What is 5 Whys?

5 Whys is a process that can be useful for uncovering root causes of a problem and selecting an improvement to work on while working through FOCUS-PDCA. The theory is that asking the question “Why does that happen?” five times will reveal the root causes that contribute to the issue being addressed.

How to get started?

Organize an improvement team of approximately 4-6 people who are involved with the process. One of the group members should act as facilitator of the 5 “Why Cycles”. Or, complete this on your own if you are implementing this performance improvement as an individual.

5 Whys Steps

1. The main concept that is being addressed should be entered in the “Main Concept” block on the diagram. The facilitator will then lead 5 “Why Cycles”, asking “Why does this happen?” for each cycle:
   1. The facilitator asks the group why this situation occurs (Why Cycle 1). Examples of questions:
      • What causes patient wait time to be so long?
      • Why is our clinic’s telephone abandonment rate so high?
      • What causes our exam rooms to be not well stocked?
   2. For each of the answers provided for the first cycle, the “Why Cycle” is repeated. Examples of answers to “What causes patient wait time to be so long?”
      • Exam rooms not ready
      • Clinicians falling behind
      • Staff shortage
   3. “Why does this happen” should be asked for each of these answers
   4. Step b is repeated for each subsequent answer set until the process has been completed five times*
2. After 5 cycles, the resulting answers are the root causes that result in the main concept occurring. Theoretically, if these root causes are addressed, then the main concept will not occur (along with all intermediate “Why Cycle” issues).
3. The template provided facilitates two answers for each “Why Cycle” although they can be added/deleted as the team deems necessary.

*Note: Occasionally, the result of asking “Why does this happen” reaches a boundary where the answer becomes non value added. The team should use discretion as to when the information is sufficient. A good way to determine when to stop asking “why” is when you reach the point that the answer to your “why” is something that cannot be controlled.

Tips

• You don’t want to list 5 different reasons; you want to go deep on 1 reason.
• If your last answer is something you can’t control, go back up to the previous answer on 1 reason
• Why Cannot because of a specific person

*Adapted from UW Health Quickstart (https://uconnect.wisc.edu/inside-uw-health/mission-watch/uw-health-way/toolkit/tools/5-whys/)