How the 5 Whys Can Work in Healthcare

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.