1. By Dr Naphtali Agata Consultant (Health Sector) RSU for Africa, JICA
Role of 5S-Kaizen/CQI-TQM in Improving Health Sector Governance and Accountability By
Dr Naphtali Agata
Consultant (Health Sector)
RSU for Africa, JICA
GAC Regional Health Workshop
Nairobi, Kenya
March 2011

2. Presentation Outline Background Introducing 5S-Kaizen/CQI-TQM
Applying the 5S-Kaizen Principles
Implementation in the Health Sector in Africa

3. Background: Why Quality Improvement in
Provision of Services?
A report is lost
A long waiting for response to an inquiry
A driver is unable to get an officer to attend to an emergency or for mission travel
A loss of critical clients
A high staff turnover
A failing supply chain
In a disorganized enterprise….

4. Introducing 5S Principles
"5S" originally developed in the Japanese manufacturing industry in the 1960s
Used as a tool for product quality control
Stands for five (5) Japanese words that start with the letter 'S‘ with English/French/Swahili equivalents:
Seiri （整理）
Seiton （整頓）
Seiso （清掃）
Seiketu （清潔）
Shituke （躾）
Sort/Séparer /Sasambua
Set/Systématiser/Seti
Shine/Salubrité/Safisha
Standardize/Standardiser/Sanifisha
Sustain/Se discipliner, Shikilia

5. Introducing 5S Principles
Structured processes to systematically achieve total organization, cleanliness, and standardization in the workplace
It boosts the morale of the workers, promoting a sense of pride in their work and ownership of their responsibilities
A gateway to Total Quality Management (TQM)
A well-organized workplace results in a safer, more efficient, and more productive operation

6. Introducing Kaizen/CQI - TQM
Kai = further;
zen = good
Improvement for better – Ongoing: Continuous quality improvement (CQI)
Total quality management: a management philosophy that focuses on doing business to
satisfy the customer – the person paying for the product (Demand side)
satisfy the supplier (of goods and services)
continuously improve the business processes

7. THE 5S-KAIZEN PRINCIPLES
APPLYING
THE 5S-KAIZEN PRINCIPLES

8. <1> Sort:. Remove unused stuff from your place of
<1> Sort: Remove unused stuff from your place of work and reduce clutter
(Separation/Removal)
<2> Set: Organize everything needed in proper order for easy operation
(Orderliness)
<3> Shine: Maintain high standard of cleanliness (Cleanliness)
<4> Standardize: Set up the above three Ss as a part of the routine at every section in your work place (Sort, Set and Shine as a system)
<5> Sustain: Train and maintain discipline of the personnel involved
(Discipline)

9. Sort

10. Used and Unused information…All in a mess.

11. Sort
Needed records are sorted….But…!

12. <1> Sort:. Remove unused stuff from your place of
<1> Sort: Remove unused stuff from your place of work and reduce clutter
(Separation/Removal)
<2> Set: Organize everything needed in proper order for easy operation
(Orderliness)
<3> Shine: Maintain high standard of cleanliness (Cleanliness)
<4> Standardize: Set up the above three Ss as a part of the routine at every section in your work place (Sort, Set and Shine as a system)
<5> Sustain: Train and maintain discipline of the personnel involved
(Discipline)

13. Seiton - Set Orderliness is all about efficiency
Putting everything in its proper order/ location so that it can be
Accessed or retrieved quickly
Easily returned to the same place
Setting items in their proper order leads to
Efficient workflow
Enhanced productivity
Correct place/position should be selected carefully in relation to how work will be done

14. Sort
Set

15. 5-S Labeling and tagging Simple but effective methods 1999
2001
2000
1999
Make Visible A1 A2
Labeling and tagging

16. After 5-S: Better organized with labeling
Improved retrieval time

17. Retrieval time reduced from 10min to 10 seconds
OPD reception at a health centre in Lusaka
Set
Retrieval time reduced from 10min to 10 seconds

18. Medical ward before 5s

19. Medical Ward after 5S

20. Telephone Desk with list of essential phone numbers

21. <1> Sort:. Remove unused stuff from your place of
<1> Sort: Remove unused stuff from your place of work and reduce clutter
(Separation/Removal)
<2> Set: Organize everything needed in proper order for easy operation
(Orderliness)
<3> Shine: Maintain high standard of cleanliness (Cleanliness)
<4> Standardize: Set up the above three Ss as a part of the routine at every section in your work place (Sort, Set and Shine as a system)
<5> Sustain: Train and maintain discipline of the personnel involved
(Discipline)

22. Seiso - Shine Cleaning up the workplace and giving it a 'shine‘
Must be done by everyone in the organization (participatory)
Clean environment enhances safety and productivity

23. NO motivation for perfection to cleaning staff …!

24. Shine: Participatory
Your territory can be better arranged and cleaned only with your participation…!

25. <1> Sort:. Remove unused stuff from your place of
<1> Sort: Remove unused stuff from your place of work and reduce clutter
(Separation/Removal)
<2> Set: Organize everything needed in proper order for easy operation
(Orderliness)
<3> Shine: Maintain high standard of cleanliness (Cleanliness)
<4> Standardize: Set up the above three Ss as part of the routine at every section in your work place (Sort, Set and Shine as a system)
<5> Sustain: Train and maintain discipline of the personnel involved
(Discipline, Change of Mind-Set)

26. Seiketsu - Standardise
Standardised sorting, setting and clean-up
Defining the standards by which personnel must measure and maintain 'cleanliness‘
Encompasses both personal and environmental cleanliness
Visual management such as color-coding and standardized coloration of surroundings is an important ingredient of seiketsu

27. Make slogans visible
Standardize

28. Colour coding applied for visual display

29. Self-explanatory signboard at entrance of a hospital
Enhances Transparency and is client friendly

30. One of pilot hospitals in Malawi

31. MATHARI HOSPITAL KENYA
MAIN GATE
One of pilot hospitals in Kenya
with clear directions at entrance 31

32. Improvements at Mathari Referral Hospital in Kenya

33. Locations of office equipment designated and labeled

34. Details attached to each equipment to facilitate handling and use

35. <1> Sort:. Remove unused stuff from your place of
<1> Sort: Remove unused stuff from your place of work and reduce clutter
(Separation/Removal)
<2> Set: Organize everything needed in proper order for easy operation
(Orderliness)
<3> Shine: Maintain high standard of cleanliness (Cleanliness)
<4> Standardize: Set up the above three Ss as a part of the routine at every section in your work place (Sort, Set and Shine as a system)
<5> Sustain: Train and maintain discipline of the personnel involved
(Discipline)

36. Shitsuke - Sustain Discipline – Positive attitude development
Denotes commitment to maintain orderliness and to practice the first 4 S as a way of life 
Emphasis is elimination of bad habits and constant practice of good ones 
Once true shitsuke is achieved, personnel voluntarily observe orderliness and cleanliness at all times, without having to be reminded by management.

37. Sustain
Improve attitude to learning and practice

38. One of pilot hospitals in Kenya: Promoting transparency and accountability

39. 24 December 2010

40. CA Coast Provincial Hospital with Trophies worn 2009 & 2010

41. In Summary
5S – Kaizen
Is a participatory process involving all levels of an organisation (QIT and WIT)
Promotes transparency in running affairs of an organisation
Facilitates creation of a sense of ownership among the workforce in an organisation
Has a focus quality for the customer
Promotes efficiency

42. Implementation of Strategy in Africa
Group 1 Countries
Implementation started March 2007
Eritrea, Kenya (Mathare Referral and CPG Hospital), Madagascar, Malawi, Nigeria, Senegal, Tanzania (Mbeya Referral Hospital) and Uganda (Tororo Hospital)
Group 2 Countries
Implementation started in March 2009
Benin, Burkina Faso, Burundi (Prince Regent Charles Hospital, Bujumbura), Niger, Mali, DRC and Morocco

43. Progress in Implementation
Group 1 countries are consolidating implementation of the 5S principles and moving on to Kaizen and national role out
Group 2 countries are in the first 3S of implementation
In Kenya, the MOMS and MOPHS have developed a Kenya Quality Assurance Model to be implemented using 5S-Kaizen

44. THANK YOU AHSANTE SANA MERCI