Understanding 5S: How does Visual Management activate our brain? Gabriela Salim Spagnol Nurse & MSc student, School of Medical Sciences Research Group for Innovation and Healthcare Management, University of Campinas – Brazil Co-Authors: Brunno M. de Campos, Research Physicist & PhD Student and Li Min Li, MD, PhD, BBA Professor, School of Medical Sciences, Brazil 1

AFTERBEFORE “If I can see it, I can fix it” Dr. Thoralf Sundt of Mayo Clinic 1. Visual Management (Shook, 2012) 2

The 5S event (Spagnol, 2015) 3

(Kanamori et al, 2015) Sri Lanka, Tanzania and Senegal 5S: officially adopted as a national strategy United States Jordan India Sri Lanka The 5S event in healthcare Improves process flow Increases capacity Reduces infection rate Releases time for direct care of patients Improves patient and professional satisfaction 4 4

Neuroscience & Visual Management Hypothesis: Neuroscience can provide further understanding to improve visual management. Hypothesis: Neuroscience can provide further understanding to improve visual management. Image: BRAINN website 5

Oxyhemoglobins Oxygen Deoxyhemoglobins 6 O2 ≠ Magnetic susceptibility Blood-Oxygen-Level Dependent signal

Q1 - What is the best visual arrangement for performance improvement and error reduction? Investigation of subjects performance when required to search objects in images that illustrate different steps of 5S. Q2 - What are the neural correlates of information processing in different stages of 5S? Investigation of brain activation in subjects when required to search objects in images that illustrate different steps of 5S. Research questions 7

Lean Education Course A courtesy of Prof. Murmann, MIT 8

2. Methods Participants  40 (22 female): university community  Age = 26 years [SD=8.0]; 19–50 years; 9 (a courtesy of Prof. Murmann, MIT) 10s to read instruction 20s to circle objects

Image acquisition and processing (Arcuri & McGuire, 2001) 3 Tesla MRI scanner (Philips Achieva) 3 Tesla MRI scanner (Philips Achieva) Functional Image: BOLD signal Functional Image: BOLD signal Structural Image 10 Analysis in SPM8 (Statistical Parametric Map) for MatLab

Paradigm of stimuli presentation 11

Number of correct objects 3. Results – Q1: Performance of Participants Significant differences (p<0.001, paired t-test): 12 T1 T2 T4 T5 T2 T4

13 Number of incorrect objects

(Task 5 – Task 1) Results – Q2: Brain Activation Left posterior superior view Right lateral view Left lateral view 14

Middle Temporal Gyrus Recognition of patterns (Achenson & Haggort, 2013; Sakurai et al, 2008) 15  Cognitive intelligence: problem solving, comprehension of communication and spatial relations Superior and Inferior Parietal Lobule 標準

Q1 - a major increase in performance was achieved when all 5S`s were implemented. This study shows Discussion 16 Q2 - a significantly higher activation in specific pathways during T5 when compared to T1: Recognition of patterns Problem solving, communication and spatial relations Suggesting that… -visual attention targets individual objects, which are perceived as patterns, not their categories.

Most important... Visual arrangement must place objects individually, not only in categories, applying all steps of 5S to fully achieve its advantages. 5. Conclusion 17

Gabriela Spagnol, RN, MSc Student School of Medical Sciences Research Group for Innovation and Healthcare Management University of Campinas – Brazil 18