The findings indicated that the 5S implementation significantly changed the service quality and the family health unit, nutrition unit, physician’s office. This showed the positive impact of 5S implementation on the selected units (family health, nutrition unit, physician’s office). The comparison before and after the implementation of 5S in the community health center, which include (organization, arrangement, standardization and discipline), also significantly changed.
The findings of our study were similar to Nouri et al. (2014, which show that the 5S audit score in the operating room before the implementation of this technique was 3.2 and after the implementation of the technique was 4.6 score [12]. In line with our research Nana et al. also concluded that the results of the 5S implementation seem to be satisfactory [19].
The present study also indicated that although after implementation of the 5S management method, the quality of provided services was still less than the patients’ expectations, 5S implementation had decreased the quality gap from the patients' perspective in all studied fields. The results were similar to the Tak et al. study, which indicated that the 5S implementation is effective in raising staff incentive, decreasing the waiting time and satisfying patients from health services [20]. A study by Sharifirad et al. showed that there is still much room for improvement and reformation of the existing gap between patients' expectations and perceptions. Consequently, using quality promotion methods can help in conducting some measures to improve and reform this gap [21].
The present study indicated that the 5S, as a management tool or a model for implementing service quality promotion, doesn’t cost a lot, in addition to being easily implemented. In a study carried out by Bakhshinik (2009) it was found that this model had a great impact on resources development. In this study, it was found that using proper methods in carrying out determined activities effectively led to productivity in related sectors and it was concluded that using them will have positive effects on the other systems needed by the organization [22]. Farrokhi et al (2012), implementing 5S project in the Operating Room, concluded that 5S should be used as a simple tool in the first step toward quality management activities and it can improve quality at lower cost [23]. Rexhepi (2011) and Waldhausen (2010), concluded that training and implementation of 5S workplace organization technique in hospitals demonstrated that this technique implementation improves environmental factors such as the workplace cleanliness, fast and easy access to the essentials as well as a pleasant workplace for staff [25, 26].
In this study, the best dimension of service quality (the smallest gap), observed after the 5S implementation was responsibility. In the study of Kebriaei et al. (2004), the highest mean gap was in the responsiveness dimension [27] and in the study of Wisniewski and Wisniewski (2005), it was in the dimension of reliability [28].