title: Applicability of the 5S management method for quality improvement in health-care facilities: a review.
abstract: BACKGROUND
  The 5S management method (where 5S stands for sort, set in order, shine, standardize, and sustain) was originally implemented by manufacturing enterprises in Japan. It was then introduced to the manufacturing sector in the West and eventually applied to the health sector for organizing and standardizing the workplace. 5S has recently received attention as a potential solution for improving government health-care services in low- and middle-income countries. We conducted a narrative literature review to explore its applicability to health-care facilities globally, with a focus on three aspects: (a) the context of its application, (b) its impacts, and (c) its adoption as part of government initiatives.
  
  
  METHODS
  To identify relevant research articles, we researched public health databases in English, including CINAHL, PubMed, ScienceDirect, and Web of Science. We found 15 of the 114 articles obtained from the search results to be relevant for full-text analysis of the context and impacts of the 5S application. To identify additional information particularly on its adoption as part of government initiatives, we also examined other types of resources including reference books, reports, didactic materials, government documents, and websites.
  
  
  RESULTS
  The 15 empirical studies highlighted its application in primary health-care facilities and a wide range of hospital areas in Brazil, India, Jordan, Senegal, Sri Lanka, Tanzania, the UK, and the USA. The review also found that 5S was considered to be the starting point for health-care quality improvement. Ten studies presented its impacts on quality improvements; the changes resulting from the 5S application were classified into the three dimensions of safety, efficiency, and patient-centeredness. Furthermore, 5S was adopted as part of government quality improvement strategies in India, Senegal, Sri Lanka, and Tanzania.
  
  
  CONCLUSIONS
  5S could be applied to health-care facilities regardless of locations. It could be not only a tool for health workers and facility managers but also a strategic option for policymakers. They could consider 5S as the starting point of a government-led quality improvement initiative for improving safety, efficiency, or patient-centeredness aspects particularly in low- and middle-income countries. However, the evidence base, particularly in resource-poor settings, must be expanded.
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan ; IC Net Limited, Land Axis Tower, 27th Floor, 11-2 Shintoshin, Chuo-ku Saitama-shi, Saitama, 330-6027 Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kanamori
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shibanuma
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
keywords: 5S; Health-care; Lean; Low- and middle-income countries; Quality improvement