[Text on screen: QI Hub Presents: 5 Whys Exercise The Ohio State University College of Medicine The Ohio State University Wexner Medical Center] [Text on screen: 5 Whys Approach identify possible causes for a problem] Speaker: In this video, we will discuss an activity that helps teams identify possible causes for a problem using the 5 Whys approach. [Image of doctor with thought bubble above their head. Thought bubble contains two flags with dotted line connecting them] [Text on screen: Where to start?] For many teams, one of the most difficult tasks in seeking change is deciding the right place to start. [Animation of various doctors with thought bubbles containing various text] [Text on screen: Where to start? Why are we having this outcome? Where is this process going awry? WHY?] What is the true reason we are having this outcome? Where exactly is this process going awry and why? [Image of various doctors with piles of paperwork] [Animation zooms in on a calendar with half the month crossed off and goal flag at the end of the month] For example, consider a situation where you are working on a project and your team is starting to worry that the project is falling behind schedule. [Image of question mark] Your team wants to prevent more delays but is not sure where to start. [Animation of doctor speaking in a meeting with low motivation dial] In a meeting, one team member mentions that they believe progress is stalling because some people on the team are not motivated and perhaps they do not understand the importance of the project. [Text on screen: Don't understand importance of project Not making it a priority] Consequently, they are not making it a priority. [Text on screen: Project's impacts:] [Animation of white board with various blank notes being placed. An arrow leads from the white board to hospital building] The team member proposes holding a brainstorming session to discuss all the ways this project could make an impact on the healthcare system. [Animation of four arrows leading from the image] [Picture of thumbs up emerges] This information could then be communicated widely to help the team prioritize the project. [Animation of another doctor speaking at the meeting with high passion dial] A second member of the team notes that while this may be part of the issue, [Image of calendar plus virtual meeting equals More Delays!] they know many of the team members are very passionate about the project and taking additional time to schedule and conduct the meeting may cause further delays. [Text on screen: Let's look for some root causes for the delays.] The team members suggest that it might be helpful to determine some of the primary reasons or root causes for the delays that are occurring. [Text on screen: 5 Whys] This scenario presents an opportunity to use what is often referred to as the 5 Whys exercise. [Text on screen: 5 Whys Create a deeper understanding of a specific problem Identify new solutions to reach a desired goal Repeatedly ask "why" to refine and clarify root causes Prevents teams from jumping to conclusions and missing key factors Helps to avoid: Focusing on the wrong issues Depleting resources Overshadowing effective solutions] The 5 Whys exercise can create both a deeper understanding of a specific problem and identify potential new solutions to help teams reach a desired goal. It is an approach where a team repeatedly asks why in order to sequentially refine and clarify a root cause or causes of a problem. This prevents teams from jumping to conclusions and missing key factors. Without a proper root cause analysis, teams might focus on the wrong issues which can deplete resources and overshadow more effective solutions. [Animation of doctors communicating in a meeting] [Text on screen: Agree on Problem should be clear, concise, and agreed upon by all] Going back to the example, the team first needs to agree on the problem they are experiencing. The problem statement should be clear, concise, and agreed upon by all team members. [Text on screen: Problem Statement: The research project has fallen behind schedule for 8 of 10 weeks causing major delays toward completion.] One member states that the research project has fallen behind schedule for 8 out of 10 weeks, causing major delays toward completion. [Text on screen: Why? Why is the project behind schedule?] Next, the team members should ask the first why. Why is the project behind schedule? [Animation of doctors communicating] The team should suggest some potential answers to the why question to find one that seems to resonate well with the group. [Text on screen: Because tasks are not being completed on time] In this case, the team might agree that because tasks are not being completed on time is a good response. [Text on screen: Why?] Then the team should ask why to this statement. [Text on screen: Why are tasks not completed on time?] In other words, why are tasks not being completed on time? [Text on screen: Because team members are missing deadlines] This should kick off another round of suggestions that leads to something like because team members are missing deadlines. Notice that the answer to this first why leads to the second why. [Text on screen: Why A Because B Why B Because C] [Arrow leading between each] It is important to note that for the entire process, the next why builds off the previous statement, and the team does not return to the original problem statement. [Arrows continue leading between following text] [Text on screen: Why C Because D Why D Because E] [Red circle appears around "Because E" and text "Root Cause" with arrow leading to it] Instead, each successive why continues to dig deeper to a root cause of the problem. [Text on screen: Why are tasks not completed on time? Because team members are missing deadlines Why are team members missing deadlines? Because they're unsure about responsibilities] [Text on screen: Why are they unsure about responsibilities? Because no clear communication] Returning to the example, the team should attempt to go another level and ask, why are team members missing deadlines? Because they are unsure about their individual responsibilities. Why are they unsure about their responsibilities? Because there was no clear communication of who is responsible for what tasks. [Text on screen: Why no clear communication? Because plan was not shared widely, no meeting to clarify roles] Why was there no clear communication? Because the project plan was not shared widely beyond a few people, and there was no meeting to clarify roles among the full team. [Text on screen: Not due to lack of motivation Due to lack of planning and communication Because plan was not shared widely, no meeting to clarify roles] Arriving here, the team is able to see that the issue is probably not due to a lack of team member motivation. Instead, it is likely due to limited project planning and communication. [Text on screen: Share project plan Clarify roles] [Image of upside down triangle with large person at bottom and smaller people leading up the triangle] Your team discusses. If we shared the project plan and clarified roles, would this help address the problem? [Image of same upside down triangle and various doctors with a thumbs up above them] They agree this would likely have a major impact on their ability to get project elements completed faster. [Five boxes with the word "Why" are arranged in a vertical line with arrows leading from each to the next. The last one has an arrow leading to "Root Cause"] Sometimes in order to find a root cause, teams only need to ask the question of why 5 times. However, that's not always the case. [More boxes with "Why" appear, and then all boxes but three disappear] Teams might need to ask more than 5 times, or it might take less than 5 times to get to a root cause. The key is to keep asking until you believe you have reached the root of the problem. Zero in on the last why. [Text on screen: Why Would fixing this 'why' prevent the problem from happening again? Yes Root Cause] If fixing it would prevent the problem from happening again, you have likely found a root cause. [Text on screen: No Keep asking 'why'] If not, the team has identified a contributing factor and should keep asking why until the true root cause is found. [Text on screen: Root Cause: The plan was not shared widely, and there was no meeting to clarify roles] By using the 5 Whys, your team was able to discover a root cause of their problem. [Text on screen: Create a detailed project plan] Now they can build tangible ideas to take action, like creating and sharing a detailed project plan to help prevent future delays. [Text on screen: 5 Whys Helps teams quickly, efficiently, and acutely examine less complex issue Helps teams develop effective interventions] In summary, the 5 Whys is an exercise that helps teams quickly, efficiently, and acutely examine a specific aspect of a less complex issue. Drilling down to the root cause helps teams develop effective interventions to fix the problem. [Text on screen: For more complex issues Fishbone Diagram (Cause and Effect or Ishikawa Diagram) Visualize problems that have multiple potential causes] [Image of Fishbone Diagram] For more complex issues, another tool, the Fishbone Diagram, sometimes referred to as a cause and effect or an Ishikawa diagram, helps teams in visualizing problems that are likely to have multiple potential causes. This will be discussed in a separate lesson. [Text on screen: Thank you! Scan the QR code for references and resources QI Hub The Ohio State University College of Medicine The Ohio State University Wexner Medical Center] [QR code links to: https://go.osu.edu/qihub]