Root Cause Analysis: Look at the Process Map? Five Whys?

June 29, 2010 at 7:28 pm Leave a comment

Another installment in our look at a systematic, sustainable, repeatable approach to Performance Improvement and PI CME.

If we have done our job of describing “current performance” (see previous Blogs) we may already have some idea(s) about what is actually causing us not to achieve the outcomes we desire. But rather than jump to early conclusions we need to go one step further to gain a deep understanding of what is actually keeping us from achieving our desired results. Quite frequently, what appears to be the most obvious cause of the performance problem is not really the root cause but rather a symptom of the problem.

Why are we not doing the work we should be doing to get our desired outcomes? We can gain this understanding through an informed “Root Cause Analysis”. This is similar to a physician trying to get at the real cause of a patients medical problem. I don’t want my physician to guess what my problem might be without some good information that can be used to confirm my diagnosis. The same is true for making changes in a medical practice. Get a good idea of what is keeping the team from doing what should be done that will lead to improvements in the practice, or providing appropriate care, or improved patient outcomes.

There are many ways the team might approach this task. You might start by having the team brainstorm a list of likely problems and then gain a consensus on the most likely root cause for each problem. Simple and efficient but perhaps not an analysis that will give you the depth of understanding you need before committing resources to solutions.

You might have the team examine the Process Map that was done to describe the current situation. Many times the team can see from this graphic depiction of a process, things that are totally unnecessary in the work flow and can eliminate something on the spot. This is also an efficient was to get at some problems on the work processes but may not be enough to get a deep understanding of what is keeping the team form accomplishing their desired results.

Two additional tools that might also prove useful in getting at the root cause of performance problems – the “Five Why’s” and the “Fishbone diagram. We’ll talk about the “Five Why’s” in this Blog and save the “Fishbone” until the next installment.

Your root cause analysis using the “Five Why’s’” can start by making a list of the main problem(s). A good brainstorming session involving all of the people in the process will go a long way in getting this task completed. Next for each problem ask why this is a problem. Treat each answer to the “why” question as a potential root cause until there seems to be no answer to the “why” question. At this point you have probably reached a consensus on the root cause of the problem being discussed. A good rule-of-thumb is that you haven’t reached the root cause until you’ve asked “why?” at least five times. Do this for each of the problems listed as a potential root cause that might be keeping you from reaching your desired outcomes? You will end up with a very robust list of potential root causes you can select from to begin any improvement effort. Keep the list. Addressing only one root cause may not solve the entire performance problem. You can come back to this list and select other things to focus on in your continuing improvement efforts.

Tips: Root Cause Analysis using the Five Whys

  • Probe deep enough to get to the right cause(s) of the performance of concern.
  • Have the patience to ask the “5 why” questions for each potential problem.
  • Be sure the answer to each of the “Why” questions links cause to effect in some manner.
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Entry filed under: CME Issues, Improvement, PI CME. Tags: , .

Commercial Support and University of Michigan CME Program The Face of CME: Bringing CME to the Pursuit of Improvement

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