Finding the root Cause with the 5 Whys technique in Health Care

Quality problems are like weeds. If you don’t pull them out by the root, they grow right back.

Understanding a problem completely , meaning its deep reasoning and causes is the first step to solving it. We frequently try to address an issue before identifying it because our attention is diverted too rapidly from it.

Understanding the underlying cause, but often what we believe to be the reason, is another symptom. Asking "Why? " is one method of get to problem's underlying cause.

Asking WHY in 5 times when a problem arises, consider, "Why did this happen?

Then don't stop with the response to the initial query. Query "Why? Repeatedly until you identify the underlying cause. This straightforward technique might be surprisingly insightful in determining the actual cause of your issue and assisting you in avoiding Band-Aid solutions. It is particularly beneficial for treating chronic issues that persist over time in a complex system.

The method is credited to Taiichi Ohno, the creator of the Toyota Production System, which introduced techniques today referred to as Lean to the automobile industry. It's crucial to understand that a problem may have several primary causes. Various persons with different perspectives on the system may provide other answers to the questions.

Here's an illustration of how to ask, "Why? "five times:

Why was the medication given to the patient incorrect?
Why did the nurse leave patient identification incomplete?
Why was there no bracelet on the patient?
Why wasn't the wristband changed?
Why didn't the printer function?

The Advantages of the Five Whys

Aids in locating the source of a problem
Recognize how a single process can lead to a series of issues
Identify the connections between several root causes.
Highly efficient without requiring complex evaluation methods

When Should Healthcare Employ this Approach?

For easy to a little challenging issues
This approach might need to be combined with others for more complex issues.
When issues involve people or human connections. Therefore, if a procedure involves a human mistake.

Important Points to Bear in Mind

Separate symptoms from causes or causal factors
Try working backward to ensure you give each "why" the proper response.
You are free to elaborate on your responses as much as you desire. More is always better.
Always base your responses on data and facts.
Don't forget to evaluate the procedure, not the people.

How it Might Function in Healthcare

It has been found that "Continuous Process Improvement" (CPI), which is essential for healthcare professionals to understand and apply as we strive to survive changes in payment models and other delivery systems, is necessary. This necessitates critically examining current practices and considering whether they benefit our patients and our long-term survival as a species.

Working to get better is always advantageous, according to CPI. However, we must begin by assuming that there is waste and that there is room for improvement. If you examine how healthcare is provided in your neighborhood, you may find methods to enhance it.

Finding a problem, thinking of solutions, and then correcting it is one way to fix things in our environment. Sounds easy, and frequently, this process occurs in an office setting or a meeting with the "C-Suite" or someone with higher-up authority. Although it might be effective for some, this might not be the most excellent technique in the long run. Instead, a CPI approach is to use the "This includes enlisting the aid of others to find a solution.

The first step is knowing that you might not have all the answers. Instead, ask the "process owner" or the person who performs the work, "Why are you doing that, or why are you doing what you are doing the way you are doing it?" The anticipated responses would be "We have always done it this way" or "This is the way I was taught"; however, do either of these responses get to the "root" of the matter? "of the issue?

If you ask a second why, you can get an answer like "I don't know," "because," or "because that's part of my work." Does that, once more, address the core issue? Wouldn't it be good to hear, "Because this is a crucial step in delivering patient care," or "By doing it this way, I'm assisting others in the process in performing their duties more efficiently," as an answer?

The same is true of the personnel; when asked why they do what they do or how they do it, it will result in a greater understanding. Asking, "why don't you think of a better way to do things" is one of the whys that could result in them providing a solution!

Since it was their idea, this straightforward procedure of asking why up to five times will lead to deeper comprehension, potential solutions, and more specific implementation through staff involvement. However, using the "5 whys" as a technique for conducting RCAs should be discontinued, especially for patient safety. "For every problem, there is an answer that is clear, simple, and erroneous," says the (apocryphal)

Reference and further reading :