title: Impact of the Japanese 5S management method on patients' and caretakers' satisfaction: a quasi-experimental study in Senegal.
abstract: BACKGROUND
  The 5S method is a lean management tool for workplace organization, with 5S being an abbreviation for five Japanese words that translate to English as Sort, Set in Order, Shine, Standardize, and Sustain. In Senegal, the 5S intervention program was implemented in 10 health centers in two regions between 2011 and 2014.
  
  
  OBJECTIVE
  To identify the impact of the 5S intervention program on the satisfaction of clients (patients and caretakers) who visited the health centers.
  
  
  METHODS
  A standardized 5S intervention protocol was implemented in the health centers using a quasi-experimental separate pre-post samples design (four intervention and three control health facilities). A questionnaire with 10 five-point Likert items was used to measure client satisfaction. Linear regression analysis was conducted to identify the intervention's effect on the client satisfaction scores, represented by an equally weighted average of the 10 Likert items (Cronbach's alpha=0.83). Additional regression analyses were conducted to identify the intervention's effect on the scores of each Likert item.
  
  
  RESULTS
  Backward stepwise linear regression (n=1,928) indicated a statistically significant effect of the 5S intervention, represented by an increase of 0.19 points in the client satisfaction scores in the intervention group, 6 to 8 months after the intervention (p=0.014). Additional regression analyses showed significant score increases of 0.44 (p=0.002), 0.14 (p=0.002), 0.06 (p=0.019), and 0.17 (p=0.044) points on four items, which, respectively were healthcare staff members' communication, explanations about illnesses or cases, and consultation duration, and clients' overall satisfaction.
  
  
  CONCLUSIONS
  The 5S has the potential to improve client satisfaction at resource-poor health facilities and could therefore be recommended as a strategic option for improving the quality of healthcare service in low- and middle-income countries. To explore more effective intervention modalities, further studies need to address the mechanisms by which 5S leads to attitude changes in healthcare staff.
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.|IC Net Limited, Saitama, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kanamori
authors.affiliation: Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Marcia C
authors.initials: MC
authors.lastname: Castro
authors.affiliation: Agence Africaine de Santé Publique, Dakar, Senegal.
authors.forename: Seydou
authors.initials: S
authors.lastname: Sow
authors.affiliation: Faculty of Medicine School of Health Sciences, Gunma University, Maebashi, Japan.
authors.forename: Rui
authors.initials: R
authors.lastname: Matsuno
authors.affiliation: Actions pour le Changement, Dakar, Senegal.
authors.forename: Alioune
authors.initials: A
authors.lastname: Cissokho
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; mjimba@m.u-tokyo.ac.jp.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
keywords: 5S; Senegal; patient satisfaction; program evaluation; quality of healthcare