“Why?” That is the question that parents of toddlers hear countless times a day. It is a word that may elicit an internal—or perhaps an external—groan because it is the start of a litany of “whys” that will not cease until a satisfactory answer is given. What causes toddlers to ask “why?” so frequently? According to a study conducted at the University of Michigan, it is because they really do want an explanation.1
You may be asking yourself, “Why are we talking about toddlers and their constant need to ask ‘why’?” Good question! Every day, as administrators, we have the opportunity to improve how our practices function within the evolving landscape of oncology—from implementing more efficient approaches for scheduling appointments to raising patient satisfaction scores.
In our article published in the March issue of Oncology Practice Management, we discussed how design thinking can help you find valuable solutions to some of the challenges you encounter in your practice. Now, we will explore a different technique that you may also find helpful for overcoming problems.
The 5 Whys Method
The 5 Whys method is a simple question-asking strategy that explores the cause-and-effect relationships’ underlying problems.2 It uses a root-cause analysis approach to identify the origin of recurring challenges by repeating the question “why?” 5 times, with each answer forming the basis for the next question of “why?” Once you identify the root cause of a problem, you can find a solution to prevent the problem from happening again.
The 5 Whys method was originally developed by Sakichi Toyoda, the founder of Toyota Motor Company, and is still in use today. It is considered one of the most important techniques taught to the organization’s employees during problem-solving training. The architect of the Toyota Production System and creator of lean manufacturing techniques, Taiichi Ohno, stated that the 5 Whys method is the basis of Toyota’s scientific approach, and that by repeating “Why?” 5 times, the root cause of a problem, as well as a solution, becomes clear.3
Steps of the 5 Whys Method
Step 1: Identify the Problem That Needs to Be Solved
Before diving into your first “why?” it is necessary to identify the problem that needs to be solved. Begin by soliciting feedback from your team to identify an actionable item for resolution. When striving to tackle a problem, consider building a group with at least 1 team member from each department that is affected by the problem.
See the Table for an example of using the 5 Whys method to address a problem that frequently occurs in medical practices.
Step 2: State the Problem
The goal of this step is to simply identify the problem. If there are several factors leading to the problem, you may need to identify each root cause in sequential order. This often leads to the main issue. Refrain from overcomplicating this step in the process. It is just a matter of putting the problem down on paper as a simple statement.
Step 3: Ask the First “Why?”
This is the first step to making real progress. As in Step 2, try to keep this process fluid by maintaining focus on the specific problem your group has identified. Often, team members may find themselves sidetracked by their feeling surrounding the issue at hand. Recenter these individuals by reminding them that the goal is to identify the first “why?”
Step 4: Keep Asking “Why?”
Although you may begin to feel like the toddlers mentioned at the beginning of this article, it is important to persist until you develop the root cause of the problem statement. While navigating this process is simple, an effort should be placed on continuing to answer the “why?” questions. Again, the benefit of including team members across many disciplines cannot be understated. Each individual may have a different answer to a “why?” question.
Step 5: State the Root Cause
You will know that you have revealed the root cause of the problem when asking “why” produces no additional useful responses, and you cannot go any further. If you are uncertain as to whether you have discovered the real root cause, you may consider using a more in-depth problem-solving technique, such as root-cause analysis, a systematic process for identifying the origin of problems or events and an approach for responding to them.4
Step 6: Identify and Implement a Solution
The solution often requires research, observation, feedback, and, in some cases, approval. Do not rush to the solution. Instead, work together to ensure that the solution will truly address the root cause. Encourage creativity and innovation and congratulate your team with enthusiasm once a potential solution is reached.
Step 7: Monitor and Adjust as Necessary
It may take some trial and error, but it is important that there is continuous monitoring and tweaking when necessary.
Conclusion
The 5 Whys method can be time-consuming, but the meaningful change that results will benefit everyone involved. This process requires the group to take a deep look at the issue and to work together. There may be times when you discover more than one root cause of a problem. If this occurs, trust in the process and do not hesitate to conquer large projects that may arise because of your digging. Although quick, easily implemented, and low-cost solutions are desirable, do not be afraid to put the work in that will provide the greatest benefit to your team—and ultimately your patients.
References
- Frazier BN, Gelman SA, Wellman HM. Preschoolers’ search for explanatory information within adult-child conversation. Child Dev. 2009;80:1592-1611.
- Serrat O. The five whys technique. February 2009. www.adb.org/sites/default/files/publication/27641/five-whys-technique.pdf. Accessed March 10, 2021.
- Trout J. The 5 whys method: getting to the root cause quickly. www.reliableplant.com/5-whys-31870. Accessed March 10, 2021.
- Washington State Department of Enterprise Services. Root cause analysis. https://des.wa.gov/services/risk-management/about-risk-management/enterprise-risk-management/root-cause-analysis #:~:text=Root%20cause%20analysis%20(RCA)%20is,a%20way%20to%20prevent%20them. Accessed March 10, 2021.
