Casi Mondragon: Hi, my name is Casi. I am a nurse at the Inpatient Rehab Hospital.

Hayley Serpa: And I'm Hayley. I'm a PT at the Rehab Hospital. And we're here to talk to you guys about the 5S methodology that we did with the Model Cell Program.

Casi Mondragon: A little description of what the rehab hospital is. So, we are a 16-bed inpatient acute rehabilitation hospital. Our patients come to us after having accidents, strokes, any kind of acute illness that caused them to be debilitated. So, it's patients that are requiring some intense therapy. They get three hours of therapy a day. They're required to do three hours of therapy a day. Average stay for patients at the inpatient rehab is usually around 10 to 14 days. Some patients we have for up to 21 days. I think we're a very valuable aspect of the hospital, and I think a community of our size is lucky to have an inpatient rehab hospital. The nearest one to us is in Albuquerque, so it's great that patients are able to stay local while they rehab, and then hopefully go home independently.

Hayley Serpa: We even serve the Four Corners Region in general. Most of our patients are from San Juan, but we do get Albuquerque, Denver, Phoenix, and then all across the Navajo reservation. So, it's really not just here, but we do serve the Greater Four Corners region. So, that's been a really good asset to the whole community in general.

Casi Mondragon: So, a group of us participated in a model cell project. So, there were multidisciplinary representation in our model cell, because we do have multidisciplinaries in the hospital that work closely together.

Hayley Serpa: We had the RN, PT, rehab tech, admin. And we had some of the managers work with us too to really work on some of our processes and organization. So, the big thing we're going to focus on today is the 5S that really helped us with organization. So, we organized a bunch of closets throughout the facility. And that included equipment, therapy, equipment, nursing equipment to really help us be more efficient and organized. And overall, there are some really pretty unsafe closets that we worked with.

Casi Mondragon: So, the 5S's are sort, set in order, shine, standardize, and sustain.

Hayley Serpa: So, the first thing to do is sort. So, you want to distinguish between necessary and unnecessary things and get rid of what we're really not using. When we were looking in some closets, there was just trash in there. Like just old plastic bags, old equipment bags, just actual trash too. So, you just take all that stuff out, you put it in a big pile, and then you want to sort everything into what we actually need, what's necessary, and then make a pile of stuff that's not necessary. And making sure we're prioritizing certain equipment, objects, things that we need to make sure they're going to be in that closet or if we need to rehome them. So, just sorting all that stuff out is that first big task.

Casi Mondragon: And we also had a donate pile. So, there were some things that we were able to pull as we were doing it that we set aside for donation. The first project we did was a relatively small equipment closet that held equipment mostly for physical therapists to use with patients. But there's also some equipment that occupational therapists used. There were walkers stacked on top of each other, shelves that it really was dangerous to open that closet and try to reach for things, because stuff fell down.

Hayley Serpa: I had a couple boxes fall on me. And the walkers were just vomiting out of the closet, So, It was just a very, very unsafe closet to start with. And it was a big hazard and you couldn't even reach what you needed in there. So, half the stuff wasn't even being used.

Casi Mondragon: And it was frustrating when people did need to pull stuff out of there because you had to move a bunch of stuff to get to what you needed. So, it was a small closet that we started with, but it made a big impact.

Hayley Serpa: Yeah. As a PT myself, that closet is my pride and joy now. It makes it so much easier just to grab a walker quickly and not have something fall on top of me in the middle of that.

Casi Mondragon: So, the next step as far as setting order goes, when we were doing that small closet, we arranged like items together. We decided which items we definitely wanted to go back into the closet. Made sure that we had plenty of space for those items, and kind of made a plan for how we wanted to organize the closet when we put everything back.

Hayley Serpa: Specifically with that closet, we organized the walkers into specialty walkers and regular walkers and had some more therapy equipment together and made it so much easier so everyone could access it, even our per diem staff and staff that isn't there quite frequently. And then, our next step was that we would clean the closet, just give it a good old shine to it, wipe down the shells vacuum, just the normal cleaning.

Casi Mondragon: And then, a big part of the 5S is the standardizing. So, that involves a few different things. Every shelf, every wall hook, everything was labeled, so that anybody that pulled something out of that closet could open the door and they would know exactly where the items needed to be returned back to.

Hayley Serpa: And that's the biggest step there. It takes the longest time. But it really has helped. We've cleaned these closets before, but they've just gone back to their, you know, messy, unorganized closets and now we have the standard work that now they're labeled, people know where to put them, there's really no question about it. And to help with the organization, on the doors, we put pictures of how the closet should look, and we have itemized lists in there of what should be in there. And to avoid adding clutter to the spaces, we've marked off some shelves and floors with big Xs that say, you know, "Don't put stuff here," this closet to be unsafe," or "Nothing should be on this shelf. It's too high. It's too heavy to put up there." And so, we labeled it, put the photos there, made the list to help make it a new process, and just standardize it so anyone can just walk in there.

And then, we review it about once a week. We go in there usually on Mondays and make sure it looks like the photo and flip the little postcard that says, "We did it." And it's been working pretty good. We even had all of our floors redone recently at the hospital. And we are using our standardized work as references to put everything back.

Casi Mondragon: When we first started doing it, and even that first little closet when we pulled everything out, it was kind of overwhelming, just the sheer amount of stuff. And we had, what, two hours...

Hayley Serpa: Yeah. About that.

Casi Mondragon: ...to work on the closet. And I didn't think we were going to get it done. But the steps of the 5S, they were really helpful. And we got it done and we had time to spare at the end of it. So, that inspired me after we finished that day. I went and bought a label maker on the way home, and I went home and organized my pantry. So, the method is—

Hayley Serpa: Really helpful.

Casi Mondragon: Yeah, really helpful.

Hayley Serpa: Casi, you kind of made it fun, didn't you?

Casi Mondragon: Yes. You can get label makers with different colored label tape, which I didn't realize, and some of them even have cute little designs. So, I was labeling everything in my house, including like my pet food bins. So, they now have cute little pictures of cats and dogs on the labels with the bins.

Hayley Serpa: Yeah. And you can get like color tape and glitter tape or patterns. So, it can make it fun and enjoyable at home too. I know I recently moved and I didn't quite label everything, but I did gather all my stuff and threw about four bags' worth of clothes out and a bunch of just duplicate areas that we had throughout the house and condensed it into one. So, it definitely helped with reducing clutter.

Casi Mondragon: So after we did that first small closet, there was another—it's not even a closet—a whole good size room that was just stacked with equipment. There were wheelchairs in there, bedside commodes.

Hayley Serpa: More walkers, a huge pile, a mountain pile of leg braces.

Casi Mondragon: There was an old locker that had paint that was probably 15 years old that we went through and got rid of that. That was a huge undertaking, taking care of that room. But because we had done the smaller closet, we knew what to do and we knew the process. And so even that, we did in, what, two and a half hours, three hours? And it was something that I would've thought would been a days-long process, but going through the steps of the 5S really made it easy. And that closet has also been maintained and people know where stuff goes. Other staff have also been really appreciative of the 5S projects that we've done because it's benefited them a lot too. So, people are pretty on board with sustaining it and keeping things the way they are.

Hayley Serpa: Yeah, I think everybody was super appreciative, and it was just simple enough that they could follow along with no big meeting really. They maybe asked questions, but that was okay. They were all positive reactions. It's really made all of our closets and rooms so accessible. Like, all these rooms that we talked about, you couldn't even walk into them. They were just filled. And I couldn't get the equipment I needed for patients without, like, removing five wheelchairs or crawling over something, risking my safety. And it took so much time. It was taking time out of treatment time with my patients. And so, now, it's been so easy to just walk in, grab the chair and leave without climbing over things.

Casi Mondragon: And we still have areas that we're working on. I know, Hayley, you with the occupational therapist, have been working on the occupational therapy side of the gym. We've got plans in the nursing station. We've got lots of cabinets and closet areas that have stuff that have piled up, actually over the last 15, 20 years. So, those are next on the list of things that we want to tackle and go through the 5S methodology to improve those areas.

Hayley Serpa: I think, overall, it's been really good. And, yeah, we're going throughout the whole rehab now, making it all standardized. And it's really just been good to kind of see what we actually have and then see what we need to improve on, what equipment we need to add to, and what's really out of date. That was a big thing. Just a lot of stuff was out of date and we really just weren't using it, and it was just a lot of waste.

Casi Mondragon: And it feels much better. The spaces are being utilized better. It's more efficient. It's just been a good project and experience overall.

Hayley Serpa: Yeah, we recommend it. It takes time, but I think it's worth the time to really do it and sit down for those couple hours. And I know it takes time, but I think it is really worth it. This was Hayley and Casi from the Rehab Hospital. And thanks for joining us.

Casi Mondragon: Thank you.