Practice Management Systems


Add value to your practice by “5S’ing.”

By Scott C. Spradling

The concept of 5S is just one of several key elements of the lean principle, which is designed to improve efficiency in the workplace while promoting organization and cleanliness. 5S was developed in Japan in the late 1960s as part of the “Just-in-Time” manufacturing system, better known today as the Toyota Production System. It made its way to the West in the 1980s and has been adopted by such companies as Motorola, IBM, Boeing, and the Virginia Mason Medical Center health care system.

The 5 “S’s” in Japanese are Seiri (tidiness), Seiton (orderliness), Seiso (cleanliness), Seiketsu (standardization), and Shitsuke (discipline). In keeping with the history of the “S” when translated to English, these were edited into Sort, Set, Shine, Standardize, and Sustain. Some companies have further edited the words to best suit their organization, though always in keeping with the “S.”

So how can this manufacturing production concept be used in private practice? In its simplest form it is designed to keep the workplace safe and organized without regard to size or pace. We will use the clinic front office for the purposes of our example. The goal of 5S is to remove waste, both actual and conceptual, by eliminating excess inventory and out-of-stock supplies, and reducing wasted time searching for, getting to, and waiting for supplies.

Step One: Sort
“Sort” means to sort through everything in each work area. Keep only what is necessary. Materials and supplies that are not frequently used should be moved to a separate, central storage area. Items that are no longer used should be discarded or recycled. Do not keep things around in the hopes they might be used in the future.

Step Two: Set
In this second step, identify, organize, and arrange everything in the work area, so that items can be efficiently and effectively retrieved and then returned to their proper location. Everything should have a place and a purpose. Put things away in a logical location that makes commonly used materials convenient and easy to access.

Step Three: Shine
Once you have everything sorted and set, it is important to keep it that way. This requires regular cleaning, which is why our third step is known as “Shine.”

5S Shine is more than your typical “run a dust rag over the counter when you notice it.” It requires regular and consistent cleaning. The front office should be returned to the condition it was in when the day started, including putting away all materials and supplies used that day.

This also allows you to take note while cleaning of any equipment, material, or supplies that need to be fixed, replaced, or restocked.

Step Four: Standardize
The first three steps in our 5S paradigm should then be formalized in Step 4 by creating standards. Develop written structures and standards that will support the new practices and turn them into habits. Every office is different, and the 5S practices initially implemented can always be improved. As your experience grows and you become more familiar with the first three steps, you can update and modify your 5S standards to make each process simpler and easier. One of the more common standards in this step is stock levels. Establish how much of something you truly need and when it is the appropriate time to reorder that item to prevent wasted time waiting for it to be restocked.

Standardize is one of the harder steps in 5S as it calls for changing habits. Familiarity breeds comfort, but consistent use and positive reinforcement will help staff see how the changes have added value to their workplace and day.

Step Five: Sustain
5S is a commitment. It is a commitment to reduce waste and improve efficiency; it is a commitment to recognizing what adds value to your organization; it is the ultimate exercise in “trial and error,” without so much on the “error” side.

In this step of 5S, training staff to clean, organize, and inspect their work areas every day and not let clutter accumulate is essential. The overall goal of 5S Sustain is to ensure the 5S standards that resulted from the first four steps of 5S continue to be followed, and that standards are modified or created to address situations not anticipated during the initial implementation of 5S.

With the landscape of health care reform and payment model changes that are moving away from volume and focusing on value, the 5S paradigm offers a simple and structured method for identifying, analyzing, and organizing (or reorganizing) our everyday processes in a manner that is guaranteed to reduce waste and add value.


Scott C. Spradling is a member of the PPS Administrators Council and a certified administrator since 2011. He is the administrator of Movement Systems Physical Therapy in Seattle, Washington, and can be reached at

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

Are you a PPS Member?
Please sign in to access site.
Enter Site!