problem solving in the medical practice using the five whys

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Problem Solving in the Medical Practice Using the Five Whys

Ron Harman King, MS | Neil Baum, MD

December 8, 2018

There is no doctor or medical practice that hasn’t experienced a problem or a crisis in either the care of patients or the business aspect of the practice. Unfortunately, most doctors have few or no skills in crisis management or nonclinical problem solving. This task often is left to the office manager or the practice’s medical director. This article discusses the use of the root cause analysis and how it can be applied to nearly every medical practice. The “five whys” concept is a way to try to find the causes of potentially complex problems. When done properly, this strategy will help you to get to the root cause of many issues so that it can be addressed, rather than just focusing on symptoms of that problem.

When done properly, the “five whys” strategy has been shown not only to be effective, but also to be easy to use on a wide range of issues throughout many medical practices. It also can be combined and used with a variety of other techniques used to identify and solve workplace problems.

The five whys technique, which began in Japan at the Toyota Motor Company, is based on a scientific approach to problem solving. It has been applied through just about every type of industry around the world and could easily be used in the healthcare profession as well.

In the five whys process, you ask “why?” at least five times to get to the root cause of a problem. The process starts out with a problem that is affecting the practice, and then keeps asking why things happened until the root cause of the issue has been identified.

One of the best ways to get a good understanding of the five whys is to look at examples of how it has been explained with an example from the automotive industry. The following example is commonly used—how to discover the root cause of a car that will not start. The initial problem is “The car will not start.” From there, the five whys are asked:

Why won’t the car start? Answer: The battery is dead.

Why is the battery dead? Answer: The alternator is not working properly.

Why isn’t the alternator working? Answer: The serpentine belt has broken.

Why did the serpentine belt break? Answer: It was not replaced when worn.

Why wasn’t it replaced? Answer: The owner did not follow the recommended service schedule.

The last why is considered the root cause of the problem. If the owner of the vehicle had followed the recommended service schedule, this issue would not have happened. Not only that, but following the recommended service schedule will help to prevent a wide range of other problems including a decrease in radiator, brake, and oil fluids.

Applying the Five Whys Process to the Healthcare Practice

The problem to be solved is the practice is running behind schedule:

Why is the practice already one hour behind schedule in seeing patients by mid-morning when the doctor is supposed to start seeing patients at 9:00 AM? Answer: Patients are arriving 30 to 60 minutes late for their appointments.

Why are patients showing up late for their appointments? Answer: The doctor is usually 30 to 60 minutes late, and patients don’t want to wait to be seen so they arrive and check in 30 to 60 minutes after their designated appointment times.

Why is the doctor 30 to 60 minutes late by mid-morning? Answer: The doctor arrives for his office clinic 30 minutes late because patients usually are not taken to the exam rooms until 9:30. Instead the doctor goes to the computer to check e-mails.

Why are patients put in the rooms 30 minutes after their appointment times? Answer: The staff doesn’t arrive until 8:30 and is not ready to place patients in the rooms until 9:30.

Why is the lab data previously ordered not placed in the chart or recorded on the electronic medical record causing delays making decisions regarding patient care? Answer: The results have been sent to the office via fax but not recorded in the patient’s cart.

Solution: Start the day at 8:00 A.M. and start putting patients in the room at 8:45. Inform the doctor that he or she should arrive in the office by at least 8:45, allowing a few minutes to look at the computer, and that patients are to be seen starting promptly at 9:00.

Finding the Root Cause

The primary goal of the five whys is to take a problem and find the root cause so a solution can be identified and put in place. When done properly, a practice can find the root cause of most problems so that they can take actions to prevent it from happening in the future.

One of the best things about the five whys is that it is inexpensive to implement. A medical practice or a hospital can begin using it without added expense. The only cost is the time required to go through the process.

Why Look for the Root Cause

Most medical practices solve problems by identifying a problem and then using a quick fix for prompt resolution. In the long run, it is much better to identify the root cause of the issue and fix it—that will prevent the problem from occurring again. Seeking a root cause solution rather than just addressing the symptoms allows the practice to reduce recurrence (by dealing with the root cause, the symptoms are less likely to happen again in the future); prevent problems before they occur; gather information that identifies other issues that are impacting the practice; and place an emphasis on quality and safety over speed by avoiding a quick fix that temporarily solves the problem.

Every practice is unique, and all workplaces have their own set of problems that need to be dealt with. Implementing the use of the five whys can help medical practices to better understand their issues, and give them a clear roadmap on how those issues can be addressed permanently.

Getting Started with the Five Whys

The five whys system can be customized based on the specific needs of a given practice. Most practices or hospitals that are implementing this type of strategy will use some general rules or guidelines that can help keep the strategy focused on finding the root cause of the problem. Here are a few rules of performing the five whys:

Form the questions from the patient’s point of view. For example, when the practice runs behind schedule, patients are not happy that they are being seen 60 or even 90 minutes after their designated appointment. Another example would be that patients complain that they don’t receive results of lab tests or imaging studies until two or three weeks after the test or the procedure.

Keep asking or drilling until the root cause is discovered (even if more than five whys are required). This strategy is looking to find the root cause of the problem, not to place blame on any person(s) in the practice.

Base all statements on facts, not assumptions or hearsay.

Make sure to clearly distinguish the causes of problems from the symptoms of the problem (example: Doctor doesn’t start on time is a problem; Patients are upset is a symptom).

Involve physicians, nurses, administration, and ancillary personal as needed.

Focus on long-term success rather than short-term or quick-fix solutions.

Write down the problem at the top of a white board or flip chart and make sure that everyone understands the problem.

Try to make your answers concise and precise.

Be patient and don’t jump to conclusions.

Focus on the process, not on finding someone to blame.

Perform a root cause analysis as soon as possible after the error or variance occurs; otherwise, important details may be missed.

Explain that the purpose of the root cause analysis process is to focus on fixing or correcting the error and the systems involved. Make a point of stressing that the purpose of the analysis is not to assign blame but to solve problems.

Ask the question “Why?” until the root cause is determined. It is important to understand that in healthcare there may be more than one root cause for an event or a problem. The difficult part of identifying the root cause often requires persistence.

Finally, after the root cause is identified, conclude with the solution that will prevent the error from occurring again

It is this last step—identifying corrective action(s)—that will prevent recurrence of the problem that initially started the analysis. It is necessary to check that each corrective action, if it were to be implemented, is likely to reduce or prevent the specific problem from occurring.

The purpose of identifying solutions to a problem is to prevent recurrence. If there are alternative solutions that are equally effective, then the simplest or lowest-cost approach is preferred.

It is important that the group that identifies the solutions that will be implemented agrees on those solutions. Obtaining a consensus of the group that all are in agreement before solutions are implemented is important. You want to make every effort not to introduce or create a new problem that is worse than the original issue that you were attempting to solve.

The primary aims of root cause analysis are:

To identify the factors that caused the problem that may even result in harmful outcomes;

To determine what behaviors, actions, inactions, or conditions need to be changed;

To prevent recurrence of similar and perhaps harmful outcomes; and

To identify solutions that will promote the achievement of better outcomes and improved patient satisfaction.

To be effective, root cause analysis must be performed systematically using the five whys to drill down to the seminal event that initiates or produces the problem. The best result occurs when the root cause is identified and then backed up by documented evidence. For this systematic process to succeed, a team effort is typically required.

Bottom Line: Root cause analysis can help transform a reactive culture or one that moves from one crisis to the next into a forward-looking culture or a practice that solves problems before they occur or escalate into a full-blown crisis. More importantly, a practice that uses the five whys/root cause analysis reduces the frequency of problems occurring over time.

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Problem Solving in the Medical Practice Using the Five Whys

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There is no doctor or medical practice that hasn't experienced a problem or a crisis in either the care of patients or the business aspect of the practice. Unfortunately, most doctors have few or no skills in crisis management or nonclinical problem solving. This task often is left to the office manager or the practice's medical director. This article discusses the use of the root cause analysis and how it can be applied to nearly every medical practice. The "five whys" concept is a way to try to find the causes of potentially complex problems. When done properly, this strategy will help you to get to the root cause of many issues so that it can be addressed, rather than just focusing on symptoms of that problem.

KEY WORDS: Problem solving; medical practice; healthcare practice.

hen done properly, the "five whys" strategy has been shown not only to be effective, but also to be easy to use on a wide range of issues throughout many medical practices. It also can be combined and used with a variety of other techniques used to identify and solve workplace problems.

The five whys technique, which began in Japan at the Toyota Motor Company, is based on a scientific approach to problem solving. It has been applied through just about every type of industry around the world and could easily be used in the healthcare profession as well.

In the five whys process, you ask "why?" at least five times to get to the root cause of a problem. The process starts out with a problem that is affecting the practice, and then keeps asking why things happened until the root cause of the issue has been identified.

One of the best ways to get a good understanding of the five whys is to look at examples of how it has been explained with an example from the automotive industry. The following example is commonly used-how to discover the root cause of a car that will not start. The initial problem is "The car will not start." From there, the five whys are asked:

* Why won't the car start? Answer: The battery is dead.

* Why is the battery dead? Answer: The alternator is not working properly.

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Cause Analysis: The 5 whys method

Although CLIA includes brief requirements for corrective actions, it does not include a requirement for cause analysis (also referred to root cause analysis). However, a core element of the ISO management system requirements that form the basis for ISO 15189 is corrective action, starting with cause analysis. The standard is designed to place planned, thoughtful consideration and investigation into how the nonconformance occurred and dig deeper into the issue and determine how to prevent future recurrence. In addition, a cause analysis can also prevent deficiencies that have yet to occur. Oftentimes, a single issue can be the cause of multiple nonconformities, and therefore, solving one issue will reduce the risk of another occurring.

Properly identifying the problem through cause analysis is critical not only to achieve and maintain ISO 15189 accreditation, but also to maintain high-quality patient care.

A top-down approach

Cause analysis takes a top-down approach by first identifying the deficiency then taking small steps to dig deeper and determine the root of the nonconformity. One of the best ways to do this is using a method called “the 5 Whys.” As the name suggests, the process involves identifying a problem statement and asking yourself “why” a multitude of times until the cause can be identified. The answer to each question should parrot the problem statement before it for logical transitions and a clear line of thought.

Take, for example, internal quality control materials failed to fall within the defined range of acceptability. ISO 15189 requires labs to ensure the validity of examination results in clause 7.3.7.2, stating, “When internal QC defined acceptability criteria are not fulfilled and indicate results are likely to contain clinically significant errors, the results shall be rejected and relevant patient samples re-examined after the error has been corrected.”

In this case, the problem statement would read, “The internal quality control materials failed to fall within the defined range of acceptability, causing a rejection of results and the need for another test to be performed. Now, it’s time to start asking ‘why?’.

Why 1: Why did the quality control materials fail to fall within the acceptable range?

Answer 1: The quality control materials failed to fall within the acceptable range because the test was performed incorrectly by the technician.

Why 2: Why did the technician perform the test incorrectly?

Answer 2: The technician performed the test incorrectly because they missed a crucial step in the method.

Why 3: Why did the technician miss a step in the test method?

Answer 3: The technician missed a step because they weren’t provided the proper training on the test method.

Why 4: Why did the technician not receive proper training on the test method?

Answer 4: The technician did not receive proper training on the test method because it was not documented in the training documents.

Why 5: Why was this test method not documented in the training documents?

Answer 5: The test method was not documented in the training documents because it was added to the scope of accreditation before the scheduled review of training documents.

Resolution: When adding new methods to the scope of accreditation, document an additional step to incorporate the method into the training documents.

While basic, this is a common example of how deficiencies can happen in the laboratory and how to properly determine the core of the issue. Depending on the complexity of the nonconformity, you may only need to ask “why” three or four times before finding the cause. In other cases, you may need to ask “why” seven or eight times before you reach the true cause. Once the source of the problem and the resolution are properly determined, the corrective action can take place.

The answers to your questions may not always be obvious, so take the necessary time to thoroughly investigate. A comprehensive cause analysis will inevitably save you time in the future that may have been spent resolving related issues. It will also reduce risk in the laboratory and ensure that patients and their doctors continue to receive high-quality laboratory results that they can use to confidently make medical decisions.

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What is the “5 Whys” Technique?

Last updated on August 19th, 2023

In this post, we’ll explain what is the “5 Whys” technique and how it is applied to nursing.

You may also want to check out How To Improve Critical Thinking Skills In Nursing? 24 Strategies With Examples .

The “5 Whys” technique is a problem-solving and root cause analysis method that aims to identify the underlying causes of a problem by asking “why” multiple times.

It was developed as part of the Toyota Production System and is often associated with the concept of continuous improvement and lean manufacturing.

The idea behind the technique is to delve beyond the surface-level symptoms of a problem and dig deeper into the chain of causality to find the fundamental root cause.

By repeatedly asking “why,” you gradually uncover the underlying factors that contribute to the issue.

How to Use the “5 Whys” Technique in Nursing?

The “5 Whys” technique can be applied to nursing to identify and address issues that might arise in patient care, workflow, or processes.

Let’s walk through an example in a healthcare context:

Problem: Medication errors are occurring in a hospital.

1. Why? Nurses are administering the wrong dose of medication.

2. Why? The medication labels are unclear and easily confused.

3. Why? The labeling system lacks standardized formatting.

4. Why? There are no established guidelines for medication labeling.

5. Why? The hospital’s policy and procedure manual does not address medication labeling standards.

In this example, the problem is medication errors. By using the “5 Whys” technique, the root cause of the problem is revealed to be the lack of standardized medication labeling guidelines in the hospital’s policy and procedure manual.

This indicates that improving the manual by incorporating clear labeling standards could help prevent future medication errors.

• What is Critical Thinking in Nursing? (Explained W/ Examples)
• 15 Attitudes of Critical Thinking in Nursing (Explained W/ Examples)
• Clinical Reasoning In Nursing (Explained W/ Example)
• 8 Stages Of The Clinical Reasoning Cycle
• What Are Socratic Questions?

Applying the “5 Whys” technique in nursing allows healthcare professionals to investigate not only immediate issues but also the underlying factors contributing to those issues.

It promotes a deeper understanding of problems, encourages proactive solutions, and ultimately contributes to the overall improvement of patient care and safety.

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Solving Problems the ‘5 Whys’ Way

Posted by Neil H. Baum, MD | Dec 2020

Neil H. Baum, MD, presented “Solving Problems the ‘5 Whys’ Way ” for the Grand Rounds in Urology audience in December 2020.

How to cite: Baum, Neil H. “Solving Problems the ‘5 Whys’ Way” December 2020. Accessed Sep 2024. https://grandroundsinurology.com/solving-problems-the-5-whys-way​/

In this nine-minute commentary, Grand Rounds in Urology Contributing Editor Neil H. Baum, MD, Professor of Urology at Tulane Medical School, discusses a problem-solving solution that he uses in his practice called “the 5 whys” as an alternative to stopgap solutions. He suggests identifying the root cause of the problem, which can easily prevent future occurrences, especially if the solution is inexpensive to implement. Dr. Baum then looks at the implementation of the 5 whys in a urologic setting, using the common issue of scheduling as an example, emphasizing that the purpose of drilling down on causes to a problem is to find the root cause and therefore a solution, rather than placing blame. Dr. Baum then discusses how to implement this approach to solving problem in a urologic practice, emphasizing the need to include all staff in the solution and to focus on long-term success rather than short-term, quick-fix solutions. Finally, he goes over the steps involved in effective problem solving, in particular the need to evaluate the improvements to see if the solution was effective or not.

For more commentary from Dr. Baum, visit his Improving Your Urology Practice page.

ABOUT THE AUTHOR

Neil H. Baum, MD

Neil H. Baum, MD, is a Clinical Professor of Urology at Tulane Medical School in New Orleans, Louisiana. He is also a retired urologic surgeon. Additionally, Dr. Baum serves as the Medical Advisor to Vanguard Communications Group. Dr. Baum is the author of Marketing Your Clinical Practice - Ethically, Effectively, and Economically, which is in its 4th edition, has sold over 175,000 copies, and has been translated into Spanish. He also wrote The Complete Business Guide to a Successful Medical Practice, which was published in 2015. Dr. Baum was the columnist for American Medical News for more than 25 years. Dr. Baum also wrote the popular column, “The Bottom Line,” for Urology Times for more than 20 years. He is a requested speaker each year to the Practice Management Seminar for the American Urological Association (AUA), where he discusses techniques for making urology practices more efficient and more productive. He has written more than 9 books on practice management and over 250 peer-reviewed articles on various urologic topics. Dr. Baum is also the medical advisor to Vanguard Communications Group.

• Neil H. Baum, MD https://grandroundsinurology.com/author/nbaum/ Interviews with Icons: Paul Perito, MD, FACS
• Neil H. Baum, MD https://grandroundsinurology.com/author/nbaum/ Interviews with Icons: Alan Wein, MD, PhD, FACS
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How the 5 Whys Can Work in Healthcare

If you are looking to improve processes at your practice, an effective method for problem improvement is the "5 Whys."

A Mayo lead study group a couple months ago identified that "Continuous Process Improvement" (CPI) is critical for healthcare providers to grasp and utilize as we look to surviving payment model and other delivery systems changes. This requires all to look seriously at how things are done, question if what is current - or what we have always done-  is best for our patients and for our long-term survival.

CPI suggests that there is always a benefit to working to improve. This must start though on the assumption that there is waste and we could do things better than we do now. I truly believe that if you take an honest look at how care is delivered in your immediate area, you can find ways to improve.

One of the approaches to fixing things in our world is to identify a problem, consider alternatives, and then solve it! Sounds simple and very often this process is done in the confines of an office or in a meeting with at the "C-Suite" or a higher level of authority.

While this may work for some, it may not be the best process in the long run. Instead, a concept within CPI is to utilize the "5 why's"". This involves asking others to help achieve the solution.

Here's how it works. First, it is important to recognize that you may not have all the answers. Instead, to the "process owner" or the one who does the work and ask them the first why - either why are you doing that or why are you doing what you are doing the way you are doing it. The expected answers would be "we have always done it this way" or "this is the way I was taught"." Does either of these answers get to the "root" of the problem?

If you follow with the second why, you may get something like "I don't know" or "because" or that's part of my job. Again, does that get to the root of the problem?

Wouldn't it be nice to get an answer "because this is a key activity to providing patient care" or "my doing it this way helps out others in the process do their job more effectively!"

A simple example to prove the point is when your child comes home with a "D" in math and you ask why. "I didn't get my homework done." The reaction to this is likely the child is grounded or screen time is taken away with the expectation they will do their homework and that is that. Instead of asking why (#2) again and getting an answer like "I suck at math." The next why leads to I don't understand it, the next one is leads to it is too difficult, and finally, I just don't get it. The answer may then be not to ground, but to find better ways to help.

So it is with the staff, why are they doing what they are doing or the way they are doing it, when asked will lead to a better understanding. One of the whys may lead to them offering a solution so asking "why don't you think of a better way to do things"!

This simple process of asking why up to five times will lead to better understanding, to possible solutions, and to easier implementation of the solution through staff involvement - since it was their idea.

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Root Cause Analysis with 5 Whys Technique (With Examples)

By Sebastian Traeger

Updated: April 23, 2024

Reading Time: 7 minutes

What Is the 5 Whys Technique?

Example of the 5 whys technique, how to conduct a 5 whys analysis in 5 steps, when to use a 5 whys analysis, using 5 whys template, tips for mastering the 5 whys technique, frequently asked questions about 5 whys.

With over two decades in business – spanning strategy consulting, tech startups and executive leadership – I am committed to helping your organization thrive.

At Reliability, we’re on a mission to help enhance strategic decision-making and operational excellence through the power of Root Cause Analysis, and I hope this article will be helpful! 

Our goal is to help you better understand 5 whys techniques by offering insights and practical tips based on years of experience. Whether you’re new to doing RCAs or a seasoned pro, we trust this will be useful in your journey towards working hard and working smart.

The 5 Whys Technique is like peeling an onion – it helps you uncover the underlying reasons behind a problem, layer by layer. By repeatedly asking “why” at least five times, this method digs deep to reveal the root cause of an issue. It’s a simple yet powerful problem-solving approach that aims to get to the heart of the matter rather than just addressing surface-level symptoms.

5 Whys Technique: A method that involves iteratively asking “why” five times to unveil the fundamental cause of a problem.

In essence, the 5 Whys Technique is not just about fixing what’s broken on the surface; it’s about understanding and addressing the deeper issues that lead to problems in the first place.

The 5 Whys Technique is like a detective, uncovering the truth behind recurring problems. Let’s take a look at how this method works in two different scenarios.

Case Study: Manufacturing Defects

Imagine a company that keeps encountering the same manufacturing defects despite various attempts to fix them. By using the 5 Whys Technique, they discovered that the defects were not caused by faulty machinery, as previously assumed, but rather by human error due to unclear operating instructions. This realization led to improved training procedures and clear work guidelines, ultimately eliminating the defects.

Application in Service Industry

Now, consider a service industry struggling with frequent customer complaints and service failures. Through the 5 Whys Technique, it was revealed that these issues stemmed from inadequate staffing levels during peak hours. By addressing this root cause, such as hiring additional staff or adjusting schedules, the service quality can significantly improve, leading to higher customer satisfaction.

These examples illustrate how the 5 Whys Technique can be applied across different sectors to identify and address underlying issues effectively.

Step 1: Identify the Problem

Before diving into a 5 Whys analysis, it’s crucial to clearly identify the problem or issue at hand . This step sets the stage for the entire process and ensures that the focus remains on addressing the right concern. Take the time to gather relevant data, observe patterns, and consult with team members or stakeholders to gain a comprehensive understanding of the problem.

Step 2: Ask ‘Why’ Five Times

Once the problem is clearly defined, it’s time to start peeling back the layers. The process involves asking “why” five times, not necessarily limited to five questions but enough to delve deeper into the underlying causes of the problem . Each “why” serves as a gateway to uncovering additional factors contributing to the issue. This iterative approach helps in identifying not just one cause, but multiple interconnected elements that may be at play.

By consistently probing deeper with each “why,” you can reveal hidden complexities and nuances that may have been overlooked initially. This method allows for a more thorough understanding of the situation, paving the way for effective solutions that address root causes rather than surface-level symptoms.

This structured approach encourages critical thinking and enables teams to move beyond quick fixes towards sustainable improvements.

The 5 Whys Technique is a versatile problem-solving approach that can be applied in various scenarios to uncover root causes and drive continuous improvement. Here are two key situations where the 5 Whys Analysis can be particularly beneficial:

Recurring Issues

• The 5 Whys Technique is especially useful when dealing with recurring issues. Whether it’s a manufacturing defect that keeps resurfacing or a persistent customer complaint in the service industry, this method helps identify the underlying reasons behind these repetitive problems. By repeatedly asking “why,” it becomes possible to trace the issue back to its root cause, allowing for targeted solutions that prevent reoccurrence.

Process Improvement

• Organizations constantly strive to enhance their processes and workflows for increased efficiency and quality. When seeking to improve existing procedures, the 5 Whys Technique serves as a valuable tool. By systematically analyzing the factors contributing to inefficiencies or bottlenecks, teams can gain insights into how processes can be optimized at their core. This method enables organizations to make informed decisions about process improvements based on a deep understanding of the underlying issues.

In both cases, the 5 Whys Analysis offers a structured yet flexible approach to delve into complex problems, making it an indispensable tool for driving meaningful change and progress within organizations.

When it comes to conducting a 5 Whys analysis, utilizing a structured template can greatly facilitate the process and ensure a comprehensive investigation into the root cause identification. Using RCA software such as EasyRCA can benefit the team by streamlining your 5-why process. Here’s how organizations can benefit from using a template:

Benefits of Using a Template

• Streamlined Process: A well-designed 5 Whys template provides a clear framework for conducting the analysis, guiding teams through the iterative questioning process. This streamlines the investigation, making it easier to navigate and ensuring that no crucial aspects are overlooked.
• Thorough Investigation: By following a predefined template, teams are prompted to explore various facets of the problem systematically. This ensures that all relevant factors are considered, leading to a more thorough and insightful investigation into the underlying causes.
• Consistent Approach: Templates offer a standardized approach to conducting 5 Whys analyses within an organization. This consistency promotes uniformity in problem-solving methods across different teams or departments, enhancing overall efficiency and effectiveness.

Customizing the Template

Organizations have the flexibility to customize 5 Whys templates according to their specific needs and industry requirements. This adaptability allows for tailoring the template to address unique challenges and incorporate industry-specific considerations. Customization may include:

• Adding Industry-Specific Prompts: Tailoring the template by incorporating prompts or questions relevant to particular industries or types of issues being analyzed.
• Incorporating Visual Aids: Enhancing the template with visual aids such as flow charts or diagrams can help teams better understand and communicate complex causal relationships.
• Iterative Refinement: Regularly reviewing and refining the template based on feedback and evolving organizational needs ensures that it remains aligned with current processes and challenges.

Customizing the template empowers organizations to harness the full potential of the 5 Whys Technique in addressing diverse problems while aligning with their unique operational contexts.

Encouraging Open Communication

In mastering the 5 Whys Technique as a problem-solving method, creating an environment that fosters open communication is paramount. When team members feel comfortable expressing their perspectives and insights, it leads to a more comprehensive exploration of the underlying causes of a problem. Encouraging open communication allows for diverse viewpoints to be considered, providing a holistic understanding of the issue at hand.

By promoting an atmosphere where individuals are empowered to voice their observations and concerns, the 5 Whys analysis can benefit from a rich tapestry of ideas and experiences. This inclusive approach not only enhances the depth of the analysis but also cultivates a sense of ownership and collective responsibility for addressing root causes within the team or organization.

Continuous Improvement Mindset

A key aspect of mastering the 5 Whys Technique is embracing a continuous improvement mindset. Rather than viewing problems as isolated incidents, this approach encourages teams to see them as opportunities for growth and development. By instilling a culture of continuous improvement, organizations can leverage the insights gained from 5 Whys analyzes to drive positive change across various aspects of their operations.

Fostering a mindset focused on continuous improvement entails actively seeking feedback, evaluating processes, and implementing iterative enhancements based on the findings. It involves an ongoing commitment to learning from past experiences and leveraging that knowledge to proactively address potential issues before they escalate. Embracing this mindset ensures that the 5 Whys Technique becomes ingrained in the organizational ethos, leading to sustained progress and resilience in problem-solving efforts.

As we wrap up our exploration of the 5 Whys Technique, let’s address some common questions that may arise regarding this powerful problem-solving method.

What is the primary goal of the 5 Whys Technique?

The primary goal of the 5 Whys Technique is to uncover the root cause of a problem by iteratively asking “why” at least five times. This approach aims to move beyond surface-level symptoms and address the underlying issues that lead to recurring problems.

Is the 5 Whys Technique limited to specific industries or sectors?

No, the 5 Whys Technique is versatile and can be applied across various industries and sectors. Whether it’s manufacturing, healthcare, service, or technology, this method offers a structured yet flexible approach to identifying root causes and driving continuous improvement.

How does the 5 Whys Technique contribute to continuous improvement?

By delving into the fundamental reasons behind problems, the 5 Whys Technique provides organizations with valuable insights for driving continuous improvement. It not only helps in resolving immediate issues but also fosters a culture of ongoing enhancement and development within an organization.

Can the 5 Whys Technique be used for complex problems with multiple contributing factors?

Yes, while initially designed as a simple and straightforward method, the 5 Whys Technique can certainly be applied to complex problems with multiple interconnected factors. By systematically probing deeper into each layer of causality, this technique enables a comprehensive understanding of intricate issues.

I hope you found this guide to 5 whys technique insightful and actionable! Stay tuned for more thought-provoking articles as we continue to share our knowledge. Success is rooted in a thorough understanding and consistent application, and we hope this article was a step in unlocking the full potential of Root Cause Analysis for your organization.

Reliability runs initiatives such as an online learning center focused on the proprietary PROACT® RCA methodology and EasyRCA.com software. For additional resources, visit Reliability Resources .

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• Alan J Card
• Correspondence to Dr Alan J Card, Evidence-Based Health Solutions, LLC, PO Box 62, Notre Dame, IN 46556, USA; alan.j.card{at}gmail.com

https://doi.org/10.1136/bmjqs-2016-005849

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• Root cause analysis
• Lean management
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‘The Problem with…’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement and pervasive problems that seem to resist solution.

The ‘5 whys’ technique is one of the most widely taught approaches to root-cause analysis (RCA) in healthcare. Its use is promoted by the WHO, 1 the English National Health Service, 2 the Institute for Healthcare Improvement, 3 the Joint Commission 4 and many other organisations in the field of healthcare quality and safety. Like most such tools, though, its popularity is not the result of any evidence that it is effective. 5–8 Instead, it probably owes its place in the curriculum and practice of RCA to a combination of pedigree, simplicity and pedagogy.

This quote also makes the case for the technique's simplicity. Asking ‘why’ five times allows users to arrive at a single root cause that might not have been obvious at the outset. It may also inspire a single solution to address that root cause (though it is not clear that the ‘1H’ side of the equation has been adopted as widely).

‘5 whys’ as a teaching tool

The pedagogical argument for ‘5 whys’ is that it creates an ‘aha moment’ by revealing the hidden influence of a distant cause, which illustrates the importance of digging deeper into a causal pathway. This quick and easy learning experience can be a powerful lesson in systems safety and QI.

Possibly the most famous ‘5 whys’ case study to be used in this way focuses on efforts to preserve the Washington Monument. 12 , 13 Details vary slightly depending on the source, but it usually looks something like this:

Problem : The Washington Monument is deteriorating

Why? Harsh chemicals are being used to clean the monument

Why? The monument is covered in pigeon droppings

Why? Pigeons are attracted by the large number of spiders at the monument

Why? Spiders are attracted by the large number of midges at the monument

Why? Midges are attracted by the fact that the monument is first to be lit at night.

Solution: Turn on the lights one hour later.

This is a great teaching example because the ‘root cause’ is so unintuitive. Who would think, before exploring the issue in depth, that lighting choices could endanger a marble monument? But, as is so often the case, reality is messier than this simple illustration.

Joel Gross 12 investigated the foundation of this example and discovered that many of the details are incorrect. And, crucially, the broader story it tells is incomplete.

In terms of the story's details, the monument is question was actually the Lincoln Memorial, and it was not being damaged by the use of harsh chemicals. The real culprit was simply water. Pigeons were not an issue at all, and while there were ‘tiny spiders’ (ref. 14 , p. 8) at the memorial, they were not a major problem. Instead, most of the cleaning was necessary because swarms of midges were dazzled by the lights and flew at high speed into the walls of the memorial, leaving it splattered with bits of the insects and their eggs. 12 , 14

But that only speaks to the details that were described. The analysis is also incomplete in a number of more important ways. For instance, it only addresses one potential source of deterioration: cleaning water.

The first ‘why’ could just as easily have tackled other causes, such as rain or acid rain (a significant concern at the time), rising damp, erosion from windborne particles or damage from freeze-thaw cycles. 15 Or, if the goal had been to prevent harm to future monuments, the first ‘why’ could have focused on the use of marble as a building material, the choice of building site, etc.

However, the most important problem with this example is that, while the solution was ‘effective’ in one sense, it still failed: Messersmith [the consultant entomologist who worked on this project] thought that because the insects swarmed only at sunset, a one-hour delay in turning on the monument lights would go far in solving the problem. The technique worked, reducing the number of midges in the monuments by about 85 percent. ‘But tourists who had driven hundreds of miles to have their photographs taken at the monuments were not happy,’ he said. ‘They complained every day, and the lights went back on.’ 16

The logic of the solution was sound, as far as it went. But it was predicated on an incomplete understanding of the broader system, its stakeholders and the purpose of the monument itself. If anything, this window on the complexity of real-world problem solving adds to the value of this teaching example. If the first ‘aha moment’ is followed by this second one, trainees will not only learn that distal causes can have unexpected outcomes, but also that systems thinking requires both depth and breadth of analysis.

The problem with ‘5 whys’ in RCA

‘5 whys’ has been the subject of a number of caveats and critiques. For instance, Minoura, one of Ohno's successors at Toyota, highlights the potential for users to rely on off-the-cuff deduction, rather than situated observation when developing answers, as well as difficulty in prioritising causes, if multiple ‘5 whys’ are used. 17 Mark Graban, a thought leader in the Lean community, points out that ‘5 whys’ is just one component of what should be a far more comprehensive problem-solving process. 18 And Serrat clarifies that users should not feel constrained by the arbitrary number in the tool's title: more, or fewer, than five ‘whys’ may be required. 19

But the real problem with ‘5 whys’ is not how it is used in RCA, but rather that it so grossly oversimplifies the process of problem exploration that it should not be used at all. It forces users down a single analytical pathway for any given problem, 13 insists on a single root cause as the target for solutions 9 , 13 , 20 and assumes that the most distal link on the causal pathway (the fifth ‘why’) is inherently the most effective and efficient place to intervene.

A single causal pathway

A credible ‘5 whys’ approach to a wrong patient medication error might look like this (adapted from Battles et al ): 21

Incident : Wrong patient medication error

Why? Wristband not checked

Why? Wristband missing

Why? Wristband printer on the unit was broken

Why? Label jam

Why? Poor product design

But another team could easily come up with five wholly different and equally valid ‘whys’. And any single string of ‘5 whys’ can provide only a blinkered view of the complex causal pathway that led to the incident. This is illustrated by figure 1 , a causal tree diagram (or, more accurately, a ‘causal and contributing factors tree diagram’) depicting the underlying issues that gave rise to the adverse event.

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A causal event tree (adapted from ref. 21 ). ID, identification; IT, information technology.

It is clear from the tree diagram that the causal pathway related to the wristband printer is neither the only relevant cause of the incident nor indisputably the most important. A serious effort to solve the myriad problems that gave rise to this incident would have to tackle a number of other causal pathways as well.

These might include pathways related to a maladaptive workplace culture, 22–25 clinical and information technology (IT) staffing, orientation of agency staff and the absence of a forcing function 26 to ensure that patients are properly identified before medication is administered. It could also include a focus on improved infection control and better preparedness for infectious disease outbreaks. Solutions based on the ‘5 whys’ in the example above would leave all of these issues unaddressed.

There is also no objective or reliable means of mapping out the causal pathway, which is a critical failing when only one pathway will be examined. Consider the variant below, which follows essentially the same causal reasoning as the first example:

Why? Healthcare system purchased an unreliable printer

Why? Poor process for evaluating and purchasing ‘non-clinical’ equipment

Why? Equipment deemed ‘non-clinical’ is not seen as safety-critical

This version skips the step of asking why the wristband was not checked and moves directly to asking why it was not there. It also sticks to the high-level issue of the printer being broken, without delving into the details of the label jam. ‘Skipping’ these questions allows the analysis to go deeper because it leaves more ‘whys’ available. This example also maintains a focus on issues within the organisation, rather than the design of the printer. This would lead to very different solutions.

But because this approach skips past the question of why the wristband was not checked, it closes the door to questions about other reasons why it was not checked. In figure 1 , this would include the lack of a forcing function. But in another scenario, it might include a desire to avoid waking the patient; 27 an unreadable wristband (eg, smudged, crinkled or occluded); 28 the lack of a label on the medication; 29 confusion caused by multiple wristbands; 30 lack of trust in the wristband data due to frequent errors 31 or any of a number of other causes. 28–31

Users could also go down an entirely different causal pathway. An equally reasonable ‘5 whys’ for this incident could look like this:

Why? Patients with similar names in the same room

Why? Not feasible to try ‘juggling beds’

Why? Not enough nurses to deal with the influx of patients

Why? Nurses affected by an outbreak of norovirus

Why? Poor adherence to time-consuming infection control interventions

Why? A culture of ‘just get the job done’

There are many ‘correct’ ways a team might use ‘5 whys’ to assess even this one incident. And it is unlikely that any two teams would independently arrive at exactly the same results. This subjectivity is critically important because ‘5 whys’ focuses on only one root cause at the end of one causal pathway.

More sophisticated practice in the use of ‘5 whys’ might produce two causal pathways, focusing on the main service failures uncovered, rather than the event itself (ie, a set of ‘5 whys’ for ‘wristband not checked’ and another for ‘verbal identification failure’). But this is not how use of the tool has generally been taught in the healthcare industry. 1 , 3 , 32 And even this unusually thorough approach would identify only 2 of the 30 causal pathways shown in the tree diagram.

A single root cause

Forcing users down a single causal pathway should be disqualifying by itself. But ‘5 whys’ narrows the scope for improvement even further by insisting that risk control efforts must focus on a single root cause for each causal pathway. In the first healthcare example above, for instance, the root cause would be ‘poor product design’, and this would serve as the sole target for improvement efforts.

But accidents are seldom the result of a single root cause. 33 So focusing exclusively on one (or even a few) arbitrarily determined ‘root causes’ is not a reliable method for driving improvement—especially in a system as complex as healthcare. As Wieman and Wieman wrote: “Unfortunately … restricting the number of variables [considered] in a complex system only results in an increased potential for errors of omission” (ref. 34 , p. 117).

How much might be omitted when using ‘5 whys’? The tree diagram for our example uncovers more than 75 whys (causes and contributing factors), each of which is a potential target for action to reduce the risk of a recurrence. The ‘5 whys’ approach would identify only one (or possibly two) root cause as target for action. At best, this represents <3% of the opportunities for improvement identified using the tree diagram.

Targeting only the most distal cause

Not only are users of ‘5 whys’ limited to one root cause per causal pathway, but they are also limited to selecting only the most distal cause (conventionally, the fifth ‘why’). There is, however, no logical reason to assume that this is always the most effective or most efficient target for intervention.

Actually, if it were possible to magically place a 100% effective risk control at any one point on the tree diagram, it would be best used on a proximate cause. For instance, making it impossible to administer medication without checking the wristband would render all the more distal causes moot for the purpose of preventing a recurrence.

And, while 100% effective risk controls are seldom available, an action plan that includes a proven 26 (if certainly imperfect) 29 intervention like a well-designed bar-code reader with a forcing function for patient identification (ID) is more likely to prevent another serious ‘wrong patient’ medication error than switching to a well-designed printer.

This is not to suggest that more distal causes are not appropriate targets for improvement efforts. In the example presented in figure 1 , for instance, there is clearly a profound need to change the culture from one that is task-oriented and sometimes hostile to one that is outcomes-oriented and psychologically safe. The pervasive impact of such a culture change would be far more important than merely reducing the risk that this particular incident might recur; it would influence almost every quality and safety issue in the organisation.

And, in contrast to that powerful-but-difficult lever for shifting outcomes, sometimes more distal causes represent ‘low-hanging fruit’ that can be addressed while a more proximate solution is in the works. In figure 1 , educating patients about why clinicians will be constantly asking them to identify themselves would be far from foolproof. But it would be fast, cheap and easy. And it might reduce an important barrier to best practice in verbal identification.

Appropriate targets for intervention may occur anywhere along the causal continuum and on any causal pathway. And efforts to improve safety and quality will often require more than one intervention targeting more than one underlying hazard. It is useful to identify all the key hazards that gave rise to an incident and ensure that each of these is either addressed or intentionally accepted. 35 (See, for instance, the Options Evaluation Matrix.) 36 But the use of ‘5 whys’ makes this impossible.

Considering the virtues of ‘5 whys’

What, then, of the virtues of ‘5 whys?’ Are the issues above redeemed by the tool's simplicity and pedigree?

Simplicity is a complicated virtue when it comes to the frameworks, tools and techniques of QI. For instance, the conceptual simplicity of the Plan-Do-Study-Act (PDSA) framework is one of its main selling points, but it may also lead organisations to underestimate the messy work involved in applying PDSA to real-world problems. 37

But, as this paper has shown, the ‘5 whys’ approach has clearly overshot the mark: it is not simple, but simplistic . It is, as Leveson describes, “… perhaps the most simplistic [accident analysis technique] and … leads to the least amount of learning from events”. 13

Charles Vincent famously called for RCA to serve as “a window on the system”. 38 If that is the goal, then ‘5 whys’ is doomed to fail. It purposely discards the vast majority of what might be learned about the system being interrogated.

The reality of most healthcare processes and systems is that we face classic design problems: problems that are highly contextualised and often “ill-defined, ill-structured, or ‘wicked’” 39 (ref. 40 , p. 224). A ‘5 whys’ analysis ignores this. Most of the causal pathways that led to an event are amputated from the start, and consideration of those that remain is limited to a single root cause.

This creates a toy problem i in which it is assumed that simple optimisation of one, or at most a handful of variables will lead to improvement, without any need to consider the rest of the system. This flies in the face of everything we know about solving problems in complex adaptive systems like healthcare. 41

The positive reputation enjoyed by TPS/Lean provides an aura of credibility for ‘5 whys’. But how applicable is this to the question at hand? The reputation of TPS/Lean was built in a very different context. And the use of ‘5 whys’ as an RCA tool is by no means the same thing as the use of the full TPS/Lean methodology.

Healthcare organisations are not automobile factories. And while there is much to be learned from the automotive industry and other high-reliability organisations (HROs), healthcare delivery will never be truly comparable to automobile manufacturing. Despite efforts in the healthcare industry to adopt the tenets of HROs, 42 , 43 current practice provides recommended care only about 70% of the time. 44 And the percentage of hospital patients who experience an adverse event may be as high as 25–33%. 45–50

HROs commonly aim for a reliability rate of ‘six sigma’ (three errors per million opportunities). By these measures, healthcare is struggling to move beyond two sigma (308 500 errors per million opportunities, or a 30.85% error rate). 51

Reliability in the healthcare industry can improve, and indeed it has (cf. ref. 52). But healthcare is far more complex 34 , 53 than automobile manufacturing, and takes place amid processes and systems that are woefully underdesigned in comparison to a modern factory. Further, the safety and quality workforce in healthcare is only beginning to move towards professionalisation 54 , 55 and often lacks formal training in engineering, human factors, ergonomics or similar domains.

As a result, approaches developed for solving problems in the automotive manufacturing context may not be as effective in the healthcare arena. And, indeed, the evidence base for the use of Lean/TPS in healthcare is weak 56–58 and increasingly negative. 59 , 60

It is also important to differentiate between the use of ‘5 whys’ as a QI method and the use of Lean/TPS as a QI methodology. Though the two are sometimes conflated in both the literature 59 and practice, 61 they are by no means equivalent. And the use of ‘5 whys’ in healthcare RCA is not typically part of a full-scale Lean management approach.

If the use of ‘5 whys’ does not imply the adoption of Lean, and if the evidence to date does not support the effectiveness of Lean in healthcare in any case, there is little reason to be swayed by the pedigree argument.

Using ‘5 whys’ undermines an already weak RCA process

A recent article by Peerally et al 33 describes a number of important weaknesses in healthcare RCA practice. Some of these have been explored above (eg, focusing on a single root cause or a small handful of them; and poor quality investigations), but it also raises a number of other issues, such as misuse of the RCA process to pursue (or avoid) other agendas; failure to support feedback loops and double-loop learning; a focus on individual and isolated incidents; a confused approach to blame; the ‘problem of many hands’ (see also ref. 63 ) and the shortfalls of a retrospective approach.

The authors also note that RCA often results in poorly designed and/or poorly implemented risk controls. 33 While the goal of learning from incidents is to reduce risk and prevent future harm, the actual tools and techniques of current practice focus exclusively on diagnosing problems; they provide no direct support for prescribing and managing treatments for the organisational pathologies they uncover. 64 , 65

Some organisations have adopted the PDSA approach to continuous improvement of their risk control action plans. 37 , 66 But this is a high-level framework, akin to the scientific method. And like the scientific method, it must be implemented through an appropriate set of tools and techniques to produce reliable results. 37 Although a handful of such tools have been introduced in recent years, 35 , 36 , 67–72 they have not yet been adopted as the current standard of practice.

Perhaps as a result, there is little evidence to suggest that current practice in RCA improves outcomes. 65

These challenges do not mean that RCA is never worthwhile; it certainly can be a source of important learning 73 and improvement. 74 But it does mean that we cannot afford to compound these problems through the use of an RCA tool that is so deeply and fundamentally flawed. Other more systems-focused techniques, such as fishbone 75 or lovebug diagrams, 72 causal tree diagrams, 21 Causal Analysis based on Systems Theory (CAST) 76 or even prospective risk assessment approaches, 77–81 should be considered instead.

When used carefully, ‘5 whys’ may play a powerful role in the classroom. It can illustrate both the need for depth (as a positive example) and the need for breadth (as a negative example) when analysing complex problems.

As a tool for conducting RCAs, however, especially in the area of patient safety, the use of ‘5 whys’ should be abandoned. As the (apocryphal) quote goes: “For every complex problem, there is an answer that is clear, simple and wrong”. 82 When it comes to accident investigation, ‘5 whys’ is that answer.

• ↵ World Health Organisation . The WHO patient safety curriculum guide: multi-professional edition . Geneva , 2011 .
• ↵ NHS Improving Quality . Improvement tools. http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety/improvement-resources/improvement-tools.aspx (accessed 28 Jan 2016 ).
• ↵ Institute for Healthcare Improvement . Ask ‘why’ five times to get to the root cause. Improv. stories. http://www.ihi.org/resources/Pages/ImprovementStories/AskWhyFiveTimestoGettotheRootCause.aspx (accessed 28 Jan 2016 ).
• ↵ The Joint Commission . Sentinel event policy and procedures . 2016 . http://www.jointcommission.org/sentinel_event_policy_and_procedures/ (accessed 28 Jan 2016 ).
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Competing interests None declared.

Provenance and peer review Commissioned; internally peer reviewed.

↵ i A toy problem is: “A deliberately oversimplified case of a challenging problem used to investigate, prototype, or test algorithms for a real problem. Sometimes used pejoratively”. 62

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5 Whys: Examples, explanations, and how to find the causes of problems

At some point, we’ve all experienced a problem with a process or strategy at work. But figuring out why the problem exists can be a daunting task. When you sit your teammates down for a discussion, emotions run high and miscommunication is common.

The 5 Whys is a powerful, easy-to-use technique for getting at the root of a problem. It empowers you and your team to understand why a problem persists and to decide on a path forward.

• What is the 5 Whys framework?

The 5 Whys is a popular problem-solving method that individuals and teams use to understand the potential causes of a specific issue. Years ago, Toyota developed the approach to help them get at the heart of complex mechanical issues, so you know it’s legitimate! The technique is easy to use: you ask why a problem happened, and then you ask four more times. By asking “why” on a step-by-step basis, you can get to the root cause of a defect, failure, challenge, or malfunction.

• When and Why the 5 Whys Analysis is Used

The 5 Whys framework is useful in a variety of situations. People love it because it helps you have a focused discussion and avoid getting distracted by other topics. You just start with a problem statement, ask why the problem exists, and keep moving through the exercise until you’ve uncovered the problem.

Here are some scenarios where you might find the 5 Whys approach to be useful.

Working on complex products

Remember, the 5 Whys technique was originally developed by Toyota. The car manufacturer needed a clear-cut way of dealing with a product that has thousands of parts. But that doesn’t mean the technique only works for large physical goods. Many organizations use the 5 Whys approach when software malfunctions, when a key deliverable with many moving parts doesn’t work properly, or when a multi-step process breaks down.

Solving complex problems

When a problem is so complex that engineers, designers, or decision-makers are scratching their heads, the 5 Whys approach may serve you well. Maybe your complicated marketing strategy didn’t hit your targets, or an important API isn’t working. Instead of getting overwhelmed, the 5 Whys framework helps you wrap your head around the problem.

Dealing with consistent problems

Maybe the problem doesn’t seem complex, but it keeps coming up. Or maybe you’ve tried multiple solutions and none seem to work. Rather than burning precious time and money on yet another risky bandaid, try the 5 Whys to finally discover what’s going on.

• How to conduct a 5 Whys analysis in 6 steps

One of the great things about the 5 Whys framework is that it’s easy to understand. Unlike many other problem-solving techniques, which can be difficult to grasp, you can explain the 5 Whys to your team in minutes. Follow these guidelines any time you need to use the approach.

Step 1 – Form your problem statement.

Start by asking your team what problem you’re about to analyze. Everyone should get a chance to articulate the problem so you’re all on the same page. Sometimes, you might find yourself using the 5 Whys approach to uncover the root of a difficult or charged obstacle. If that’s the case, give your team the time and space to be honest with each other and to have difficult conversations. Write down the problem statement for everyone to reference.

Step 2 – Ask “why has this happened?” 5 times.

Don’t be too literal with it. Feel free to amend the “why” statement to something like “Why does this keep happening?” or “Why are we having this problem?” Keep going until you’ve asked “why” five or more times. It might feel unnatural, but eventually, you’ll push through any awkwardness to uncover the root of the problem.

Step 3 – Jot down logical causes.

Okay, now you have a pretty good handle on your problem. Write down any logical causes that have followed from your 5 Whys analysis. Regardless of whether those causes came from your first “why” or your fifth, make a detailed note of them. Discuss the causes with your team and make sure you’re all agreed.

Step 4 – Hypothesize an answer.

Now that you have your logical cause, it’s time to come up with some potential solutions. At this stage, you’re just having a conversation. You don’t need to come up with the perfect solution in this meeting. Have everyone go around the room and say (or write down) a possible solution. Ask everyone to vote on the most actionable one.

Step 5 – Test your hypothesis.

Put your solution to the test with some experiments. If you’ve decided that a marketing campaign failed because you didn’t choose the correct target audience, then maybe you can come up with some A/B tests to vet possible solutions. Aim for low-stakes tests that you can use to draw meaningful conclusions.

Step 6 – Repeat until solved.

Iterate until you’ve solved the problem! Don’t be discouraged if it doesn’t happen right away. Sometimes, it might take multiple rounds of “whys” followed by many rounds of testing to uncover a solution. Keep an open line of communication among your teammates and don’t give up.

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• A simple 5 Whys example

The 5 Whys is an adaptable, easy-to-use framework for uncovering the root of a problem. Organizations and teams of all sizes use the framework to overcome complex, high-stakes challenges. Here’s a quick example to help you bring this method of analysis to your own team.

Let’s say your team has been working on an app for many months. You rolled out a beta version late last quarter. You were supposed to ship the app to the rest of your users at the beginning of this quarter, but a problem arose: a bunch of your early users complained of a fatal error that caused the app to crash. As a result, you couldn’t ship it, and your customers were disappointed.

Step 1 — Write down your problem statement. 

As we mentioned above, the first step in following the 5 Whys framework is to clearly and succinctly define what problem you’re trying to solve. The entire group should be clear about this issue. In this case, the problem statement is: your app wasn’t ready to ship to your customers.

Step 2 — Start with the broadest possible question.

Start with the broadest possible question. Then aim to answer it. Why wasn’t the app ready for your customers? It wasn’t ready because there was a bug in the code that caused it to crash.

Drill down into that question. Why was there a bug in the code that caused it to crash? There was a bug in the code because the engineers didn’t get user feedback in time to fix it.

Keep drilling down. Why didn’t the engineers get that user feedback? They didn’t get the feedback because the development team didn’t provide an easy way for users to submit their feedback.

Continue drilling down, asking more and more precise questions as you get closer to the answer. Why didn’t the development team provide an easy way for users to leave feedback? They didn’t provide an easy way for users to leave feedback because they weren’t clear on deadlines for the project.

Ask “why” at least one more time. Why wasn’t the development team clear on deadlines for the project? They weren’t clear on deadlines because they weren’t meeting with stakeholders often enough to know when the timeline changed.

Step 3 – Write down logical issues.

Now you have enough information to write down logical causes. It seems that this problem stemmed from a lack of communication between stakeholders. That caused the development team and engineering team to become misaligned.

Step 4 – Once you’re ready, you can come up with a possible solution to this problem.

Once you’re ready, you can come up with a possible solution to this problem. In the future, internal stakeholders will hold weekly check-ins to make sure they’re aligned on where the project is headed.

Step 5 – Put that hypothesis into action.

Here’s where you get to test out your hypothesis and see what effects it has. Moving forward, start holding weekly check-ins and see what happens. If miscommunication and confusion goes down, you’ll know you’re on the right track.Step 6 – Adjust your strategy, if needed

Resist the urge to consider a problem “solved” and move on immediately. It’s important to revisit how the solution is functioning in the weeks ahead, continually checking in with everyone on the team to see how they’re feeling about it. You may need to tweak your strategy over time.

• How 5 Whys helped solve the problem

This example clearly showcases the power of the 5 Whys. What looked like a problem with code turned out to be a symptom of miscommunication.

Although this is just a hypothetical, we all know stuff like this happens every day. But it’s often difficult to uncover the root causes of a problem without months and months of exploration. With the 5 Whys, you can overcome costly challenges in a much shorter amount of time.

• Try the 5 Whys template for free

Clearly, asking “why?” isn’t just a technique used by persistent 4-year-olds – it’s actually a quick and easy way to identify a root cause. Countless teams across different industries have had great results using this framework. Save time, collaborate with your team, and solve hard problems with Miro’s free 5 Whys template .

• How Miro helps distributed teams collaborate

Working with a remote team can be challenging — but it also offers unparalleled opportunities for creativity and collaboration. Miro’s online whiteboard helps teams overcome cultural divides, communication silos, geographic barriers, and micro-cultures to empower you to stay connected and do great things.

Miro has a variety of templates and tools for teams to help you and your team:

• Create a mind map
• Manage a scrum board
• Create user story maps and customer journey maps
• Work with sticky notes, even if you aren’t in the same room
• Generate flow charts and diagrams
• Run brainstorming sessions

And lots more… try Miro for remote collaboration today!

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Root Cause Analysis – The 5 Whys Technique

This elementary and often effective approach to problem-solving promotes deep thinking through questioning, and can be adapted quickly and applied to most problems. For example, asking “Why?” may be a favorite technique of your three-year-old child in driving you crazy, but it could teach you a valuable problem-solving technique.

“If you don’t ask the right questions, you don’t get the right answers. A question asked in the right way often points to its answer. Asking questions is the ABC of diagnosis. Only the inquiring mind solves problems.” – Edward Hodnett

The “5 Whys” is a simple problem-solving technique that helps you to get to the root of a problem quickly, which was originally developed by Sakichi Toyota. It was used within the Toyota Motor Corporation during the evolution of its manufacturing methodologies. It is a critical component of problem-solving training, delivered as part of the induction into the Toyota Production System.

How to Conduct 5 Whys Analysis?

When you’re looking to solve a problem, start at the result and work backward (toward the root cause), continually asking: “Why?” You’ll need to repeat this over and over until the root cause of the problem becomes apparent.

The 5 Whys strategy involves looking at any problem and asking: “Why?” and “What caused this problem?” Very often, the answer to the first “why” will prompt another “why” and the answer to the second “why” will prompt another and so on; hence the name the 5 Whys strategy.

The 5 Whys exercise is vastly improved when applied by a team and there are five basic steps to conducting it:

• Write down the specific problem. Writing the issue helps you formalize the problem and describe it completely. It also helps a team focus on the same problem.
• Ask “Why” the problem happens and write the answer down below the problem.
• If the answer you just provided doesn’t identify the root cause of the problem that you wrote down in Step 1, ask “Why” again and write that answer down.
• Loopback to step 3 until the team is in agreement that the problem’s root cause is identified. Again, this may take fewer or more times than five Whys.
• After settling on the most probable root cause of the problem and obtaining confirmation of the logic behind the analysis, develop appropriate corrective actions to remove the root cause from the system.

Edit this Diagram

5 Whys Example

The vehicle will not start. (The problem)

• Why? – The battery is dead. (First why)
• Why? – The alternator is not functioning. (Second why)
• Why? – The alternator belt has broken. (Third why)
• Why? – The alternator belt was well beyond its useful service life and not replaced. (Fourth why)
• Why? – The vehicle was not maintained according to the recommended service schedule. (Fifth why, a root cause)

Note: A 5 Whys analysis sometime could be taken further to a sixth, seventh, or higher level, but five iterations of asking why are generally sufficient to get to a root cause.

5-Whys Criticisms

Here are each of the criticisms as listed on the Wikipedia:

• Stopping at symptoms, not the root cause
• Limited by the investigator’s knowledge.
• Not asking the right Why questions.
• Not repeatable – Different people build different 5 Whys.
• The tendency to isolate a single root cause

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• July 12, 2024

What if you could solve your organization's problems by repeatedly asking the question “Why?” That's precisely what we're talking about today: the power of the 5 Whys, a simple but highly effective tool for identifying the initial problem.

In this article, you'll get an in-depth understanding of this methodology and its many advantages, and learn the steps you need to take to put it into practice. We'll also give you practical advice on asking the right questions and concrete examples of its application in different sectors. Finally, we'll look at how the UTrakk solution can facilitate and optimize the use of this methodology to improve operational processes and performance.

Key takeaways:

• The 5 Whys method is a straightforward yet powerful tool for root cause analysis, enhancing problem-solving efficiency.
• By asking "Why?" multiple times , teams can delve deeper into issues, uncovering underlying causes rather than superficial symptoms.
• Implementing the 5 Whys method encourages a culture of continuous improvement and critical thinking within organizations.
• This method is versatile and can be applied across various industries to address different types of problems.
• Effective use of the 5 Whys involves clear problem definition, stakeholder involvement, and thorough documentation of findings and actions.

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Root cause analysis: Understanding the 5 Whys

The 5 Whys analysis is a simple but powerful problem-solving method that identifies one or multiple root causes for the same problem by asking “Why?” repeatedly, usually five times. Each answer leads to the formulation of the next question until the real root cause is revealed and a solution is found. This methodology focuses on deeper issues behind symptoms and small recurrent problems. 

The 5 Whys were originally developed by Sakichi Toyoda, founder of Toyota Industries, in the 1930s. Described as “the basis of Toyota's scientific approach”, they have been widely adopted and popularized by Toyota Motor Corporation as part of the TPS (Toyota Production System). This manufacturing model is rooted in many modern quality management and continuous improvement practices, such as Lean Manufacturing .  

When should you use the 5 Whys?

Many effective problem-solving techniques exist, such as the Ishikawa diagram, the 5 Ws and H, the PDCA cycle , etc.

The 5 Whys are particularly relevant in the following situations:

• For simple to moderately complex problems that don't require in-depth analysis or where the causes are not immediately apparent.
• For quick resolution when time is critical, the 5 Whys technique enables root cause analysis without requiring significant resources or time. 
• In organizations seeking to establish a culture of continuous improvement , the simplicity of this methodology makes it an accessible tool for all hierarchical levels.

The 5 Whys can also be a first step before opting for more complex processes. For example, you can use it to identify a root cause, which can be explored in greater detail using an Ishikawa diagram or as part of a PDCA cycle.

The advantages of the 5 Whys methodology

• Simplicity and accessibility: The 5 Whys technique is straightforward to understand and implement. It requires no complex training or sophisticated tools, making it accessible to all employees, regardless of their technical expertise.  
• Root cause identification: One of the main advantages of the 5 Whys methodology is its ability to go beyond the apparent symptoms of a problem to find its root cause. We no longer focus solely on superficial solutions but ensure the problem is dealt with at source. It enables more effective and sustainable corrective action to be taken.
• Promoting continuous improvement: The 5 Whys fit perfectly into a continuous improvement approach . By encouraging systematic identification of the underlying causes of problems, this methodology fosters a culture of questioning and constant search for more effective solutions.
• Reduced implementation costs: Using the 5 Whys requires neither significant financial investment nor unique material resources. It makes it an attractive option for companies of all sizes, including those with limited budgets for continuous improvement initiatives.
• Developing critical thinking skills: Repeating the question “Why?” encourages teams to think critically and analyze more deeply. It strengthens employees' ability to identify and solve problems independently, increasing their job satisfaction.
• Adaptability to various contexts: The 5 Whys process is versatile and can be applied in various contexts such as manufacturing, services, IT, etc.

Key steps to implementing the 5 Whys process

1. Identify the problem

The first step is clearly defining the problem you are trying to solve. A precise, concise description is essential to guide the questions that follow. 

Try to focus on one problem at a time to avoid confusion.

2. Ask the first question “Why?”

It allows you to begin exploring the possible causes of the problem. The answer to this question should be specific and factual.

3. Ask the second question “Why?”

Based on the answer to the first question, ask the "Why?" question again to explore the underlying cause.

4. Repeat the exercise until the fifth question “Why?”

Continue asking the "Why?" question, using the previous answers. Repeat this process up to five times or until the real cause is identified.

5. Identify the root cause

Once you've asked the question "Why?" five times (or less if the root cause is identified first), you should be able to determine the problem's cause. It is the starting point for effective corrective action.

6. Implement corrective actions

Once the root cause has been identified, corrective actions must be implemented to solve the original problem and prevent it from recurring. These actions must be specific, measurable, achievable, realistic, and time-bound (SMART).

Tips for asking the right questions and avoiding common mistakes

The 5 Whys may be simple, but asking the right questions is essential to avoid common mistakes and get the maximum benefit.

• Stay factual and precise: Base your questions and answers on facts and verifiable data. Avoid assumptions, opinions, or judgments. Asking questions that are too general or vague will not help you pinpoint the cause of the problem.
• Involve stakeholders: Include the people directly affected by the problem in the questioning process. They often have valuable knowledge and perspectives. Don't conduct your investigation in isolation without consulting the experts on the floor or the operators involved.
• Avoid bias: Focus on processes rather than individuals. The 5 Whys practice is about improving systems, not blaming individuals. Framing questions as if you were looking for someone to blame can create a climate of mistrust and defensiveness.
• Ask open-ended questions: Ask questions that encourage detailed, explanatory answers. Closed yes/no answers limit responses and don't fully explore the cause of the problem.
• Explore all avenues: Don't stop at the first apparent cause. Keep asking the question “Why?” until you're sure you've found the root cause.  
• Document the whole process: Document every step, including the questions you ask and the answers you get. This will keep a clear record, verify reasoning, and ensure transparency .
• Monitor and evaluate: As always, it's essential to monitor the implementation of corrective actions and measure their effectiveness to ensure that they address the root cause of the problem.

Two useful application examples of the 5 Whys

1. manufacturing sector – product quality problem.

Problem identified: The defect rate of a factory's finished products is high.

First Why: Why is the defect rate high?

Answer: Because some parts are poorly adjusted.

Second Why: Why are some parts poorly adjusted?

Answer: Because the assembly machine parameters are not correctly configured.

Third Why: Why are the assembly machine parameters not correctly configured?

Answer: Because operators don't follow configuration instructions.

Fourth Why: Why don't the operators follow the configuration instructions?

Answer: Because the instructions are not transparent or well documented.

Fifth Why: Why must the instructions be more transparent and well-documented?

Answer: Because there is no standardization of instruction procedures.

Root cause identified: Lack of standardization of instruction procedures.

Corrective action: Develop and implement standardized procedures for configuring assembly machines, accompanied by operator training sessions.

2. Service sector – Customer satisfaction problem

Problem identified: The customer satisfaction rate fell by 15% last quarter.

First Why: Why did the customer satisfaction rate drop by 15% last quarter?

Answer: Because waiting times for customer support have increased.

Second Why: Why have customer support waiting times increased?

Answer: Because the number of incoming calls has increased significantly.

Third Why : Why has the number of inbound calls increased significantly?

Answer: Because many customers are experiencing problems with the new software version.

Fourth Why: Why did many customers experience problems with the new software version?

Answer: Because the version was deployed with several unresolved bugs.

Fifth Why: Why was the version deployed with several unresolved bugs?

Answer: Because the test phase was shortened to meet the planned launch date.

Root cause identified: The test phase was shortened to meet the planned release date.

Corrective action: Revise the software development process to include a complete test phase before any deployment. Communicate the importance of this phase to all stakeholders to avoid shortcuts.

How UTrakk supports the 5 Whys method

UTrakk Daily Management System enables effective problem-solving to improve operations management and elevate performance, by providing multiple capabilities that support problem analysis tools like the 5 Whys.

Problem identification

Scheduled on a regular basis in UTrakk, floor tours and audits include digital checklists that enable managers to closely monitor floor operations and proactively identify variances.

The DMS solution's dashboards help identify problems and corroborate responses and root causes, with comprehensive, reliable data pulled from a variety of integrated data sources .

Documentation and trackability

UTrakk lets you document the 5 Whys process steps in a structured and accessible way. Questions and answers can be recorded in the Notes module, then linked to rituals – continuous improvement committees, production review meetings , audits, floor tours, etc. – to maintain complete trackability of the problem-solving process and justify a specific decision.

Team collaboration and involvement

UTrakk DMS offers collaboration tools that allow employees to simultaneously contribute to problem-solving. Teams can work together in real time, share ideas, and validate responses, facilitating cooperation between team members.

Planning and tracking of corrective actions

The Daily Management System enables effective corrective actions planning, assignment, and tracking, from ideation to completion. Managers can ensure that actions are implemented according to plan and quickly resolve problems before they impact operations.

Improvement tracking and adjustments

Using digitalized floor tours and audits, as well as UTrakk dashboards, managers and supervisors can track solutions and their results. By monitoring floor operations and KPIs, they can make sure that improvements are effective or make the necessary adjustments for optimal performance.

Turning challenges into opportunities: The power of the 5 Whys and UTrakk

By breaking a problem down to the root cause, the 5 Whys method offers valuable clarity for sustainable solutions. Accessible, simple, and practical, it can be adapted to various business contexts, making it a simple yet powerful tool for any company seeking to improve its processes and proactively solve problems .

It is a fundamental method, even more so when combined with data analysis, structured action plans, and collaborative practices . This way, organizations can solve problems more quickly and prevent them from recurring.

UTrakk significantly optimizes this process by accelerating problem identification, providing detailed documentation, facilitating real-time collaboration and action planning, and supporting improvement tracking. With the DMS solution’s advanced features, companies can transform the way their teams approach problem resolution and establish a culture of continuous improvement and high performance.

FAQ on the 5 Whys method

What is the 5 whys method.

The 5 Whys method is a problem-solving technique that identifies root causes by asking "Why?" five times. This approach helps uncover deeper issues behind a problem, allowing for effective and sustainable solutions.

How does the 5 Whys method work?

The 5 Whys method works by repeatedly asking the question "Why?" in response to each answer about a problem. This process continues until the fundamental root cause is identified, typically within five iterations.

When should you use the 5 Whys method?

Use the 5 Whys method for simple to moderately complex problems, where causes are not immediately apparent. It’s ideal for quick resolutions and organizations aiming to foster continuous improvement without extensive resources.

What are the benefits of the 5 Whys method?

The 5 Whys method offers simplicity, accessibility, and the ability to identify root causes. It promotes continuous improvement, reduces implementation costs, develops critical thinking skills, and is adaptable across various industries.

How can you effectively implement the 5 Whys method?

To effectively implement the 5 Whys method, clearly define the problem, ask "Why?" up to five times based on factual answers, involve stakeholders, avoid biases, and document the process thoroughly. Implement and monitor corrective actions based on identified root causes.

Switch to proactive problem-solving and optimize operations with UTrakk

Looking to improve your problem-solving process? Let the experts at Proaction International show you how the 5 Whys technique combined with the UTrakk tool can revolutionize your approach and boost your performance.

Adeline de Oliveira

Writer and editorial manager for about 15 years, Adeline is passionate about human behavior and communication dynamics. At Proaction International, she covers topics ranging from Industry 5.0 to operational excellence, with a focus on leadership development. This expertise enables her to offer insights and advice on employee engagement and continuous improvement of managerial skills.

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Five Whys (5 Whys)

Get past the symptoms of a problem to the root cause.

Jeremy Brown

What Is Five Whys (5 Whys) ?

The "Five Whys" is a way to figure out what causes a problem. You keep asking "why" until you find the real reason. It was made up by Taiichi Ohno at Toyota.

Why Do Five Whys (5 Whys) ?

The Five Whys technique is a useful tool for identifying the root cause of a problem. It can help teams get to the bottom of an issue quickly and efficiently, leading to more effective solutions that address the underlying cause rather than just treating symptoms. By asking "why" multiple times, you can uncover deeper insights and gain a better understanding of the factors at play. Additionally, using the Five Whys encourages a culture of continuous improvement and problem-solving within an organization.

Here's an example problem: the car won't start.

• Why? – The car battery is dead.
• Why? – The car alternator isn't working.
• Why? – The alternator belt broke.
• Why? – The alternator belt was old and worn out.
• Why? – The car wasn't maintained as recommended. (This is the real cause.)

You can ask "why" up to five times (or more) to find the real reason for a problem. It's important to avoid guessing and follow the cause-and-effect chain to the root cause. In this example, the fifth "why" shows a problem with a process or behavior that needs to be fixed.

The five-whys approach is about finding the root cause of a problem. It's important to look for a process that's not working well or not there at all. Sometimes people will say the problem is not enough time, money, or resources. But we can't control those things. So, we should ask why the process failed instead of just asking why.

How to do Five Whys (5 Whys) ?

To use the 5 Whys:

• Get a Team Together: Get people who know about the problem and someone to keep everyone on track.
• Figure Out the Problem: Look at the problem and write it down so everyone can see it.
• Ask "Why?" the First Time: Ask why the problem is happening, but use facts instead of guesses.
• Ask "Why?" Four More Times: For each answer, ask "why?" four more times, based on the last answer.

Look at Five Whys (5 Whys)

Blog Project Management

Applying the 5 Whys Technique in Agile Retrospectives

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If your retrospectives aren’t getting results, it may be time for your team to ask why.

The 5 Whys are a tool frequently used in root cause analysis, but they can add plenty of insights into your regular retrospectives, too. If you’re looking for a quick and easy way to analyze issues with your team, take a look at how you can incorporate the 5 Whys into your retrospectives.

In this post, we’ll cover:

• What the 5 Whys Technique is
• How to include the 5 Whys in retrospectives
• 5 Whys best practices

Want to figure out where a problem is coming from? You need data. Visor gives you an easy way to share data with stakeholders throughout your organization. Try Visor for free to see how it can bring clarity and focus to your regular retrospectives.

What is the 5 Whys Technique?

The 5 Whys is a simple problem-solving tool that lets your inner child out to play. The gist of it is you and your team drill down into the root cause of an issue (or a success) by asking “Why?”

The idea was developed by Toyota Founder Sakicki Toyoda to be used for problem solving training. By asking why again and again, he found his teams could get beyond the symptoms of a problem to find the underlying causes of an issue.

Why Use the 5 Whys in Agile Retrospectives?

The whole point of agile retrospectives is to let teams reflect on their processes and outcomes. The 5 Whys technique fits seamlessly into this context, letting teams:

• Identify and address the root causes of recurring issues or successes.
• Promote deeper understanding and learning.
• Encourage a mindset of continuous improvement.
• Foster open communication and collaboration.

Steps to Apply the 5 Whys in Agile Retrospectives

If you’ve never tried the 5 Whys before, it’s easy to learn. Here’s how to run this exercise in your next retrospective:

1. Identify the Problem

Begin the retrospective by identifying a specific issue or challenge the team faced during the sprint. This could be anything from a missed deadline to a recurring defect in the code. Clearly define the problem statement to ensure everyone is on the same page.

By the way, you can run the same exercise to break down a success your team experienced, too. Say you were able to turn in a project ahead of deadline – you can use the 5 Whys to figure out what went right so you can replicate your success again.

2. Assemble the Team

Gather the entire team for the retrospective. By involving all team members, you ensure you’re getting diverse perspectives. It also fosters a sense of collective ownership of the problem-solving process, empowering them to find a solution.

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3. Ask “Why?” Five Times

Start with the identified problem and ask “Why did this happen?” Write down the answer and then ask “Why?” again based on the previous answer. Repeat this process multiple times, each time probing deeper into the cause of the previous answer. Here’s an example:

• Why? The server ran out of disk space.
• Why? Logs were not being rotated.
• Why? The log rotation script was not running.
• Why? The cron job was misconfigured.
• Why? The configuration file was overwritten during a recent update.

Note : While the name of the exercise is the 5 Whys, you may need more or less than five whys to actually get your answer. Don’t give up if you’re not at your answer yet!

4. Analyze the Findings

Once you have gotten to your last why, take a look at the final answer. Congratulations! You’ve likely found the root cause of the problem.

This is a place where you’re best able to verify your findings with data, now that you know what you’re looking for. Pulling specific numbers is easy with Visor’s Dashboard view, which automatically pulls percentages, counts, and creates easy to understand charts in just a few clicks.

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5. Develop an Action Plan

Once you’ve figured out the root cause, it’s time to brainstorm potential solutions and develop an action plan to address it. Take time to assign specific tasks to team members and set deadlines to ensure accountability. You should also document the action items you come up with and follow up on them in later retrospectives.

6. Reflect and Learn

At the end of the retrospective, take a moment to reflect on the process itself. Discuss what went well and what could be improved in the application of the 5 Whys technique. These meta-reflections help the team improve their problem-solving skills and make sure future retrospectives are even more effective.

Tips for Using the 5 Whys in Retrospectives

• Stay Focused: Keep the discussion focused on the specific problem at hand. Avoid getting distracted by unrelated issues.
• Be Honest: Encourage team members to be honest and open in their responses. Creating a safe environment for candid discussion is crucial. You won’t be able to get an accurate answer if your team is afraid to speak up.
• Avoid Blame: On that note, make sure you’re focusing on the process and system, not individuals. The goal is to identify and address root causes, not to assign blame. It’ll help your team feel safe enough to share their minds.
• Document the Process: Want to prevent a problem from recurring? Document. Document. Document. Keep a record of the 5 Whys analysis and the resulting action plan so that you know what you did and let it inform what you do in the future.

Powering Your Agile Retrospective with Data

Agile retrospectives are designed to help you improve the way your team functions. The 5 Whys help you spot problems, making it easier to achieve your goals. Together they make a powerful team, giving you the insights you need to streamline processes.

Another tool to add to your team? Visor. Visor offers an accessible way to share the data you need during your next retrospective with everyone on – and off – your team. Try Visor for free and find out how it can add the data you need to your next retro.

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If this article was helpful, read these next:

• How Project Managers Can Do Root Cause Analysis
• How to Run a Successful Tag up Meeting
• Creating Your Own After Action Templates For Every Situation

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