Training Guide: Using the 5 Whys in Healthcare
Critical Thinking Exercise: Teaching Others About Quality Improvement Tools HINF 4020 – Gap Analysis for Continuous Improvement
Colleen Shannon University of Denver College of Professional Studies
April 20, 2025
Faculty: Colette Martinez, MHA
Director: Wendy Charles, PhD
Dean: Michael J. McGuire, MLS
Start
Objectives
This e-learning module will help you:
- Understand the 5 Whys tool for quality improvement, and how it fits into Lean methodology
- See how it is commonly used in healthcare
- Know when and how to use this tool in your own organization.
Introducing the 5 Whys Tool
About the 5 Whys process, and how it grew from Lean methodology
Modules
Healthcare Use Cases
5 Whys is an intuitive tool that's easy to use. It's perfect for simple problems and quick results.
How the 5 Whys tool can be used in healthcare, and a case study
Using 5 Whys
When to use it - and when not to. Applying the tool in your organization
Module 1: Introducing the 5 Whys Tool
The 5 Whys is part of Lean methodology
Lean quality improvement (QI) methodology started in car manufacturing at Toyota in the 1930s-1940s. Lean found its way into wider management in the 1990s, and its focus is on :
- Putting the customer at the center
- Maximizing value
- Making the most of available resources, and reducing waste
This is how the Lean QI cycle could look in healthcare.(Ellis, 2020)
+More info
+ References
Module 1: Introducing the 5 Whys Tool
About the 5 Whys
The 5 Whys is a simple root cause analysis (RCA) tool. The idea is to determine why the problem occurred, so you can fix it.
- You start with a problem statement.
- Then you ask: "Why did that happen?"
- The answer will bring you a bit closer to the root of the problem. But you're not done yet. Keep asking "why" as you dig deeper.
- It's called the "5 Whys" because you'll usually need to ask the "why" questions at least 5 times.
+ References
Module 1: Test your knowledge
1/2
Module 1: Test your knowledge
2/2
Module 2: Healthcare Use Cases
Practical uses for the 5 Whys
Training and education
Logistics
Click the + buttons to see more details
Communication
Workflow
Module 2: Healthcare Use Cases
Case Study: How the 5 Whys Works
The problem
Our clinics are running behind schedule.
Question 1: Why are we behind?
A: Too many patients are arriving late for their appointments.
Question 2: Why are patients arriving late?
A: They are having problems with transportation.
Question 3: Why are they having problems with transportation?
A: They are not using the Medicaid ride service.
Module 2: Healthcare Use Cases
Case Study (continued)
Question 4: Why aren't they using the ride service?
Answer: They don't know how to book a ride.
Q5: Why don't they know how to book a ride?
Answer: Because they haven't seen the HealthFirst information page online.
Simple solutions
Signpost the link and phone number when patients make appointments. Put flyers in the waiting room.
Module 3: Using the 5 Whys
The 5 Whys, Step-by-Step
2. Make sure it's appropriate
1. Define your problem
You need a clear focus, and you can only solve one problem at a time.
5 Whys is too simplistic for safety-critical or complex problems, so it should not be used in these cases.
4. Ask your questions
3. Consider a team approach
Is this a problem you can analyze on your own? Involving a team often works best.
Start asking your "why" questions and see where the answers take you.
5. Gather data
6. Share your findings
Even if you could analyze the problem on your own, solving it is probably a team effort.
As you go along, you'll find you need more information to answer some of the questions.
+ References
Module 3: Test your knowledge
1/1
Module 3: Using the 5 Whys
Reflecting on the 5 Whys
Remember, the 5 Whys is a simple root cause analysis (RCA) tool. The idea is to determine why the problem occurred, so you can fix it.
- What are some of the problems you've noticed in your workplace?
- Which ones could be suitable for a root cause analysis using the 5 Whys tool?
- What makes these problems a good match for the 5 Whys approach?
- Which problems might be unsuitable for 5 Whys?
- What makes those problems poor candidates for a simple analysis like 5 Whys?
References
References
Card, Alan J. "The Problem with ‘5 Whys’." BMJ Quality & Safety 26, no. 8 (2017): 671-677. https://doi.org/10.1136/bmjqs-2016-005849 Ellis, Lisa D. “The Importance of Adopting a Lean Mindset and Culture for Health Care Organizations.” Harvard Medical School. November 13, 2020. Accessed April 27, 2025. https://postgraduateeducation.hms.harvard.edu/trends-medicine/importance-adopting-lean-mindset-culture-health-care-organizations No author. “Five Whys for Root Cause Analysis.” No date. Centers for Medicare & Medicaid (CMS). Accessed April 22, 2025. https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/downloads/fivewhys.pdf No author. “5 Whys: Finding the Root Cause of a Problem.” Institute for Healthcare Improvement (IHI). Accessed April 23, 2025. https://www.ihi.org/sites/default/files/SafetyToolkit_5Whys.pdf
No author. “Five Whys.” No date. Lean Enterprise Institute. Accessed April 22, 2025. https://www.lean.org/lexicon-terms/5-whys/
No author. NHS England. “Using Five Whys to Review a Simple Problem.” No date. Accessed April 23, 2025. https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-using-five-whys-to-review-a-simple-problem.pdf
Educating professionals
Using the 5 Whys method to examine problems as part of professional training encourages reflective thinking.
References
Ellis, Lisa D. “The Importance of Adopting a Lean Mindset and Culture for Health Care Organizations.” Harvard Medical School. November 13, 2020. https://postgraduateeducation.hms.harvard.edu/trends-medicine/importance-adopting-lean-mindset-culture-health-care-organizations Lean Enterprise Institute. “A Brief History of Lean.” No date. Accessed April 16, 2025. https://www.lean.org/explore-lean/a-brief-history-of-lean/Lean Enterprise Institute. “Lean Thinking and Practice.” No date. Accessed April 16, 2025. https://www.lean.org/lexicon-terms/lean-thinking-and-practice/
Gap analysis in logistics
If people, equipment or supplies are not turning up where they are needed, the 5 Whys might help you find out why.
The power of "why?"
"A relentless barrage of 'whys' is the best way to prepare your mind to pierce the clouded veil of thinking caused by the status quo. Use it often.” – Shigeo Shingo, twentieth century leader in Lean methodology.
Keep information flowing
When important messages aren't being heard, you can pinpoint the reason by applying the 5 Whys. This works for communication with patients; between clinicians, teams and organizations; and with external stakeholders.
References
Card, Alan J. "The Problem with ‘5 Whys’." BMJ Quality & Safety 26, no. 8 (2017): 671-677. https://doi.org/10.1136/bmjqs-2016-005849 “Using Five Whys to Review a Simple Problem.” NHS England. No date. Accessed April 23, 2025. https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-using-five-whys-to-review-a-simple-problem.pdf
Identify bottlenecks
If a clinical or administrative process is not working efficiently, applying the 5 Whys might show you where the problem is.
References
“Five Whys for Root Cause Analysis.” No date. Centers for Medicare & Medicaid (CMS). Accessed April 22, 2025. https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/downloads/fivewhys.pdf “5 Whys: Finding the Root Cause of a Problem.” Institute for Healthcare Improvement (IHI). No date. Accessed April 23, 2025. https://www.ihi.org/sites/default/files/SafetyToolkit_5Whys.pdf “Five Whys.” No date. Lean Enterprise Institute. Accessed April 22, 2025. https://www.lean.org/lexicon-terms/5-whys/
“Using Five Whys to Review a Simple Problem.” No date. NHS England. Accessed April 23, 2025. https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-using-five-whys-to-review-a-simple-problem.pdf
Training Guide: Using the 5 Whys in Healthcare
Colleen Shannon
Created on April 27, 2025
This short e-learning course introduces the 5 Whys tool, explains its roots in Lean methodology, sets out healthcare use cases, and shows you how to apply the tool in your own healthcare organization.
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Transcript
Training Guide: Using the 5 Whys in Healthcare
Critical Thinking Exercise: Teaching Others About Quality Improvement Tools HINF 4020 – Gap Analysis for Continuous Improvement Colleen Shannon University of Denver College of Professional Studies April 20, 2025 Faculty: Colette Martinez, MHA Director: Wendy Charles, PhD Dean: Michael J. McGuire, MLS
Start
Objectives
This e-learning module will help you:
Introducing the 5 Whys Tool
About the 5 Whys process, and how it grew from Lean methodology
Modules
Healthcare Use Cases
5 Whys is an intuitive tool that's easy to use. It's perfect for simple problems and quick results.
How the 5 Whys tool can be used in healthcare, and a case study
Using 5 Whys
When to use it - and when not to. Applying the tool in your organization
Module 1: Introducing the 5 Whys Tool
The 5 Whys is part of Lean methodology
Lean quality improvement (QI) methodology started in car manufacturing at Toyota in the 1930s-1940s. Lean found its way into wider management in the 1990s, and its focus is on :
This is how the Lean QI cycle could look in healthcare.(Ellis, 2020)
+More info
+ References
Module 1: Introducing the 5 Whys Tool
About the 5 Whys
The 5 Whys is a simple root cause analysis (RCA) tool. The idea is to determine why the problem occurred, so you can fix it.
+ References
Module 1: Test your knowledge
1/2
Module 1: Test your knowledge
2/2
Module 2: Healthcare Use Cases
Practical uses for the 5 Whys
Training and education
Logistics
Click the + buttons to see more details
Communication
Workflow
Module 2: Healthcare Use Cases
Case Study: How the 5 Whys Works
The problem
Our clinics are running behind schedule.
Question 1: Why are we behind?
A: Too many patients are arriving late for their appointments.
Question 2: Why are patients arriving late?
A: They are having problems with transportation.
Question 3: Why are they having problems with transportation?
A: They are not using the Medicaid ride service.
Module 2: Healthcare Use Cases
Case Study (continued)
Question 4: Why aren't they using the ride service?
Answer: They don't know how to book a ride.
Q5: Why don't they know how to book a ride?
Answer: Because they haven't seen the HealthFirst information page online.
Simple solutions
Signpost the link and phone number when patients make appointments. Put flyers in the waiting room.
Module 3: Using the 5 Whys
The 5 Whys, Step-by-Step
2. Make sure it's appropriate
1. Define your problem
You need a clear focus, and you can only solve one problem at a time.
5 Whys is too simplistic for safety-critical or complex problems, so it should not be used in these cases.
4. Ask your questions
3. Consider a team approach
Is this a problem you can analyze on your own? Involving a team often works best.
Start asking your "why" questions and see where the answers take you.
5. Gather data
6. Share your findings
Even if you could analyze the problem on your own, solving it is probably a team effort.
As you go along, you'll find you need more information to answer some of the questions.
+ References
Module 3: Test your knowledge
1/1
Module 3: Using the 5 Whys
Reflecting on the 5 Whys
Remember, the 5 Whys is a simple root cause analysis (RCA) tool. The idea is to determine why the problem occurred, so you can fix it.
References
References
Card, Alan J. "The Problem with ‘5 Whys’." BMJ Quality & Safety 26, no. 8 (2017): 671-677. https://doi.org/10.1136/bmjqs-2016-005849 Ellis, Lisa D. “The Importance of Adopting a Lean Mindset and Culture for Health Care Organizations.” Harvard Medical School. November 13, 2020. Accessed April 27, 2025. https://postgraduateeducation.hms.harvard.edu/trends-medicine/importance-adopting-lean-mindset-culture-health-care-organizations No author. “Five Whys for Root Cause Analysis.” No date. Centers for Medicare & Medicaid (CMS). Accessed April 22, 2025. https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/downloads/fivewhys.pdf No author. “5 Whys: Finding the Root Cause of a Problem.” Institute for Healthcare Improvement (IHI). Accessed April 23, 2025. https://www.ihi.org/sites/default/files/SafetyToolkit_5Whys.pdf No author. “Five Whys.” No date. Lean Enterprise Institute. Accessed April 22, 2025. https://www.lean.org/lexicon-terms/5-whys/ No author. NHS England. “Using Five Whys to Review a Simple Problem.” No date. Accessed April 23, 2025. https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-using-five-whys-to-review-a-simple-problem.pdf
Educating professionals
Using the 5 Whys method to examine problems as part of professional training encourages reflective thinking.
References
Ellis, Lisa D. “The Importance of Adopting a Lean Mindset and Culture for Health Care Organizations.” Harvard Medical School. November 13, 2020. https://postgraduateeducation.hms.harvard.edu/trends-medicine/importance-adopting-lean-mindset-culture-health-care-organizations Lean Enterprise Institute. “A Brief History of Lean.” No date. Accessed April 16, 2025. https://www.lean.org/explore-lean/a-brief-history-of-lean/Lean Enterprise Institute. “Lean Thinking and Practice.” No date. Accessed April 16, 2025. https://www.lean.org/lexicon-terms/lean-thinking-and-practice/
Gap analysis in logistics
If people, equipment or supplies are not turning up where they are needed, the 5 Whys might help you find out why.
The power of "why?"
"A relentless barrage of 'whys' is the best way to prepare your mind to pierce the clouded veil of thinking caused by the status quo. Use it often.” – Shigeo Shingo, twentieth century leader in Lean methodology.
Keep information flowing
When important messages aren't being heard, you can pinpoint the reason by applying the 5 Whys. This works for communication with patients; between clinicians, teams and organizations; and with external stakeholders.
References
Card, Alan J. "The Problem with ‘5 Whys’." BMJ Quality & Safety 26, no. 8 (2017): 671-677. https://doi.org/10.1136/bmjqs-2016-005849 “Using Five Whys to Review a Simple Problem.” NHS England. No date. Accessed April 23, 2025. https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-using-five-whys-to-review-a-simple-problem.pdf
Identify bottlenecks
If a clinical or administrative process is not working efficiently, applying the 5 Whys might show you where the problem is.
References
“Five Whys for Root Cause Analysis.” No date. Centers for Medicare & Medicaid (CMS). Accessed April 22, 2025. https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/downloads/fivewhys.pdf “5 Whys: Finding the Root Cause of a Problem.” Institute for Healthcare Improvement (IHI). No date. Accessed April 23, 2025. https://www.ihi.org/sites/default/files/SafetyToolkit_5Whys.pdf “Five Whys.” No date. Lean Enterprise Institute. Accessed April 22, 2025. https://www.lean.org/lexicon-terms/5-whys/ “Using Five Whys to Review a Simple Problem.” No date. NHS England. Accessed April 23, 2025. https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-using-five-whys-to-review-a-simple-problem.pdf