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Five‐S, a simple tool was utilized as the initial step towards total quality management activities at a public hospital in Sri Lanka. This paper introduces the system improvement activities at the hospital which won several awards for quality of service at national level. Though there are multiple reasons for the significant improvement of performance at the hospital, the study team observes that Five‐S has contributed heavily towards the success. The unique feature observed was that Five‐S activity reorganizes the system radically compared to most of the continuous quality improvement (CQI) approaches which depend on problem solving. In the hospitals of developing countries, in which even the basic processes are unsatisfactory, Five‐S approach may be suited for the initiation of the CQI process. Further research is needed to evaluate the quality improvement activity based on standardized criteria and to assess the factors which influenced the process.