The Effect of 5S on Employee Performance: An Empirical Study among Lebanese Hospitals

Info Articles ____________________ History Articles: Submitted 23 May 2019 Revised 15 October 2019 Accepted 3 December 2019 ____________________


INTRODUCTION
Quality improvement is considered as "strategic tool for organizations that seek sustainability, productivity and advanced performance" (El-Sherbiny et al., 2017). Diverse quality approaches were discussed previously and 5S is an influential technique in strengthening the organizational goals for continuous improvement. By definition, 5S system is "a technique which maintains the quality of working environment in the association and it is originated from five Japanese words known as Seiri, Seiton, Seiso, Seiketsu and Shitsuke" (Ho et al., 1995;Gapp et al., 2008;HungLing, 2011). These quality improvements require empowerment of employees to achieve the organizational objectives. In addition, measuring the employee performance continuously is essential to control the quality of procedures inside the organization (Younis, 2017).
Mainly, employee performance is greatly appreciated in the healthcare sector. Aoun et al., (2018) state that "hospitals are dynamic organizations that are getting more involved in implementing quality approaches to be accredited by the authorized parties and to better compete in the healthcare industry. Hospitals have to concentrate more on their employees' transformation skills and appropriately invest so they can successfully innovate through applying and adopting different improvement strategies such like lean practices and soft total quality management". Several studies have been previously conducted to examine the relation between diverse quality methodologies and employee performance between different sectors. Yet, there is lack of literature that reports the implementation of these approaches in the Lebanese healthcare sector. Although 5S is directly associated to the employees' daily actions , there is no focus on how to improve these operations. Therefore, the first objective of this study is to "determine to which extent 5S is implemented in the Lebanese hospitals" and the second objective is to study "the effect of 5S on employee performance in these hospitals" as shown in figure 1.

Healthcare Sector in Lebanon
According to MOPH statistical bulletin (2017), there is total of 147 hospitals in Lebanon (117 private and 30 public). Noticeably, the Lebanese healthcare sector has shown high commitment to quality standards. Based on the strict policies of MOPH, all Lebanese hospitals are being periodically accredited to maintain high level of performance and to ensure safe healthcare services to customers. Hospitals have developed sets of key performance indicators (KPI) to monitor the quality of healthcare services in terms of "employee's satisfaction, customer satisfaction, cost reduction and financial benefits" (Sabry, 2014).

The 5S-Quality Approach
By definition, 5S is "a system of workplace that can be looked over as rules devised to create a safe and productive work environment and to provide efficient and effective realization of business tasks" (John, 2015). As described in figure  2, The American Society for Quality (ASQ, 2018) defined "the five Japanese words to sort, set in order, shine, standardize and sustain".

Employee's performance
Employee performance is defined as "the overall expected value from employees' behaviors fulfilled over the course of a set period of time" (Motowidlo, Borman, & Schmidt, 1997). According to Oppler (2019), employee performance "assesses whether a person performs a job well and it is an important criterion for organizational aftermath and success". Moreover, employee performance is categorized into "task performance and contextual performance". Task performance refers "to direct transformation of raw materials to goods and services which are typically included in job descriptions". As for the contextual performance, it refers to "the contribution of behaviors to the overall effectiveness as it supports the psychological and the social climate where work is done" (Borman & Motowidlo, 1993).

Previous Studies
Generally, previous studies have measured the correlation between different quality attitudes and employee performance. For example, Jiménez et al. (2015) considered "the effect of the 5S on quality, productivity and organizational climate in two manufacturing SME located in Usaquen; Bogotá". The results showed that "there was a boost in productivity (83% -68%) and quality (36% -67%) according to performance measurements as well as development of the organizational climate (18% -33%)".
Similarly, a study conducted by El-Sherbiny et al. (2017) assessed "the operation of the 5S-Kaizen approach in developing the care arrangement quality in hospitals and gauge its effects on the job satisfaction of the healthcare jobholders". The results included "Patient-hospital cycle time was minimized by more than 50% after the implementation of the 5S-Kaizen approach. In addition to that, the healthcare professionals believe that they had saved time, money and efforts while decreasing their everyday workload and stress by the application of the 5S-Kaizen approach". Table 1 summarizes some of the practical outcomes that were addressed in literature review. Respectively, the following proposed hypotheses are summarized in Table 1.

METHODS
This study is based on a quantitative methodology. In South Lebanon, there are 16 hospitals (12 private and 4 public hospitals). For this survey, only four Hospitals agreed to participate. For each hospital, the human resource manager provided the necessary information as shown in table 3. The population of this study tis represented by the total number of employees (670 employees).  Morgan (1970) suggested that the best sample size for population between 600 and 700 should be between 234 and 248. Therefore, the sample size was limited to 240 employees from the four hospitals. For data collection, selfadministered questionnaires were randomly dispersed among target respondents during a short time horizon "April 2019 to May 2019". The questionnaire includes three sections as shown in the appendix. Items were measured using "Five Likert Scale (1-strongly disagree to 5-strongly agree)".

Results of Descriptive Statistics
The descriptive statistics results show that the mean and standard deviation of 5S (3.87; 0.559) and employee performance (4.36; 0.495) reflects an agreement of respondents on the implementation of research variables. Table 4 summarizes the demographic results of this study.

Testing Hypotheses
The result showed high level of consistency of the measure. For testing reliability, the results of cronbach's alpha are (employee performance, 0.777); (5S, 0.869) and the Cronbach alpha for all variables is (0.877). For correlation test , table 5 summarizes the obtained results where positive (r=0.528>0.3) and significant (sig=0.000<0.005) correlation exists between 5S and employee performance and therefore, H 1 is accepted.

Table 5. Total Correlation between Research Variables
As shown in Table 6, all obtained results are significantly and positively correlated with the exception of 5S1 and 5S2 (p > 0.005). Those items describe the fifth S "Sort". Hence, the proposed hypotheses were accepted but H a was rejected.  Table 7 summarizes the results of Regression analysis. As shown, 5S explains 27.9 % of the variability of employee performance.

CONCLUSION
During this survey, it was obvious that most of respondents implement the 5S regularly in their everyday activities unintentionally, which means they were not formally applying these steps as a quality standard approach. All employees are empowered to be a part of the continuous improvement process and responsible to deliver high quality services. Moreover, employees are authorized to interfere whenever they sense any shortcoming in the supply chain of the hospital. However, the research findings showed that sorting has been insignificantly related to employee performance unlike the remaining 4S. This reflects how much employees are committed in adapting such quality approaches that support hospitals in being well organized, and helps eliminating wastes and furthermore, makes employees extremely effective in providing clean, standardized and sustained place of work. In conclusion, employees should be formally informed through a guideline on how to sort the items and do necessary training on how to take actions and make operations easier and more accessible. Managers are also recommended to make employees more involved in establishing the quality standards since they are more in touch with workplace operations. Khalek El-Sherbiny, N., Younis Elsary, A. and H Ibrahim, E., 2017