Use 5 Sequential "Whys," not 5 Random Ones
I had an opportunity to coach somebody, remotely, the other day on the Lean problem solving process called the 5 Whys.
The person presented a situation that was something like this — I’m changing the details and making up a scenario.
The 5 Whys she gave were along these lines:
- Why are patients waiting so long for discharge?
- Why do we wait so long for each consulting physician to get back to us about discharging the patient?
- Why do we wait for the nurse to be available to transport the patient?
- Why aren’t transporters available?
- Why do we not get enough advance notice about discharge instructions?
My feedback was that they had asked 5 different and related “why?” questions but they hadn’t really followed the “5 Whys” process.
The 5 Whys starts with a problem statement and then digs deeper rather than just asking related questions.
The format should be more like this:
Problem Statement: Patients wait too long to be discharged
- Why? Statement that answers the question
- Why is that? New statement
- Well why is that? New statement
- Why is that? New statement — possibly the root cause
There’s no specific magic to why you get the root cause after 3 whys or 6 whys.
Here is a good example from an article published by a pharmacy industry group, the American Society of Health-System Pharmacists.
Problem: delays in medication turnaround time.
- Why? Need to wait for deliveries to unit.
- Why? I.V. preparation of first doses takes too long.
- Why? Time is wasted time in work area.
- Why? Excessive walking is required.
- Why? The work area layout is inefficient.
Of the five questions, the primary root cause is identified as being the work area layout.
Do you see how those questions were sequential? The chain of questions might branch off — for example, why do I.V. preparation of first doses take too long? There might be two valid answers you want to dig into. It might form more of a tree than a vertical stick: