple of years. The health system followed the Lean and 5S process to reorganize its surgical bays, making their workflow more efficient.

The first step was to empty the room and sort through each supply item and piece of equipment. “We went through everything, saying, ‘Do we need this piece of equipment?’” he explains. “If not, then we would get rid of it and put it where we would need it.”

For example, if the operating room only needed 10 of a particular item, but there were 12 in stock, the extra two items were removed, he says. “If we need a basket on this side of the room, we put it there,” Selig says. “If a scanner doesn’t reach across the room, we make it wireless.”

The goal was to put the precise items needed in the best location for easy access. This reduces the amount of time staff spend reaching or hunting for what they need. “You spend a lot of time making that one room right so your staff can minimize movement and time,” Selig explains. “You don’t have extra junk in the room that you don’t need.”

Certainly, the 5S process can be time-consuming. Going through the initial clean-up process with one room can take a couple of days, Selig notes. “We’ve done week-long workshops on a single storeroom,” he recalls. “It’s all about making sure you know where everything is at all times. I should be able to know when I walk into the room that there will be 10 test tubes in that area at any moment.”

When the room is changed and everyone agrees it is arranged as needed, then all other rooms go through the 5S process. “All of the rooms are the same, with the same experience and expectation in every space,” Selig says. “It’s one of the foundational things of Lean that is really important because it makes sure there is no waste or expired products or items that are not used.”

The process also makes employees more efficient in their work, giving them more time to spend with their patients, Selig adds. To sustain the reorganized rooms, the 5S process is followed through daily observations. “At the end of every shift, someone does an observation,” Selig says.

Someone observes the operating room, using a map of where everything should be and how it looks to make certain all items are returned to their proper place. Employees receive hands-on, written, and visual instructions on how to conduct these daily observations.

For instance, there are pictures hanging in each room. These pictures show where the sharps bin is located, where the trashcan sits, where a container of pens goes, as well as where everything else is located. The pictures can be photos of the actual items or illustrations printed from online sources. Selig says staff should be able to reset a room at any time using these visual cues alone.

“There’s a parking space for everything,” Selig says. “That’s the way we learned it, and we’re doing this across our organization.” Another way Selig helps his staff stick to the 5S process is with another phrase: “Trust the process.”

“Change is so hard,” he acknowledges. “It can be such a frustrating thing because people get stuck in their comfort zone, whether you like it or not or believe in it or not.”

Part of maintaining sustainability is measuring results. The University of Kansas Health System collects data on the number of rooms that are not reset correctly and the number of times a standard work process is not followed, such as whether people signed their names to documents, as required. “We look at the process, whether the result was there or not,” Selig explains.