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The waiting game

How we freed up 10 hours of clinical time by re-organising our consulting rooms

Dr Iolanthe Fowler describes how implementing the 5S principles improved her practice environment, boosting morale and saving time

What we did

We are a five partner, 8,500 patient, urban practice in Sheffield. We decided to improve the surgery environment, so had an afternoon of training on the principles of the 5 Ss for all staff. 5S is an acronym of Japanese words describing a method of making processes and the environment safer. In English, they are:

Sort– We got rid of everything we didn’t need from the rooms, which turned up some things we couldn’t even remember what they were for.

Set– We made sure every item had their set place in the room, which was clearly labelled. We also organised the items by how often we used them – regularly used items were in easier reach than those we use more rarely.

Shine– We built in a daily cleaning routine. With the lack of clutter this was much easier.

Standardise– We made sure the places we put equipment were standardised across the surgery, for example all consulting rooms had specimen bags in the fifth draw down – easy for people moving rooms. This saves time, and also helps us restock easily – if a shelf is labelled for a certain item, but is empty, we know we need to order more of that item.

Sustain– We have continued practising and repeating these processes, linking it to the jobs we do.


Committing to the time was a challenge. Building the training, carried out by a group from NHS Improving Quality (NHSIQ), into an afternoon where we would have our practice meeting anyway helped, but having the senior team of GPs and our practice manager on board was essential. We managed to organise most rooms within this one afternoon training session.

Allowing other people (both other staff and those running the training session) to look closely at our rooms was potentially very uncomfortable. Asking for volunteers to offer their rooms to start the process worked well by building confidence in the process and in our approach to it.

Some people were concerned that standardisation of rooms and spaces would mean that they would need to sacrifice their individual preferences. This was not found to be a problem. Once the basic equipment was installed in a standardised way, the addition of specialised or individual items could be done, as long as 5S principles were otherwise adhered too.


It has saved time in the consultation because everyone knows where to look, staff no longer have to leave the room to track down missing stock and has made it easier for staff to work in different rooms from where they might work usually. A conservative estimate would be that it saves an average of five minutes per day per working clinician, which would be 10 hours a week of clinical time saved in our surgery.

The exercise was also fun and developed a sense of productive team working. One or two rooms did not get the 5S treatment on the day, and staff asked to have time to do this at a later date, which has happened.

We think that any practice could give this a try, unaided - just follow the 5S principles. Although it really helped us to have the process explained to us by specialists, the real limiting step is committing to releasing time in the practice to do this.

This intervention was uniformly appreciated by all staff in our practice, and we are still maintaining the changes, and reaping benefits, with minimal effort.

Dr Iolanthe Fowler is a GP in Sheffield 

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Readers' comments (4)

  • Brilliant, thanks for sharing

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  • Harry Longman

    I'm an engineer, soaked (sozzled?) in manufacturing so this is familiar territory. Interesting that you have an estimate of time saving - at least 5 minutes per day. We work in lots of practices but we never make an issue of 5S because, although it's not wrong, it barely scratches the surface of the real problems which GPs and their patients face. This is not going to cut the queue of people trying to see you every morning. But a different way of thinking, demand led, and a different model of consulting, largely remote, precisely addresses the main presenting problem for most practices.
    I might ask, why is NHSIQ bothering with this, when we have bags of evidence of what really works?

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  • Restocking rooms would be so easy and out of date stock a thing of the past. Poor CQC...
    How on earth did you get the other GPs to do it?

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  • Dear Harry Longman,
    I found your statement interesting.Could you clarify to all us interested doctors what the''different way of thinking'' is? How exactly is a GP practice to modify its processes to ''demand led''when there is no funding to increase resources to provide service?and unlike toyota/Nissan we cant lay off and hire at will?Could you also explain just how does remote consulting free up Dr time and availability?How exactly does SKYPE allow me to see more patients?How does it reduce the demand?How does it increase ability to do ''more''?The main difference Harry, between engineering and Medicine is that in Engineering you put the machine off to make it safe...we cant do that.

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